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Title: Characteristics of autistic children
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Table of Contents
    Title Page
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    Copyright
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    Front Matter
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    Acknowledgement
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    Table of Contents
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    Abstract
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Full Text


















CHARACTERISTICS OF AUTISTIC CHILDREN: A COMPARISON WITH
TRAINABLE MENTALLY HANDICAPPED CHILDREN










By

SHEILA DAY LETO SCOTT


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE
UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY



UNIVERSITY OF FLORIDA

1988


Z~r~ r;? """-` "?"""







































Copyright 1988

by

Sheila Day Leto Scott


L


















We would argue that one answer to the question "What
is autism?" is that "autism is a possibility." It is a
possibility because it enables us to make a choice, or
adopt a view, about an important other person. If we are
even part way deluded into thinking that this child does
not count--does not have full value--then autism is a
hopeless condition. But if we take the view, and this we
can do, that autism--whatever it might be medically or
psychologically--offers us an opportunity to form an
attitude, not just toward our autistic children but all
those we meet, then it is, indeed, a possibility. (Webster,
1980, p. 18)


















ACKNOWLEDGMENTS


I would like to thank Dr. Janet Larsen, who has given so much of

herself, because she believed in me. I also want to thank Dr. Paul

Fitzgerald, who led me into school psychology; Dr. Tom Fillmer, who

taught me about reading and about words; and Dr. Linda Lombardino, who

shared her knowledge about autism.

St. Mark's Episcopal Day School made my Ed.S. possible, and Dr.

Jim Rockwell and Dr. Lane Roosa made this degree possible. I owe a

debt to Duval County for training me to be a conscientious school

psychologist, Broward County for providing me with varied and

challenging experiences, and Palm Beach County for educating my son.

I want to thank school district personnel of all three counties for

cooperating so graciously with my research. I especially thank the

principals and teachers who gave their time.

My family has been supportive of my work and of my efforts to

further my education. They have made many sacrifices over the years.

I thank John for putting up with the crazy person I sometimes became.

I am thankful to Sheryl for inspiring me to be a doctor, too. I thank

Ed for helping me master the word processor. I am thankful to

Jonathan for being willing to entertain himself the year I studied for














my quals (a lot to ask of a sixth grader). I didn't spend too much

time with my mother when she visited, because I was always in

the back room "working on the dissertation," but she never complained.

I thank her.

Finally, I would like to thank Raymond, the first autistic child

I ever evaluated, and all the others who have followed him. Autism is

"a possibility."



















TABLE OF CONTENTS



ACKNOWLEDGMENTS . . . . . . .

LIST OF TABLES . . . . . . .

ABSTRACT . . . . . . . . .

CHAPTERS

I INTRODUCTION . . . . . .


Statement of the Problem
Need for the Study .
Theoretical Explanations
Purpose of the Study
Rationale . . .
Hypotheses . . .
Definition of Terms
Overview . . . .


of Autism


II REVIEW OF THE LITERATURE . . . . . .

Diagnostic Criteria . . . . . . .
Autism . . . . . . .
Trainable Mental Handicap . . . . .
Characteristics of Autistic and Trainable Mentally
Handicapped Children . . . . . .
Autistic Characteristics ....
Trainable Mentally Handicapped Characteristics
Piaget's Theory of Human Development .
Prevalence of Autism and Trainable Mental Handicap
Autism Prevalence . . . .
Trainable Mental Handicap Prevalence . .
Variables
The Object Permanence Variable . . . .
The Imitation Variable . . . . . .
The Behavioral Characteristics Variables .
Instruments . . . . . . . . .


viii













The Uzgiris and Hunt Scales of Infant Psychological
Development. . . . . . . .
The Childhood Autism Rating Scale (CARS) . . .
The Psychoeducational Profile (PEP): Imitation Scale
The Test of Language Development-Primary (Told-P):
Sentence Imitation Scale . . . . . . .

III METHODOLOGY . . . . . . . . . . .


Overview . . .
Subjects . . .
Procedure ..
Variables . . .
Instruments . .
Qualifications of Test
Analysis . . .

IV ANALYSIS OF RESULTS

Research Hypothesis 1
Research Hypothesis 2
Research Hypothesis 3
Research Hypothesis 4
Research Hypothesis 5
Research Hypothesis 6
Research Hypothesis 7
Research Hypothesis 8

V DISCUSSION . . .


Results . . . .
Limitations . . .
Conclusions . .
Implications for Educat
Summation . . .


. . . . . . . . . 6
. . . . . . . . 65
. . . . . . . . . 67
. . . . . . . . 69
. . . . . . . . . 69
Administrators . . . ... 70
. . . . . . . . . 71

. . . . . . . . . 72


ion and Further


Research
. . .


APPENDICES

A COVER LETTER . . . . . . . . . .

B INFORMED CONSENT . . . . . . . . .

C EXAMINER'S NOTES DURING TESTING: AUTISTIC STUDENTS

D EXAMINER'S NOTES DURING TESTING: TRAINABLE STUDENTS

REFERENCES . . . . . . . . . . . .

BIOGRAPHICAL SKETCH . . . . . . . . . .


100


105

114



















LIST OF TABLES



Tables

1 Characteristics of Subjects . . . . . . .... 74

2 Performance of Autistic Subjects . . . . . .. .. 77

3 Performance of Trainable Subjects . . . . .... 78

4 Dependent Sample t Test Analysis Between Groups . . . 79

5 Wilcoxon Matched-Pairs Signed-Ranks Analysis ...... 80

6 Significance Levels for Each Hypothesis . . . ... 81


viii


















Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

CHARACTERISTICS OF AUTISTIC CHILDREN:
A COMPARISON WITH TRAINABLE MENTALLY HANDICAPPED CHILDREN

By

Sheila Day Leto Scott

December 1988

Chairperson: Janet J. Larsen
Major Department: Counselor Education

Investigated in this study were comparisons between 18 autistic

and nonautistic trainable mentally handicapped students, ages 5 to 12

years, in regard to object permanence, vocal and gestural imitation,

and 15 behavioral characteristics which are combined in a rating scale

widely used by educators to identify presence of the autism syndrome.

The behavioral characteristics included relating to people; imitating;

responding emotionally; moving the body; using objects; adapting to

change; responding visually; responding to sounds; using the taste,

smell, and touch responses; having fears; communicating verbally;

communicating nonverbally; being active; and functioning

intellectually. Also investigated was whether there were differences

within the autistic and trainable groups on level of development of

vocal and gestural imitation.










Autistic children in three Florida counties (Broward, Duval, and

Palm Beach) were compared to trainable mentally handicapped children

from the same counties. All had been placed using Florida definitions

for their respective exceptionalities. They were matched on age

(within 6 months), gender, and general intellectual level (i.e., all

were three to five standard deviations below the mean).

Children in the autistic and trainable programs were found to be

significantly different on the Vocal Imitation and Gestural Imitation

scales of the Uzgiris and Hunt Scales of Infant Psychological

Development, the Imitation scale of the Psychoeducational Profile, and

the behavioral characteristics of the Childhood Autism Rating Scale.

They were not found to be significantly different on the Visual

Pursuit and the Permanence of Objects scale of the Uzgiris and Hunt.

The autistic children scored significantly different on the

gestural imitation than on the vocal imitation scales of the Uzgiris

and Hunt. The trainable children did not.

Conclusions were that, in the state of Florida, mentally

handicapped children in the autistic program have not developed the

ability to imitate vocally or gesturally as well as those in the

trainable program. Autistic students exhibit behavioral disorders

more than trainable students do. They are not different from

trainable students in development of object permanence. Autistic

students are stronger in gestural than vocal imitation. Trainable

students are the same in both. Individual Education Programs should

reflect differences found.


















CHAPTER I
INTRODUCTION



The history of how people in society have treated disabled

children, particularly those with severe problems, is not pleasant.

Those obviously abnormal at birth were often left to die. Disabled

children who lived had miserable lives and were sometimes hidden away

from society. "Misguided family friends and professionals would say,

'put them away and forget them'" (Mulliken & Buckley, 1983, p. 3).

Gradually, the attitude of society toward disabled children

changed. A belief in normalization, that is, the right of individuals

to live normal lives within the limits of their potential, began to

creep into public policy. Eventually, Public Law 94-142, the

Education for All Handicapped Children Act of 1975, was passed

(Erikson, 1987). With its passage, educators' interest in helping

severely handicapped children mounted. According to Public Law

94-142, "children have the right to education, which means the right

to be diagnosed and placed properly and instructed appropriately"

(Mulliken & Buckley, 1983, p. 12).

One of the most severe and disruptive childhood disorders to be

encountered in a school system is autism. An autistic student is

defined in the laws of the State of Florida as one who has a

disability reflected in severe disorders of communication, behavior















socialization, and academic skills, and whose disability was evident

in the early developmental stages of childhood. The student appears

to have an impairment of cognitive and perceptual functioning with

"limited ability to understand, communicate, learn, and participate in

social relationships" (Florida State Board of Education Administrative

Rule 6A-6.03023 FAC, p. 324A). Prior to the passage of the Education

for All Handicapped Children Act (1975), in the United States, most

children with autism were not provided with education in public

schools. After the passage of PL 94-142, school districts began to

yield to pressures from parents and other advocates and to provide

autistic children with educational services. Gradually, a separate

category for grouping autistic students was established by educators

using a historical medical- and clinical-model orientation (Mesaros &

Donnellan, 1987).

Isolating autism as a unitary syndrome is extremely difficult and

complex. Currently, there is a multiplicity of diagnostic criteria

utilized by medical and educational professionals. This situation has

arisen because the characteristics and needs of children diagnosed as

autistic are diverse (Koegel, Rincover, & Egel, 1982). Intellectually

autistic students range from the severely retarded to those with

normal intelligence. They exhibit all levels of adaptive skills.

Some autistic students have profound delays in basic self-care.

Others are capable of semi-independent living and vocational















self-sufficiency. Autistic students' social functions range from

virtual aloneness to important, though peculiar, social relatedness

(Cohen & Donnellan, 1987).

The school psychologist is part of a professional team involved

with students who are placed in the separate category of autism. As

part of a comprehensive evaluation team, the school psychologist

might observe the student in the classroom, complete a case history,

and administer formal and informal individual tests. "The

psychologist is involved as a member of the evaluation team throughout

the stages of referral, assessment, placement, and program planning"

(Morsink, 1984, p. 76).

The school psychologist has the responsibility of providing

essential information that will aid in case management and educational

planning with autistic students. Diagnosis is the first step.

Assessment then is expanded and enriched as the psychologist examines

the strengths and weaknesses of the individual, the learning styles,

and the relevant contexts in which the student is functioning. When

properly done, the school psychologist's assessment facilitates

placement and intervention decisions (Short & Marcus, 1986).

Because school psychologists must examine strengths and

weaknesses of individual autistic students during the evaluation

process, it is important that they be involved in research regarding

those strengths and weaknesses. There is a need for research because















autistic students "have been exposed to a remarkable array of

therapies," according to Schopler and Reichler (1971). However, there

has been a lack of professional consensus regarding the efficacy of

various methods. In order for school psychologists to help plan

interventions and therapies, they should know as much as possible

about the children placed in this special category.

Statement of the Problem

The program for autistic (profoundly handicapped) students has

been given a separate category within the State of Florida since 1979

(P. Hollis, personal communication, April 14, 1988). There is a

Florida state definition for inclusion in the program that all school

systems follow. Individual districts write district procedures which

guide them in program and placement decisions. These decisions are

made by committees at the local level. All district procedures must

conform with the state definition.

The problem is that there are a number of varying diagnostic

criteria and definitions of the autism syndrome (Schopler, Reichler, &

Renner, 1986). Because educators are confronted with such varying

information, there is confusion and disagreement about how to

interpret the state definition for placement of children in an

autistic program. Because the state definition is broad, and because

autistic students are a very heterogeneous group, there is uncertainty

about whether the children placed in autistic programs are really

different from the children placed in other programs. For instance,















it is difficult to make decisions regarding placement of trainable

mentally handicapped students exhibiting autistic characteristics,

because state definitions for these two programs overlap a great deal.

Need for the Study

For more than a quarter of a century, efforts have been made to

fit autism into known diagnostic and remedial classifications,

according to Fay and Schuler (1980), "but autism simply will not fit"

(p. 17). Professionals who have tried to fit autism to a theoretical

framework of developmental delay or of mental retardation have found

that such an explanation does not account for all of the aberrant

verbal behaviors. Fay and Schuler emphasized the complexity of the

condition. "Whatever its basis, there is something decidedly

language-specific in addition to (causing? resulting from?) the

cognitive, emotional, and social shortfalls characteristic of the

condition" (p. 17). There is ignorance regarding "complex

relationships of language (verbal and.nonverbal) to speech, to

communication, to cognition, and to the development of the unimpaired

personality" (p. 17).

Answers are needed to a number of questions. Why are some

children with intellectual ability between three and five standard

deviations below the mean placed in autistic (profoundly handicapped)

programs and other children with the same intellectual level placed in

trainable mentally handicapped programs? Are the children truly















different? Do the Florida definitions for autism and for trainable

mentally handicapped define two separate groups?

The Florida definition for mentally handicapped students states

that these students are significantly impaired in general intellectual

functioning concurrent with deficits in adaptive behavior. This must

have been manifested during the developmental period (Florida State

Board of Education Administrative Rule 6A-6.03011, FAC). Trainable

mentally handicapped students are those whose intellectual level is

three to five standard deviations below the mean (Florida State Board

of Education Administrative Rule 6A-6.03011 [1] [a]-[b], FAC).

The Florida definition for autistic students states that they

have a disability reflected in severe disorders of communication,

behavior socialization and academic skills. Their disabilities must

also have been evident in the early developmental stages. The

autistic child has a pervasive impairment of cognition and perceptual

functioning (Florida State Board of Education Administrative Rule

6A-6.03023 FAC).

Many autistic students' cognitive impairments cause them to

obtain measured intelligence quotients (IQs) in the same range as the

trainable students. Autistic students, by definition, have severe

disorders of behavior socialization. Trainable students, by

definition, have deficits in adaptive behavior, which includes

socialization. A trainable student with low cognitive functioning















often exhibits a severe disorder of communication, which is part of

the definition of an autistic child. A trainable child may also

exhibit behavior problems. Both groups, trainable mentally

handicapped and those autistic students with low intellectual ability,

exhibit deficits in academic skills.

The overlap between the two groups is obvious, yet Florida has

two separate categories for their education. Are there some

characteristics of these children that are significantly different

which delineate their separate classifications? Are there some things

about the students in the two groups which educators need to know so

that interventions can be planned? Is there really a difference

between the children in these two programs when you remove the

autistic students with higher intellectual ability from consideration?

Do low IQ autistic children in Florida programs have observable

behaviors that distinguish them from trainable children? There has

been some agreement through the years concerning the observable

behaviors which are characteristic of autistic children. Kanner

(1943), the British Working Party (Creak, 1964), Rutter (1978), the

National Society for Autistic Children (1978), and the American

Psychological Association's DSM-III-R (1987) all have similar

diagnostic criteria for autism. Do children with low intellectual

ability placed in autistic programs based on the Florida definition

exhibit these characteristics more than children of low IQ placed in

trainable programs?















Deficits in imitation have been demonstrated in autistic children

in past research. Koegel and Schreibman (1982) stated that "autistic

and other severely handicapped children typically fail to imitate and

do not benefit from this important source of learning" (p. 41). How

do children with intellectual ability in the trainable range who are

in autistic programs in Florida compare with children in trainable

programs in Florida in the ability to imitate, vocally and gesturally?

Object permanence, an important early developmental concept, is

crucial for further cognitive growth. It is usually acquired by age

two (Flavell, 1985). Previous research on the object concept in

autistic children has yielded varying results. Most of the research

indicated that autistic children do achieve the concept of object

permanence. However, when researchers have tested this theory, they

have usually included autistic children with varying levels of

intellectual ability (Cowan, 1978; Curcio, 1978; Hammes & Langdell,

1981; Lancy & Goldstein, 1982; Serafica, 1971; Sigman & Ungerer, 1981;

Sigman, Ungerer, Mundy, & Sherman, 1987; Thatcher, 1977). When only

those autistic children with retardation in the trainable range are

compared to children in the trainable program on object permanence,

are they the same or are they different? Do low IQ autistic children

achieve object permanence as well as or better than trainable

children?















This study was an effort to learn more about children who

usually do not function within normal expectations. Once answers to

these questions have been obtained, it will be possible to plan

activities and intervention strategies for autistic children that will

"facilitate cognitive growth in terms of movement from a lower to a

higher level of functioning within particular domains" (Dunst, 1980,

p. 7).

Theoretical Explanations of Autism

Various cognitive theories are useful in studying autism.

Until the 1970s, autism was regarded as a psychogenic emotional

disorder with secondary cognitive involvement. At the present time, a

theory of cognitive development is considered the base. There is

increasing evidence that autism is biogenic rather than psychogenic,

that it is more closely associated with organic than psychosocial

variables, and that it is now seen "more as a developmental than an

emotional disorder" (Morgan, 1984, p. 215). According to Morgan,

research findings have suggested that cognitive impairment "represents

the primary psychological defect in autism, to which the emotional and

social symptoms are secondary" (p. 216).

There have been proposals that autism is a sensorimotor disorder

with the problems in sensorimotor integration more basic than the

cognitive disturbances that appear later (Morgan, 1984). Other

researchers have suggested that autism is a perceptual-cognitive















disorder in which new stimuli are not tied to remembered experience.

Some theorists have stated that autism is a cognitive-language

disorder with severe and pervasive impairment of language and symbolic

thought, both higher cognitive functions.

In summary, most theorists seem to concur that autism results

from impairment of congitive-developmental processes. Morgan (1984)

stated that researchers agree that "autism represents an impairment

along the cognitive-developmental dimension, but differ in their

hypotheses regarding the basic functions involved" (p. 226). He added

that though they share the premise that "some deficient cognitive

structure plays a primary role in autism, they have no common set of

terms or theoretical base" (p. 226). Morgan suggested that all the

mentioned explanations of autism are consistent with a developmental,

structural model and that Piaget's more comprehensive theoretical

views could encompass them all.

A cognitive-developmental theory is also appropriate when

studying trainable mentally handicapped students. Most researchers

who have conducted studies of such children have indicated that these

children demonstrate that they develop cognitively in the same manner

as normal children. However, they develop at a slower rate and with a

lower ceiling than do normal children (Inhelder, 1968; Stephens &

McLaughlin, 1974; Woodward, 1961, 1962).

Piaget's theory has been considered appropriate for use in

studying the development of both autistic and trainable mentally















handicapped children. McFarland and Grant (1982) observed that the

holistic and interdisciplinary approach of Piagetian theory offers

a "point of departure where we may raise questions of learning and

development" (p. 392). They stated that Piagetian theory exemplifies

an organismic, developmental model. As a structural-theoretical model

it'has "methodological implications for the description, explanation,

and modification of children" (p. 393).

This study was an attempt to differentiate between two groups of

handicapped children. Piaget's theory which helps clarify differences

is, therefore, appropriate.

Purpose of the Study

The purpose of this study was to test the hypotheses that there

were no significant differences in development of object permanence,

development of vocal and gestural imitation, and possession of the

characteristics usually associated with autism between a group of

pupils classified as autistic with intellectual ability in the

trainable range and a group classified as trainable mentally

handicapped. Whether or not the autistic students were different in

their abilities to imitate vocally and their abilities to imitate

gesturally was also part of the purpose. This was also investigated

for the trainable students.

Rationale

Kistner and Robbins (1986) examined a subset of studies on autism

published between 1971 and 1982. They concluded that subject















selection procedures were often inadequate and important descriptive

information was omitted, impairing replicability of research and

appropriate generalization of findings. They proposed that future

research should clearly delineate the diagnostic criteria used. They

suggested that children's performance on standardized measures of

intelligence should be included in a description of subjects,

emphasizing the need to "match autistic and nonautistic groups for

mental age, chronological age, and/or some specific characteristics or

behavior in order to draw conclusions that are specific to autism" (p.

82).

Hermelin and O'Connor (1970) noted that because most autistic

children function at severely subnormal levels, much of their behavior

might be explained by their low intelligence. They suggested that an

attempt to control for intellectual level would make it possible to

attribute any behavior which distinguished autistic children from

mentally defective children specifically to autism.

In the present study, the selected children were matched as

Kistner and Robbins suggested. Matching was based on gender,

chronological age, and intellectual level (three to five standard

deviations below the mean). Gender was chosen for a matching

variable, because 75% of autistic persons are males. Chronological

age was matched within six months. Intellectual level was matched

within a range rather than by computing a specific mental age. The















students in the study were those in two specific programs, but anyone

wishing to replicate this study could use the Childhood Autism Rating

Scale to verify whether or not the subjects exhibit the

characteristics usually associated with autism.

The instruments chosen for the study were flexible and appealing,

according to their authors, and appeared to be ones which would be

possible to administer to autistic children. According to Shah and

Holmes (1985), autistic children are no longer considered untestablee"

on standardized measures. However, they are sometimes very difficult

to assess. Their severe communication problems may prevent them from

understanding the complicated requirements of a test (following

directions). Also, their impairments in social interaction make it

difficult to establish good rapport, and they are often unmotivated or

preoccupied with stereotyped activities that interfere with the

scoring of timed tests.

The sensorimotor domains of imitation and object permanence were

measured by the Uzgiris and Hunt Scales of Infant Psychological

Development. Imitation was further investigated by using the

Imitation scales of the Psychological Profile (PEP) and the Sentence

Imitation subtest of the Test of Language Development-Primary

(TOLD-P). The behaviors of the autistic and trainable children were

compared by rating them on the Childhood Autism Rating Scale (CARS)

for Diagnostic Screening and Classification of Autism.















Hypotheses

1. There are no differences in performance between autistic

children and trainable mentally handicapped children on the Visual

Pursuit and Permanence of Objects scale of the Uzgiris and Hunt Scales

of Infant Psychological Development.

2. There are no differences in performance between autistic

children and trainable mentally handicapped children on the

Development of Vocal Imitation scale of the Uzgiris and Hunt Scales of

Infant Psychological Development.

3. There are no differences in performance between autistic

children and trainable mentally handicapped children on the

Development of Gestural Imitation scale of the Uzgiris and Hunt Scales

of Infant Psychological Development.

4. There are no differences in performance between autistic

children and trainable mentally handicapped children on the Imitation

scale of the Psychoeducational Profile.

5. There are no differences in performance between autistic

children and trainable mentally handicapped children on the Sentence

Imitation scale of the Test of Language Development-Primary.

6. There are no differences in performance between autistic

children and trainable mentally handicapped children on behavioral

characteristics in the Childhood Autism Rating Scale.

7. There are no differences between performance on the

Development of Vocal Imitation scale and the Development of Gestural















Imitation scale of the Uzgiris and Hunt Scales of Infant Psychological

Development for autistic children.

8. There are no differences between performance on the

Development of Vocal Imitation scale and the Development of Gestural

Imitation scale of the Uzgiris and Hunt Scales of Infant Psychological

Development for trainable mentally handicapped children.

Definition of Terms

An autistic (profoundly handicapped) student is one who has a

disability reflected in severe disorders of communication, behavior

socialization, and academic skills, and whose disability was evident

in the early developmental stages of childhood. "The autistic child

appears to suffer primarily from a pervasive impairment of cognitive

and perceptual functioning, the consequences of which are manifested

by limited ability to understand, communicate, learn, and participate

in social relationships" (Florida State Board of Education

Administrative Rule 6A-6.03023 FAC, p. 324A).

Bizarre behavior refers to stereotyped, repetitive

self-stimulatory behavior; inappropriate and repetitive play behavior;

and obsessive ritualistic behavior resisting change. Self-stimulatory

behaviors seem to serve the purpose of providing sensory input.

Examples are manipulating hands or fingers in front of eyes; eye

crossing; repetitive, meaningless vocalizations; suspending or

spinning objects in front of eyes; mouthing objects; tapping hand;















and rocking the body. In play, the bizarre behavior includes

forsaking toys to spin a household object or flick a light switch or

interacting with toys in an abnormal manner, such as stacking,

arranging, or sorting repetitively. Obsessive, ritualistic behaviors

might include a profound resistance to change in environment or

routine (Koegel et al., 1982).

Delayed echolalia is the repetition in a seemingly irrelevant

situation of a phrase a person has heard at one time or another. It

may be a saying or proverb, television commercial, song title, or a

sentence spoken by someone in his or her presence (Morgan, 1981).

Echolalia is the apparently noncommunicative repetition of a word

or utterance spoken by another person. It is a common phenomenon in

normal language development (Howlin, 1982).

Gestural imitation consists of demonstrating gestures while the

child is attentive and observing whether the child imitates them.

Some are visible to the child when repeated. Others, like wrinkling

the nose, are invisible to the child (Uzgiris & Hunt, 1975).

The individualized education program (IEP) is a written

individualized plan for each handicapped child. It must be written

before placement and reviewed at least once each year. It sets forth

the special education and related services needed. Emphasis is on

involving parents in the writing of the IEP (Mulliken & Buckley,

1983).















A mentally retarded student in the State of Florida is one who is

significantly impaired in general intellectual functioning concurrent

with deficits in adaptive behavior which are manifested during the

developmental period (Florida State Board of Education Administrative

Rule 6A-6.03011, FAC). The term "mentally handicapped" is used

interchangeably with the term "mentally retarded."

Object permanence is the ability to see an object as an entity in

its own right. The object exists and moves in a space common to it

and the subject seeing it. The object's continued existence is

construed as independent of the activity the subject may apply to it

and separate from the subject. Object permanence recognizes "that the

self is also one object among other objects" (Serafica, 1971, p. 473).

In 1975, amendments to the Education of the Handicapped Act were

passed as Public Law 94-142. The amendments were known as the

Education for All Handicapped Children Act. The law provided broad

directives in what constitutes free appropriate education, least

restrictive environment, nonbiased evaluations and placement,

individualized education program (IEP), confidential records and

freedom of access to them, appropriate discipline, related services,

and parental rights and responsibilities (including due process)

(Mulliken & Buckley, 1983).

Sensorimotor development, according to Piaget (1936), is the

development in a normal child from birth to the ages of 1 1/2 years to















2 years. The child progresses through six substages of sensorimotor

intelligence. In the earliest period, the child is reflexive

(looking, sucking, prehension). In the final period, the child can

imitate an absent model, search for and find a hidden object, and show

a great deal of evidence of internal mental activity. The child

realizes that objects no longer in the here-and-now continue to exist,

but appreciation of them is tied to concrete action (Athey & Rubadeau,

1970).

Syntax refers to the skills used in forming and understanding

sentences. It has to do with sentence structure, or the correct

sequencing of words and inflections to form sentences (Newcomer &

Hammill, 1982).

A trainable mentally retarded student is one whose intellectual

ability falls in the moderate or severe ranges of retardation of the

American Association of Mental Retardation (Grossman, 1983). Adaptive

behavior falls below age and cultural expectations (Florida State

Board of Education Administrative Rule 6A-6.03011 [1] [a]-[b], FAC).

Vocal imitation ranges from differentiation in vocal productions

through development in imitation of sound patterns. The final step is

vocalization of unfamiliar words (Uzgiris & Hunt, 1975).

Overview

Chapter II is a review of related literature which supports

and expands on elements in Chapter I. More complete definitions of















autistic and trainable mentally handicapped children are presented.

There is information from the literature on the characteristics of

both the autistic child and the trainable mentally handicapped child.

Piaget's theory is expanded, and the prevalence of autistic children

and trainable mentally handicapped children is considered. There is

further consideration of the variables investigated in the study.

Object permanence, imitation, and the behaviors measured by the CARS

are discussed. Finally, the instruments used in the study are

evaluated and their reliabilities, validities, and appropriateness

are discussed.

Chapter III consists of a description of the methodology chosen

and its limitations. In Chapter IV, results of the analysis of the

data are presented. Tables of summary data are included. Chapter V

contains a discussion of results, limitations, conclusions, and

implications for education and further research. Also, a summation of


findings is included.



















CHAPTER II
REVIEW OF THE LITERATURE



For a number of reasons, it is important to study the

developmental characteristics and behavioral characteristics of

children placed in autistic programs. It is also important to compare

them with children within the same intellectual range who remain in

programs for the mentally retarded. There is a need to know in what

areas these two groups of children are alike and in what areas they

are different. There are implications for the individual education

programs of children who are being referred and of those for whom

placement decisions are being made. It is important to consider

research which has already been done regarding both groups.

In a review of the literature, terms are defined, concepts

clarified, and the decisions made in designing the study are

explained. Light is shed on the purpose and the need for the

study. The definitions for autistic (profoundly handicapped) and

trainable mentally handicapped students from the Florida State Board

of Education Administrative Rules were stated in Chapter I in the

Definition of Terms section. Further information, including

diagnostic criteria, characteristics, developmental sequence,

prevalence, variables, and the instruments that were used, is

included in this chapter.















Diagnostic Criteria

Autism

The most widely used set of diagnostic criteria for autism in the

United States has been the definition for autistic disorder in the

Diagnostic and Statistical Manual of Mental Disorders (3rd ed.) of the

American Psychiatric Association (1980). That definition was revised

in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.,

rev.) (DSM-III-R) (American Psychiatric Association, 1987). Autism is

classified in DSM-III-R (1987) as a pervasive developmental disorder.

The new definition is considered here.

Eight of 16 specified items must be present for a diagnosis of

autistic disorder. Two must be from features listed under qualitative

impairment in reciprocal social interaction. They are

1. marked lack of awareness of the existence or feelings
of others . .
2. no or abnormal seeking of comfort at times of
distress . .
3. no or impaired imitation . .
4. no or abnormal social play . .
5. gross impairment in ability to make peer
friendships. (American Psychiatric Association, 1987,
p. 38)

One item must be present from a list of qualitative impairments in

verbal and nonverbal communication and in imaginative activity. The

list includes the following:

1. no mode of communication . .
2. markedly abnormal nonverbal communication, as in
the use of eye-to-eye gaze, facial expression, body
posture, or gestures to initiate or modulate social
interaction .















3. absence of imaginative activity . .
4. marked abnormalities in the production of speech .
5. marked abnormalities in the form or content of speech,
including stereotyped and repetitive use of speech . .
6. marked impairment in the ability to initiate or sustain
a conversation with others, despite adequate speech.
(pp. 38-39)

Onset is during infancy or childhood. Childhood onset is that which

occurs after 36 months of age and should be specified as noted.

The State of Florida definition of an autistic (profoundly

handicapped) student is consistent with the DSM-III-R (American

Psychiatric Association, 1987) diagnostic criteria. A severe disorder

of behavior socialization is required. This is equivalent to the

qualitative impairment in reciprocal social interaction and restricted

repertoire of activities and interests of DSM-III-R.

In the Florida definition, a severe disorder of communication is

required. This is consistent with the requirement of a qualitative

impairment in verbal and nonverbal communication in DSM-III-R.

The Florida definition of an autistic child also includes a

severe disorder in academic skills manifested by limited ability to

learn. The disorder must be affecting learning and interfering with

the student's ability to gain academic skills (Florida State Board of

Education Administrative Rule 6A-6.03023 FAC).

Trainable Mental Handicap

The most widely used diagnostic criteria of mental retardation or

mental handicap were suggested by the American Association of Mental















Retardation (AAMR) (Grossman, 1983). The AAMR definition was stated

as follows: "mental retardation refers to significantly subaverage

general intellectual functioning existing concurrently with deficits

in adaptive behavior, and manifested during the developmental period"

(Grossman, 1983, p. 1). Diagnosis does not refer to etiology, but

refers to level of behavioral performance (Sattler, 1982). According

to the AAMR, persons cannot be considered mentally retarded unless

they fall into the retarded category "in both intellectual functioning

and adaptive behavior functioning" (Sattler, 1982, p. 425). Criteria

for the diagnosis of trainable mentally handicapped focus on present

behavior.

The definition of mental retardation adopted by the American

Psychiatric Association (1987) is in basic agreement with the

definition by the American Association of Mental Retardation

(Grossman, 1983). In the Diagnostic and Statistical Manual of Mental

Disorders (Third Edition-Revised) of the American Psychiatric

Association (1987), it was stated that the essential feature of mental

retardation is general intellectual functioning that is significantly

subaverage. It results in, or is associated with, deficits or

impairments in adaptive behavior. Onset is before the age of 18.

Significantly subaverage intellectual functioning is defined as

an intelligence quotient of 70 or below obtained by assessment on an

individually administered general intelligence test. In DSM-III-R















(American Psychiatric Association, 1987) the degrees of severity of

mental retardation were listed. An IQ level from 50-55 to

approximately 70 is considered mild. Of particular interest to this

study were the subtypes considered moderate and severe. Moderate

retardation has an IQ level from 35-40 to 50-55 and severe is from

20-25 to 35-40.

Characteristics of Autistic and Trainable
Mentally Handicapped Children

Autistic Characteristics

When Kanner (1943) first described autism in the literature, he

saw early infantile autism as the earliest manifestation of childhood

schizophrenia. The common characteristics he noted were "profound

withdrawal, an obsessive desire for sameness, a skillful and even

affectionate relation to objects, an intelligent and pensive

physiognomy, and either mutism or the kind of language that does not

serve interpersonal communication" (Fay & Schuler, 1980, p. 3).

Kanner (1943) believed autistic children were the product of a parent

type characterized as cold, intellectual, ego-oriented, driving, and

ambitious. His original definition considered the affective

withdrawal from emotional contact and the obsessive preoccupation with

sameness primary features. Delayed or disordered speech were

considered secondary to the emotional disturbance. Despite delays in

adaptive and cognitive skills, Kanner did not believe autistic

children suffered from mental retardation. Because of the presence of















peak skills, particularly in visual memory, he believed autistic

children had normal intellectual potential (Short & Marcus, 1986).

It is now believed that fewer than 5% of autistic individuals can

be considered to have average or above average ability in all areas

(DeMyer, 1979); 75% to 80% have some degree of retardation. Most of

these have moderate to severe delays (DeMyer, Hingtgen, & Jackson,

1981; Schopler, 1983).

Short and Marcus (1986) stated that the main characteristic of

autistic persons is unevenness of development. "Certain nonverbal

skills, such as visual spatial, visual memory, and gross motor

abilities are more intact than language, complex problem solving, and

sequential processing" (Short & Marcus, 1986, p. 158). Fluctuations

and irregularities in rates of learning over periods of time are also

an aspect of this learning disorder.

Another shift since Kanner (1943) first described autism is an

abandonment of his idea of the cold parent. In 1964, Rimland

published his book, Infantile Autism, in which a genetic-cognitive

orientation replaced Kanner's approach. He theorized that an autistic

child has difficulty relating present sensation to past experience.

This causes the child's inability to understand relationships or think

abstractly. Rimland felt such a child, being unable to integrate

sensations into a comprehensive whole, would not be able to perceive

oneself as an organized and unitary entity. More than 400 articles and














six books were published between Rimland's work in 1964 and 1969. The

relative importance of disorder in language was stressed. Also,

parents have now been exonerated (Fay & Schuler, 1980). Autism was

once considered a problem for high socioeconomic (SES) families only.

Now autism has been found to span all SES levels (Gillberg &

Schaumann, 1982; Schopler, Andrews, & Strupp, 1979; Tsai, Stewart,

Faust, & Shook, 1982).

Autistic children were pooled with schizophrenic children until

1980, when the Federal Bureau of Education for the Handicapped

recognized autism as a developmental disability distinct from

schizophrenia. Autism then became seen as a separate disorder by the

educational and psychological community (Wulff, 1985).

There are many findings to support the fact that autism is

biogenic rather than psychogenic. Twin studies that were conducted

have provided data that supported this idea. Researchers have

conducted studies providing confirmation of the hypothesis that it is

with low-functioning autistic children that a familial genetic

component exists. The "transmitted factor may pertain to a more

general cognitive impairment" (Baird & August, 1985, p. 320).

Some researchers have shown that autism can arise from many

diverse neuro-pathological conditions. Recently, studies have been

reported indicating more signs of neurological dysfunction in children

with autism. The number of children diagnosed as autistic who have

abnormal EEGs is now seen as significantly higher than once thought.















The most plausible conclusion that we can draw from the
available evidence is that autism is the behavioral end-
product of an underlying organic defect (or combination
of defects) that may arise in different ways through a
variety of possible causal agents. (Morgan, 1986, p. 6)

Despite the small percentage of the population considered

autistic, the extent of the problem is great, for at this time there

is a relatively poor prognosis. "The current outlook for autistic

children as adults is generally poor" (Morgan, 1986, p. 7). Morgan

cited Lotter's (1978) review of follow-up studies on autistic children

which reported that only 5% to 17% achieved outcomes considered good

with near normal social life, and satisfactory school and work

performance, while 61% to 74% had very poor outcomes and were

incapable of leading independent lives.

The characteristics of autism can go hand in hand with visual or

hearing impairments, seizure disorders, motor handicaps, and such

syndromes as tuberous sclerosis and congenital rubella. When autism

is paired with additional handicaps, the prognosis is even poorer

(Olley & Marcus, 1984).

Trainable Mentally Handicapped Characteristics

Students labeled retarded do not form a homogeneous group. There

are two main classes within the category. One class is called the

familial type. These are usually those with milder retardation. They

are the individuals who fall in the lower portion of the normal

distribution of intelligence. "As such, their performance reflects

normal intellectual variability" (Sattler, 1982, p. 427). This














variability can be the result of normal polygenic variation. It is

the combined action of many genes. It can be the combination of

"below-average heredity in interaction with a markedly below-average

environment" (p. 427).

Most trainable mentally handicapped students are in the second

class. This is the organic type of mental retardation. It is

associated with either a genetic component linked to single gene

effects, chromosomal abnormalities, or brain damage or malformations"

which originate during the prenatal period (Sattler, 1982, p. 427).

They have a severe lag in behavioral development with sometimes an

abnormal appearance. They fail to reach normal motor and language

developmental milestones.

"Retardation may result from genetic endogenouss) or external

(exogenous) causes" (Schwartz, 1979, p. 23). Endogenous causes might

be a single dominant gene that appears in more than one generation of

a family, a genetic mutation that is specific to one pregnancy, or a

matching of two recessive genes when conception takes place. Examples

of exogenous causes are use of drugs, toxemia of pregnancy, or rubella

in the mother-to-be. These are all prenatal. An exogenous cause at

birth might be anoxia (lack of oxygen). Postnatal exogenous causes

could be illnesses or injuries that affect brain functioning or

extremely inadequate nutrition (Schwartz, 1979).















Piaget's Theory of Human Development

Piaget (1936, 1937, 1945) saw human cognition as a form of

biological adaptation by a complex organism to a complex environment.

He saw it as extremely active. It selects and interprets

environmental information in constructing its own knowledge. It does

not passively copy the information as it is presented to the senses.

The Piagetian mind reconstructs and reinterprets the environment as it

makes it fit in with the existing mental framework. It does not copy

the world (passively accepting it) and it does not ignore the world.

The mind builds knowledge structures by taking external data. It

interprets the data, transforms them, and reorganizes them. The mind

meets the environment in an active, self-directed way (Flavell, 1985).

Cognition has two simultaneous and complementary aspects of

adaptation: assimilation and accommodation. Assimilation is

integrating new perceptual, motor, or conceptual matter into existing

patterns of behavior or schemata. Accommodation is creating new

schema or modifying existing schema so that a new stimulus will fit

into it (Wadsworth, 1984). Wadsworth stated that

Piaget's system requires that a child act in the
environment if cognitive development is to proceed.
The development of cognitive structures is ensured
only if the child assimilates and accommodates stimuli
in the environment. This can happen only if the
child's senses are brought to bear on the environment.
(p. 21)















The child moves in space, manipulates objects, searches with eyes and

ears, thinks, and takes in the raw ingredients that are to be

assimilated and accommodated. This results in the development of

schemata.

Piaget asserted that there is a developmental process of

successive qualitative changes. It is a continuous process along a

continuum. The chronological ages at which children reach a certain

stage, though suggested, are not fixed. There is a general internal

monitoring system known as equilibration. This "allows new experience

to be successfully incorporated into schemata" (Wadsworth, 1984, p.

32).

Piaget (1936, 1937) outlined four periods of cognitive

development: sensorimotor period (first 2 years), preoperational

period (2 to 7 years), concrete operational period (7 to 11 years),

and formal operational period (11 years onward).

This research focused on the sensorimotor period. It consists of

six states. They are

1. Stage I (0-1 month), which is characterized by gross,

uncoordinated body movements and neonatal reflexes. It is a time of

complete egocentrism. There is no distinction between self and outer

reality. There is no clear awareness of self.

2. Stage II (1-4 months), in which new response patterns

are formed by chance. Combinations of primitive reflexes are formed.















3. Stage III (4-8 months), when the new response patterns are

coordinated and intentionally repeated to maintain interesting

environmental changes.

4. Stage IV (8-12 months), which consists of more complex

coordinations of earlier behavior patterns. These are both motor and

perceptual.

5. Stage V (12-18 months), when familiar patterns are varied to

obtain different results, direct groping emerges, and new means-end

manipulations emerge.

6. Stage VI (18-24 months) in which there is internalization of

sensorimotor behavior patterns. Symbolic representation begins.

Rather than external trial and error, there is invention of new means

through experimentation (Pulaski, 1971).

Piaget's second period, which follows sensorimotor, is the

preoperational period. Usually found in 2 to 7 year old children, it

is a time of improved strategies for processing information. The

child can perform simple actions and gain practical knowledge.

Language acquisition flourishes and the child explores the

environment. The third period is concrete operations, from 7 to 11

years. The person becomes less egocentric and begins dealing with

more than one variable at a time. Thinking becomes more logical and

efficient, but the child is not a proficient, abstract thinker.














Formal operations, Piaget's final period, from 11 years on in normal

individuals, consists of improvement in abstract thinking,

hypothesizing, and imagining. The child is no longer tied to the

concrete as one was during the concrete operational period (Fromanek &

Gurian, 1981).

Prevalence of Autism and Trainable Mental Handicap

Autism Prevalence

The problem of autism is restricted to a small percentage of the

population, but it is devastating in its impact. Previously,

researchers suggested that the incidence of autism was 4 or 5 per

10,000. A study conducted in England in 1964 of 8, 9, and 10 year old

children and a study conducted in Denmark corroborated this prevalence

figure (Wing, 1972). According to Wing, autism occurs about as often

as total deafness and more often than total blindness. She stated

that "most people will meet at least one autistic child at some time

or another in their lives" (p. 10).

Short and Marcus (1986) claimed that "more recent epidemiologic

surveys indicate an incident rate closer to 15 per 10,000" (p. 158).

This latter number more clearly approximates the proportion of the

typical school population considered autistic. Some of these students

are mentally retarded with autistic characteristics and they would

have been excluded by Kanner's definition.

Using the 1980 general population of 222 million persons in the

United States, this would amount to the following number of autistic















individuals: an incidence of 4 per 10,000 would be 88,800 and an

incidence of 15 per 10,000 would be 333,000.

Trainable Mental Handicap Prevalence

Disagreements exist as to the prevalence of mental retardation in

the United States. Estimates range from .05% to 13% of the

population. The generally accepted rule of thumb is 3%. This

estimate approximates the number of persons who would have IQs two or

more standard deviations below the mean. "Using calculations similar

to the ones presented by Dingman and Tarjan (1960) with adjustments

based on a 1980 general population of 222 million people, it is

estimated that there are 7,247,940 mentally retarded individuals in

the United States" (Matson & Bruening, 1983, p. 92).

According to Sattler (1988), approximately 0.3% of the total

population are in the trainable range of retardation. This includes

moderately and severely retarded. According to DSM-III-R (American

Psychiatric Association, 1987), it was stated that results of recent

studies have suggested that the prevalence rate of mental retardation

at any one time is 1%. Of the retarded population, 10% are moderately

retarded, and 3% to 4% of the retarded are severely retarded. Cegelka

and Prehm (1982) also stated that 1% of the population are found to be

retarded when both low measured intelligence and poor adaptive

behavior are considered in the diagnosis.















The variation in prevalence can be accounted for, in part, by the

failure to differentiate incidence from prevalence of mental

retardation, according to MacMillan (1977). The first is the number

of retarded at some time in life. The latter is the number of

retarded at any one time. Though 3% of the population may have been

diagnosed as retarded at some time, no more than 1% are diagnosed as

such at any given time (Cegelka & Prehm, 1982).

Variables

The Object Permanence Variable

Object permanence was the first variable investigated in this

study. The Piagetian concept of object permanence is the implicit,

common sense belief that all objects (and beings) are physical objects

in a common space, and that fellow objects continue to exist and may

move about in space even when one has lost perceptual contact with

them. This fundamental and "obvious" conception of objects seems to

require nearly the whole first two years of life. Flavell (1985)

discussed the different stages in his book on cognitive development.

In stage I and II (approximately 0 to 4 months), a baby will

track a moving object until it disappears. Then the baby will lose

interest or stare briefly at the point of disappearance.

In stage III (about 4 to 8 months), the baby can extrapolate from

the object's movement and lean over and look for a fallen object. The

baby can also recognize an object by seeing part of it, but will not

retrieve it if it completely disappears behind a screen.














In stage IV (8 to 12 months), the baby will manually retrieve a

covered up object. However, after a few trials with the object

beneath the same screen, the infant will continue to look there even

though the object has been seen to be put under a different one.

Stage V (12 to 18 months), is more advanced and the youngster

searches where the object was seen to disappear.

In stage VI (18 to 24 months), the child can use newly developed

symbolic skills to represent possible invisible displacements rather

than only visible displacements or what was seen.

Most investigators agree with Piaget that children lack the

object concept at birth and must acquire it, usually by age two

(Flavell, 1985).

Research conducted on object permanence in autistic children has

provided varying results. Early studies did not distinguish between

schizophrenic and autistic children. Children in this category were

said to "consistently show structural retardation in at least four

important conceptual schemes or abilities. Object permanence was one

of them (Cowan, 1978, p. 335). Serafica (1971) found that some of the

4- to 8-year-old schizophrenic children in his study failed to reach

beginning object permanence on the Uzgiris and Hunt Scales. Some did

reach stage V and others stage VI (the highest stage). Those who

reached VI did so only with familiar objects. Cowan (1978) questioned

whether these children would eventually emerge from the sensorimotor














stage or not. Morgan (1984) asked whether autistic children remain at

the sensorimotor level and "fail to acquire the symbolic codes

necessary for progressive socialization" (p. 229).

Thatcher (1977) found that there was no statistical difference

between the 10 autistic students she tested using the Visual Pursuits

and Permanence of Objects subtest of the Uzgiris and Hunt Scales and

what would be expected at their age for normal children. She believed

that autistic children above age 4 have developed object permanence.

However, her study gave no mental age or IQ for half of her subjects

and it is possible that some of the children in her study had a

relatively high cognitive levels.

Curcio (1978) conducted an assessment of 12 autistic children,

ages 4 through 12 years on object permanence tasks. The majority

performed above stage V.

In two more recent studies, autistic subjects were found to have

achieved object permanence. Hammes and Langdell (1981) compared eight

autistic and eight mentally retarded students using a disappearing

train task. They inferred that their subjects had the concept of

object permanence. Sigman and Ungerer (1981) compared 16 autistic

with 16 mentally retarded and 16 normal children. Their subjects were

young, age 3 through 6 years, but they all achieved stage VI on object

permanence using the Casati-Lezine (1968) Scale. The fact that the

autistic, the mentally retarded, and the normal children all performed














almost identically suggested that autistic children do not have a

specific deficiency in object permanence (Sigman et al., 1987).

Lancy and Goldstein (1982) compared the object permanence

abilities of 12 autistic, 12 mentally retarded, and 12 normal

children, ages 4 through 9, using a hidden food reward. All 12 of the

autistic students were successful in finding the hidden food.

In most of the studies cited above, researchers indicated that

the autistic students participating in these studies did achieve the

concept of object permanence. However, these studies were not limited

to autistic students with low cognitive ability. Their achievement of

the object concept may be a reflection of higher general cognitive

ability.

The Imitation Variable

Imitation is the second variable investigated in this study. The

ability to imitate is an important developmental landmark. It is a

prerequisite for the acquisition of subsequent symbolic activities.

According to Bayley (1969), in normal youngsters the acquisition of

imitative skills follows a characteristic course. Children imitate a

smile at an average age of 2.1 months. They imitate simple social

games at 9.7 months, simple gestures at 15 months, and block

constructions at 16.7 months. In imitation, the child must both

recollect the stimulus and transfer it into motor activity.














Imitation is one of the most frequent routes of learning in

normal children. It allows the child to reproduce an action of

another person. The child must internalize a representation of the

action. Autistic children rarely imitate spontaneously. It is

unclear whether they are unable or reluctant to do so. Some imitation

can be observed in both body movements and speech. Particularly, some

autistic children engage in echolalia (Sigman et al., 1987). Yet

Koegel and Schreibman (1982) stated that "autistic and other severely

handicapped children typically fail to imitate and do not benefit from

this important source of learning" (p. 41).

Many autistic children engage in echolalia. Echolalia, the

apparently noncommunicative repetition of an utterance or word spoken

by someone else, is common among children whose language is developing

normally. Some produce words echolalically from 9 or 10 months

onward. At about age 2 or 3 years, when phrase speech is developing,

many children frequently echo the last words of what is said to them.

Echolalia may play an important role in the development of vocabulary

and the consolidation of language skills. It may perform a variety of

different and important functions in the growth of linguistic

competence in normal children (Howlin, 1982).

Echolalia is found to be the most often cited characteristic of

autistic children who acquire speech (Prizant, 1983). There is

sometimes a progressive change in echolalic utterances leading to a

more rule-governed linguistic behavior (Prizant & Schuler, 1987).














There may be a qualitative difference between autistic and normal

echolalia, but no clearcut criteria have been developed to

differentiate between them (Schuler, 1979). Some of the specific

constructions which first appear in echolalia, are then used in both

echolalia and spontaneous speech (Howlin, 1982). This may sometimes

occur, but it is not always the case. Paul (1987) claimed that

"although echolalia often appears to be an intermediate step toward

more functional language, in many autistic individuals it can continue

into adulthood" (p. 74).

DeMyer, Barton, and Norton (1972) and DeMyer (1972) conducted

several studies on the motor performance of autistic children. They

found autistic children to be below the level of subnormal children on

motor imitation tasks. They were particularly poor in body imitation

tasks. An unpublished study by Van Smeerdjik (1981) found the

imitation skills to be consistent with their mental age. Hammes and

Langdell (1981) reported that autistic children were able to imitate

at a basic level and to demonstrate deferred imitation in a study they

conducted requiring imitation using objects.

Jones and Prior (1985) found that "autistic children have

significant handicaps in the neuro-developmental area" (p. 42). Body

imitation ability was impaired for both dynamic movement and gesture

when compared to both mental age matched and significantly younger

children. Performance of older children in the study suggested that















many have little further development than that found in 2 to 3 year

olds. DeMyer et al. (1981) have suggested, and Jones and Prior (1985)

agreed, that the poor ability autistic children have to perform motor

imitation tasks may be due to motor dyspraxia.

Thatcher (1977) used the Vocal and Gestural Imitation subtests

from the Uzgiris and Hunt Scales with autistic children. She found

that though there were some differences between the expected and

obtained stages, these differences were not significantly different

from results expected of the normal population. Thatcher's study had

10 subjects ranging in age from 50 to 173 months. It should be noted

that her three youngest subjects made no scorable responses on either

the vocal or gestural subtests.

Kahn (1983) found that the Vocal Imitation scale of the Uzgiris

and Hunt could be used to predict the Language domain of the American

Association of Mental Deficiency Adaptive Behavior Scale (ABS) and the

expressive portion of the Receptive-Expressive Emergent Language Scale

(REEL). The Uzgiris and Hunt Vocal Imitation scale also contributed

significantly to the Independent Functioning scale of the ABS.

According to the researcher, imitation is the "Piagetian example of

pure accommodation" and the acquisition of independent functioning

"requires individuals to adapt to the environment" (pp. 74-75).

Volkmar (1987) stated that attempts to teach imitation skills to

autistic children have been common. Valcante (1986) believed that















"awareness of student imitative abilities will hopefully lead to more

effective instructional planning in the future" (p. 133). If that

planning includes teaching autistic children to imitate, Koegel and

Schreibman (1982) stated it will "facilitate widespread behavior

change. Training autistic children to learn by observing the behavior

of others holds great promise" (p. 41).

The Behavioral Characteristics Variables

A number of behaviors usually associated with autism are used as

variables in this study. The first is the child's ability to relate

to people. Volkmar (1987) stated that young autistic children are not

interested in the human face or social interaction. They do not

develop social attachments as expected, although they may have unusual

and idiosyncratic attachments to objects. Autistic youngsters may

ignore people or seem hard to reach. Social relationships may fail to

develop or the quality of their development may be aberrant.

Imitation deficits, as mentioned earlier, have been demonstrated

in autistic children (Volkmar, 1987). They typically do best in

response to tasks requiring object manipulation and worse in response

to tasks which require them to imitate actions.

The emotional response of autistic children is atypical. They

may "feel at the mercy of powerful affects, which they experience as

profoundly disorganizing and threatening" (Provence & Dahl, 1987, p.

682). Many have massive and pervasive anxiety which reflects the















persistent possibility of ego disorganization. Some of the autistic

children's bizarre behaviors can be understood as "attempts on their

part to defend against such psychological 'death'" (p. 682).

Cohen, Paul, and Volkmar (1987) stated that autistic children do

not experience normal transitions from calm through active to aroused

states. They may appear too calm, showing no needs, or may be

inconsolable or miserable, no matter what is done for them. They may

have a tendency not to feel pain when injured, or act as though in

pain for no reason.

Schopler, Reichler, DeVellis, & Daly (1980) stated that bizarre

use of body movement and persistence of stereotypes are considered

major features of autism according to Creak (1961), Rutter (1978), and

others. Autistic children have peculiarities in relating to nonhuman

objects (Schopler et al., 1980). This has special significance for

educational assessments and individualized planning because of the

child's peculiar relationship to toys and materials.

Kanner (1943) identified resistance to change as a primary

feature of autism. Rutter (1978) maintained it as a primary feature

in light of subsequent research. However, it was only considered a

subsidiary characteristic by Ritvo and Freeman (1978).

Autistic children often avoid eye contact during personal

interactions or may visually avoid toys and educational materials

(Schopler et al., 1980). In those children who do make eye contact,















it may be inappropriate. It will be too fixed at some times and

averted at other times (Wing & Attwood, 1987).

Autistic children also may avoid auditory stimuli or they may

overreact to certain noises or sounds. This inconsistent response has

implications for learning speech or alternative communication skills

(Schopler et al., 1980). Many autistic children are preoccupied with

tactuall exploration, mouthing, licking, smelling, and rubbing of

objects" (Schopler et al., 1980, p. 95).

An intensive aversive response is frequently observed in autistic

children and is included in the Creak (1964) criteria. "They may show

intense fear of some harmless things, such as of a particular color,

or entering buses or bathtubs, or even of specific people. The fears

may later turn into a special fascination, or vice versa" (Wing &

Attwood, 1987, p. 7).

Paul (1987) stated that deviant language has been recognized as a

hallmark of autistic syndromes since autism was first described.

Autistic children employ aberrant verbal and nonverbal patterns and

forms of communication. Both the range and forms of early

communicative functions are deviant. However, there is a basic

intention to communicate in the autistic population, according to Paul

(1987).

Hyperactivity is frequently present in preschool autistic

children and it persists to some extent during the early grades (Paul,















1987). Autistic children are distractible and restless. Some of them

may be truly hyperactive, but that is not common (Wing & Attwood,

1987).

Cognitive skills are sometimes uneven in autistic children. They

may have unusual peak skills, such as abilities in music or with

numbers. Intellectual discrepancies are sometimes present (Schopler

et al., 1980).

Instruments

The Uzgiris and Hunt Scales of Infant Psychological Development

The instruments chosen for this study can all be used

successfully with autistic and trainable children. The Uzgiris and

Hunt Scales of Infant Psychological Development are "Piagetian-based

infant scales . appropriate for use with handicapped populations,"

according to Dunst (1980, p. 5). They can be administered in a

flexible manner which "permits the child to play with the test

materials in any way he or she desires" (p. 15). They can be

"administered in a playful manner and not be viewed as demand

situations. The more easygoing the assessment is, the more likely

optimal performance will be obtained" (p. 15). Autistic children

often do not respond as one would hope to demand situations. The

flexibility of administration and easygoing manner help make results

obtainable. The Uzgiris and Hunt scales consist of eight subscales.

Each subscale has a number of separate ordinal steps. The steps














delineate a stage in the development of the ability measured by the

subscale. The subscales are

1. object permanence

2. use of objects as means

3. learning and foresight

4. development of schemata

5. development of an understanding of causality

6. conception of objects in space

7. vocal imitation

8. gestural imitation

The Uzgiris and Hunt Scales attempt to "measure underlying

intellectual processes that are associated with natural stages of

development" (Sattler, 1982, p. 255).

Uzgiris and Hunt (1975) have presumed that competence and

intelligence are based on a "hierarchical organization of a number of

abilities and motive systems with several relatively independent

branches" (p. 15). They also presumed this hierarchical organization

of motives and abilities is made up of coordinations and

differentiations among the sensorimotor organizations present at

birth. These progress toward the symbolic representations and

regulations which comprise competence. Uzgiris and Hunt felt

"intelligence undergoes an epigenetic development analogous to

embryonic development of organ structures" (p. 15). They adopted the















working assumption that the course of development within each branch

would follow a consistent order.

Although the Uzgiris and Hunt scales were developed for assessing

infants, they are also used with "older retarded and handicapped

children who are at risk for manifesting delays and/or deviations in

their sensorimotor development" (Dunst, 1980, p. 1). The seven

branches of the scales parallel Piaget's domains of sensorimotor

development (1936, 1937, 1945). Sensorimotor intelligence is a

practical adaptive intelligence. The ordinal construction and

hierarchical sequence of each of the individual scales are such that

higher levels of achievement are intrinsically derived from those at

preceding levels and encompass them (Dunst, 1980).

With the Uzgiris and Hunt (1975) scales "it is possible to

discern a child's major strengths and weaknesses by constructing a

profile of sensorimotor abilities" (p. 1). To establish the

developmental status of a child, one notes the highest item passed on

each of the sensorimotor scales administered. An estimated

developmental age (EDA) and stage placement is obtained for each

branch. Strengths and weaknesses are determined by "graphically

depicted a child's variability in performance across the seven

branches of development" (p. 3). This ordinal scale yields only a

ceiling because of its hierarchical construction.

Ordinal scales can be administered without the standard test

procedures and standardized materials of other kinds of tests. The















goal is to obtain optimal performance in each domain. Varied

materials and eliciting situations to determine the true performance

of the child can be used. Spontaneously emitted behaviors can also be

used.

Concurrent validity of the Uzgiris-Hunt EDA placements was

investigated by Dunst using the Griffiths (1954) Mental Development

Scale. The performance scores on the two scales correlated

significantly within and across scales. "In terms of concurrent

validity, these results reveal that the EDA's are good indicators of a

child's actual quantitative developmental performance" (Dunst, 1980,

p. 98). The procedure for determining the quantitative level of

developmental performance is considered valid. "Even with

chronological age (CA) partialled out, the correlation between mental

age (MA) and EMA remained high [r (34)=0.83, 2 < 0.01, two-tailed

test]" (p. 98).

Dunst's investigation yielded results consistent with previous

studies by Wachs (1970) and Wachs and DeRemur (1978) who reported

"significant relationships between sensorimotor abilities as measured

by the Uzgiris and Hunt scales and psychometric test performance"

(Dunst, 1980, p. 100). Dunst concluded that the methods used with the

Uzgiris-Hunt "for quantifying both sensorimotor performance levels and

the extent to which there are discrepancies in development are valid

procedures" (p. 101).















Wachs (1975) conducted a study of infants between 12 and 24

months of age to investigate the relationship between the Uzgiris and

Hunt scales and the Stanford-Binet Intelligence Scale. The subscale,

Object Permanence, was significantly related to later Binet

performance at all ages tested. There was also a consistently

significant pattern of relationship across all five age levels tested

on the Object Permanence subscale.

Kahn (1976) found the Uzgiris and Hunt scales to be both reliable

and ordinal. In later research (1983), he demonstrated that a

relationship exists between certain Uzgiris and Hunt scales and

communication and adaptive behavior scales in the severely and

profoundly retarded.

Cowan (1978) stated that evidence suggests the Uzgiris and Hunt

Scales correlate significantly with the Bayley Mental Scale. Black

male infants were assessed at 17, 18, and 22 months of age by King and

Seegmiller (1973). The tests were statistically significant but low

to moderate.

The Childhood Autism Rating Scale (CARS)

The Childhood Autism Rating Scale (CARS) represents the "varied

diagnostic criteria and . .broadened, data-based definition of the

autism syndrome" (Schopler et al., 1986, pp. 9-10). It is based on

over a decade of use with more than 1,500 autistic children, is

applicable to all ages, and is objective and quantifiable. CARS















ratings can be made during diverse conditions despite level of

behavioral control of the youngster. The CARS can be used by a

"variety of well-informed individuals who are not necessarily

diagnosticians" (p. 23).

To complete the CARS, the child's behavior is observed directly

and rated on a 7-point scale. Separate ratings are summed to provide

a total score. For this total score there are cut-offs for

classifications of nonautistic, mildly to moderately autistic, and

severely autistic. The manual provides clear descriptions of sample

behaviors at 4 points on each of the separate subscales. "This makes

it possible to use this scale without extensive training" (Short &

Marcus, 1986, p. 164).

The behavioral characteristics measured by the Childhood Autism

Rating Scale (CARS) were drawn from varied diagnostic criteria and

definitions of the autism syndrome (Schopler et al., 1986). Fifteen

different items are considered in identifying whether a child is not

exhibiting the autistic syndrome, is exhibiting it in a mild to

moderate fashion, or is exhibiting autistic characteristics in a

moderate to severe fashion.

The first item is a "rating of how the child behaves in a variety

of situations involving interaction with other people" (Schopler et

al., 1986, p. 27). Both structured and unstructured situations in

which the child has a chance to interact with others are considered.















How the child reacts to varying intensity of persistence on the part

of the other person is also rated. Especially to be noted is how

persistent or forceful an adult must be to secure the child's

attention. Reaction to physical contact; physical signs of affection;

and to praise, criticism, or punishment is also considered. Also

considered are the degree to which the child clings to parents or

others; whether or not the child initiates interactions; and whether

the child is responsive, aloof, shy, and aware of strangers.

The second item rated on the CARS is imitation of verbal and

nonverbal acts. The most important instruction for this item is that

the behavior to be imitated must be clearly within the child's

abilities. Imitation ranges from repeating simple sounds to imitating

movements of the whole body or imitating behaviors with objects

(cutting with scissors or copying shapes with a pencil). The rater

must be sure the child understands that he or she is supposed to

imitate. One should try to determine whether the child is unwilling

to imitate, unable to understand that the person wants imitation, or

is unable to physically or otherwise perform the imitation. It is

also recommended that a wide variety of situations should be observed

and notice should be taken on whether the imitation occurs immediately

or after a delay (Schopler et al., 1986).

The child's emotional response is the third item rated on the

CARS. It involves rating how the child reacts to both pleasant and















unpleasant situations and determining whether or not the child's

feelings or emotions are appropriate. The type of response and the

intensity of response are both looked at. The child is evaluated on

how one responds to affection or praise, a tickle, a favorite item, or

a pleasant game. The child is rated on responses to unpleasant

stimuli such as punishment or difficult work demands. "Inappropriate

type of response may include such things as laughing when spanked or

shifting mood unpredictably, without apparent reason" (Schopler et

al., 1986, p. 31). Inappropriate degree of response includes such

things as showing a lack of emotion "in situations where normal

children of the same age would show some form of emotion" (p. 31). It

also includes tantrums, or becoming highly agitated or excited in

response to some minor occurrence.

Body use, including coordination and appropriateness of movements

is the fourth area on the CARS. The deviations included are such

things as posturing, tapping, spinning, rocking, self-directed

aggression, and toe-walking. The frequency and intensity of the

bizarre body use is evaluated. Persistence of the behaviors is

considered.

Object use is the fifth item rated. It considers the child's

interaction with toys and other objects, especially in unstructured

activities with many objects available. The level of interest

displayed is noted. Particular attention is paid to use of toys with















dangling or spinning parts. Excessive preoccupation with such items

is considered. Overly repetitious use of certain toys is noted.

Excessive interest in objects normally of no interest to a child is

also considered. Further, the child is shown a more appropriate way

to use certain items and then observed to see if the behavior changes

or persists with the usual manner continuing.

The sixth item on the CARS has to do with the child's reaction to

changing from one activity to another. The child's reaction to adult

attempts to change a pattern or routine is considered. "Does the

child establish elaborate rituals around specific activities such as

eating or going to bed?" (Schopler et al., 1986, p. 37). Arranging

items a certain way or using only certain items are also considered.

Visual response, the seventh item on the CARS, is a rating of

unusual visual attention patterns when the child is required to look

at certain objects or materials. Does the child use eyes normally?

Does the child look a person in the eye or avoid eye contact when

engaged in social interaction? How often must a child be prompted to

attend visually? Does the child have to have physical guidance to

attend visually? Does the child gaze at his or her wiggling fingers

or become absorbed in watching movements or reflections?

Listening response is a rating involving reactions to human

voices and other kinds of sound. The child's interest in various

sounds is also noted. Preferences for or fears of certain everyday















sounds are noted. Inappropriate reactions to the loudness of sounds

is considered. Behaving as though uncomfortable when normal sounds

occur is noted. It is important to consider the sound and not the

sight of the object producing the sound.

Taste, smell, and touch response is the ninth CARS item. This is

a rating of the "near" senses and whether or not the child makes

appropriate use of these sense modalities. Does the child show either

excessive avoidance of or interest in certain foods, odors, tastes, or

textures? Does the child become preoccupied with feeling certain

surfaces? Are ordinary objects smelled by the child? Does the child

attempt to eat inedible items? Does the child react in an unusual

manner to pain?

Fear or nervousness is the tenth CARS item. It is a rating of

unusual or unexplainable fears and includes rating the absence of fear

in situations where a normal child would be fearful. The frequency,

severity, and duration of the child's reaction is considered. Are the

fears reasonable or understandable? Unusual nervousness is also

considered. Does the child have an intense startle response to normal

sound or movement?

Verbal communication is the eleventh area considered. It is a

rating of all facets of the use of speech and language. The presence

or absence of speech is considered as well as the peculiarity,

bizarreness, or inappropriateness of utterances if speech is present.















When speech is present; vocabulary, sentence structure, tonal quality,

volume or loudness, rhythm, and content of meaning are all taken into

consideration. Three particular peculiarities to note are echolalia,

pronoun reversal, and the use of jargon.

Activity level is also considered as an important area.

Overactivity as well as lethargy are part of this area. How much does

the child move about in restricted and/or unrestricted situations?

How does the child move about in a free play area or react when

required to sit still? If the child is excessively active, can he or

she be calmed down easily with encouragement or reminder? The

influence medications might have on movement are also taken into

consideration when making this rating.

Level and consistency of intellectual functioning is considered

also on the CARS. This is concerned with the general level of

intellectual functioning and the consistency or evenness of

functioning across skills. The intention of this scale is to identify

the extremely unusual or "peak skills" characteristic of some autistic

children. Does the child display unusual skill in one or two areas

that are different from general level of intellectual functioning?

Does the child have special talents such as with numbers, rote memory,

or music? Does the child take things very literally past an age that

would be appropriate?

The final area on the CARS is general impressions. It is

intended to be an overall subjective impression of the degree to which















the child appears to be autistic as defined by the previous 14 items.

The rating should be done without averaging the other ratings. The

rater should take into consideration all available information from

all sources. The child's case history, opinions of the parents, and

past records should all be considered when deciding if one believes

the child exhibits no autism, mild autism, moderate autism, or severe

autism.

The 15 items from the Childhood Autism Rating Scale (CARS)

described above are evaluated in relation to the child's chronological

age. How much does the child differ from a normal child of the same

age? The more abnormal the behavior would be, the higher the score

that would be assigned (Schopler et al., 1986).

Rationale for use of the CARS is based on Kanner's (1943)

definition, the nine points of the British Working Party (Creak,

1964), Rutter's (1978) criteria, the definition of the National

Society for Autistic Children (NSAC, 1978), and that in the American

Psychiatric Association's DSM III (1980). Because of inclusion of

characteristics from varying definitions, researchers are able to test

whether a specific criterion is an essential feature, as determined by

the CARS, or "whether it is a nonessential characteristic found in

some autistic children but not in others" (Schopler et al., 1980, p.

92).

In the development of the CARS, 534 children were assessed over a

10 year span. Approximately 75% were boys. For both sexes the age















distribution was consistent. In the group, 55% were less than 6 years

old and 11% were 10 years old or older. The model socioeconomic

status (SES) of the children's families was IV-the second lowest of

five SES categories yielded by Hollingshead-Redlich (1958) two-factor

(occupation and education) index. In the sample, 71% were white and

29% were black. Intellectual deficits were present with 70% having

IQs below 70 and 11% with IQs above 85, as measured by standardized

tests (Schopler et al., 1980).

Assessment of internal consistency on the CARS was carried out by

computing a reliability coefficient alpha (Nunnally, 1967). The alpha

obtained was .94. This indicates a high degree of internal

consistency among the items on the scale. It indicates that "taken as

a whole, the CARS measures some unitary, central characteristic rather

than numerous unrelated facets of behavior" (Schopler et al., 1980, p.

96). Reliability was also assessed by correlating the ratings of two

independent, trained raters. Based on 280 cases, average interrater

reliability was .71. Both of the above indicate that the CARS is a

highly reliable instrument (Schopler et al., 1986).

To assess test-retest reliability, total scores from two testing

approximately one year apart were compared for 91 cases. The

correlation was .88 (p < .01) and the means (31.5 compared to 31.9)

were not significantly different. A review of these findings

indicates the CARS is stable over time. Also, the data were analyzed














to assess agreement of diagnostic categorizations. Agreement occurred

82% of the time. Coefficient Kappa, correcting for chance, was .64.

Kappa of .60 or higher is acceptable. Test-retest reliability was

good (Schopler et al., 1986).

To determine validity of the instrument, total scores were

compared to clinical ratings obtained at the same sessions. The

correlation was .84, p < .001. This indicates that the CARS' scores

have a lot in common with the perceptions of the clinicians. Total

scores were also correlated with independent clinical assessments made

by a child psychologist and a child psychiatrist. Correlations were

.80, p < .001. This offers "additional support for the validity of

the CARS. In summary, the CARS yields results consistent with the

judgments of clinical experts" (Schopler et al., 1980, p. 97).

According to Parks (1983), strengths of the CARS are "an

empirically derived scoring criteria ., the provision of detailed

anchor points for the subscales . ., and good interrater reliability

using a large number of cases" (p. 265). A weakness was the lack of

extensive data on validity.

Olley and Marcus (1984) stated that one of the purposes of

assessment of autistic children is to answer the question, "does this

child have the characteristics associated with autism?" (p. 73). They

added that the Childhood Autism Rating Scale is "a reliable

observational scale" (p. 75).














Psychoeducational Profile (PEP): Imitation Scales

The Psychoeducational Profile (PEP), by Schopler and Reichler

(1979), was designed primarily for planning individualized curricula

for autistic children. Administration is very flexible and language

is minimized. The PEP grew out of the Child Research Project,

Department of Psychiatry, University of North Carolina at Chapel Hill.

It has been used in the statewide program, Project TEACCH, for

autistic children for a number of years. Olley and Marcus (1984)

stated that it includes some important emphases that can provide

useful information about autism. According to Short and Marcus

(1986), many of the materials used in the PEP "have intrinsic appeal

for many autistic children" (p. 168). The imitation Scale is one of

the developmental function areas of the PEP. Gerken (1983) suggested

that the PEP is a comprehensive inventory of idiosyncratic learning

patterns in children who functionally are at a preschool level but who

are chronologically 1 to 12 years of age. The age equivalents

obtained on the PEP can be compared to mental ages on other tests.

The PEP and the CARS can be used together in the formulation of a

diagnosis, according to Short and Marcus (1986).

Normative data were collected on the PEP using 276 normal

children between the ages of 1 and 7 years residing in North Carolina.

This was done so that individual test items could be arranged

developmentally within the function areas and so that meaningful















comparisons could be made between different functions. The normal

comparison sample was not meant to be used as a standardization study.

The authors of the PEP (Schopler & Reichler, 1979) stated that it

is not used to construct a precise, standardized score that allows one

child to be compared to another on an invariant scale and that each

administration is individualized to the child. They have not provided

reliability data.

No formal validity studies have been undertaken, but they feel

validity can be demonstrated. Regarding content validity, test items

were chosen from a wide range of developmental skills, usually

mastered by normal children and during revisions (over a 10 year

period of use), items have been empirically tested. Those that were

not clinically meaningful were eliminated. A small research project

involving 69 retarded children has tentatively found that the retarded

children's profiles were similar to the normal sample so that a child

with a mental age of 3 scored approximately the same as a normal 3

year old. The retarded children also showed equivalent retarded

development across functions. On the other hand, psychotic children

had wide variations in developmental functions across the different

areas.

The items on the Imitation Scales of the PEP which were used in

this study were as follows (Schopler & Reichler, 1979):














Imitation

Motor

Manipulates a kaleidoscope

Taps the call bell twice

Rolls clay into an elongated strand

Manipulates cat puppet

Imitates gross motor movements

Vocal

Imitates animal sounds: puppets

Repeats two and three digits

Repeats four and five digits

Imitates sounds

Imitates words

The authors of the PEP emphasized the importance of the relationship

between imitation and language. "A child must be able to imitate in

order to learn words. . In addition to speech, imitation plays an

invaluable role in socialization" (Schopler & Reichler, 1979, p. 9).

Test of Language Development-Primary (TOLD-P):
Sentence Imitation Scale

The Test of Language Development-Primary (Newcomer & Hammill,

1982) was designed to assess comprehension and expression of spoken

language. It has a total of seven subtests. In this research, only

the Sentence Imitation Scale, one of the subtests, was used. It is

untimed. The TOLD-P has been found to be effective in discriminating

between language-impaired and non-impaired children.















Norms for TOLD-P are based on 1,836 children who spoke "typical

English." They were drawn from all geographic areas of the United

States and represented a variety of ethnic, linguistic, and social

class backgrounds. The authors of the TOLD-P list as one of its four

principal uses "to serve as a measurement device in research studies

involving language behavior" (Newcomer & Hammill, 1982, p. 1).

The TOLD-P has a linguistic model as a theoretical base. The

linguistic component of the subtest used in this research is syntax,

or the correct sequencing of words and inflections to form sentences.

The Sentence Imitation subtest involves speaking, or expressive

language, and emphasizes word ordering. It measures aspects of

ability to produce correct English sentences. It is based on the

assumption that it is easier to imitate grammatical forms that are part

of a child's linguistic repertoire than to repeat those that are

unfamiliar. The child is required to imitate sentences presented by

the examiner. Verbatim imitation is necessary for a sentence to be

scored as correct. The shortest sentence in the TOLD-P contains five

words.

Reliability of the TOLD-P has been examined in terms of internal

consistency, stability, and standard error of measurement. The

authors of the test reported that the Sentence Imitation and two other

subtests "have adequate internal consistency at all of the age levels

studied" (Newcomer & Hammill, 1982, p. 34). They found the














coefficients associated with those subtests to equal or exceed .80.

Other studies found the same, and a study, conducted in Canada, found

a coefficient alpha of .95 for the Sentence Imitation subtest. A

study with children diagnosed as having disorders in oral

communication had internal consistency correlations for subtests

ranging from .80 to .89. This suggests that all of the subtests of

the TOLD-P can be administered reliably to children who are

linguistically handicapped.

Stability was tested using the test-retest method. The Sentence

Imitation subtest Pearson product-moment coefficient of .98 was

statistically significant beyond the .01 level of confidence. Allen

(1985), however, warned that there were only 21 children involved in

the study of test-retest reliability. The standard error of

measurement for the Sentence Imitation subtest ranges from 0.7 to 2.1

looking at raw scores and standard scores at each age level (4 through

8).

Validity was reviewed in terms of content validity,

criterion-related validity, and construct validity. A group of 100

language professionals were asked to examine content validity. The

authors claimed that the ratings by the professionals "can be

interpreted as additional support for the content validity of the

test" (Newcomer & Hammill, 1982, p. 39).

In criterion-related validity, there is not yet proof of

predictive validity, but concurrent validity was explored. Two














criterion tests were used with the Sentence Imitation subtest. They

were the Northwestern Syntax Screening Test-Expressive (NSST) and the

Detroit Test of Learning Aptitude Related Syllables (DTLA). Pearson

product-moment correlation coefficients, with a correction formula

taking reliability into account, were .77 between Sentence Imitation

from TOLD-P and the NSST-Expressive and .84 between Sentence Imitation

and the DTLA-Related Syllables.

Construct validity was studied at length. Areas examined were

age relatedness, intercorrelation between subtests, relationship with

tests of intelligence, relationship to academic performance,

differentiation between groups of children known to be normal and

abnormal in spoken language, and "loading" on factors consistent with

the underlying theoretical model.

On the Sentence Imitation subtests, children did progressively

better as they grew older and principal subtests were highly

interrelated. The Sentence Imitation subtest correlated .71 with the

Slosson Intelligence Test for Children and Adults. Studies with the

Wechsler Intelligence Scale for Children-Revised and with tests of

reading, writing, readiness, and achievement all were highly

significant and supported construct validity. Group differentiation

was found with the Sentence Imitation subtest in studies using eight

different diagnostic groups (Newcomer & Hammill, 1982).

Allen (1985) warned that, on the Sentence Imitation Test, a

number of the items are in question form. She felt a child might










64



answer the question rather than imitate it. She also warned that it

is unclear if all the subtests are appropriate for users of

nonstandard English.


















CHAPTER III
METHODOLOGY



Overview

The purpose of this study was to investigate whether scores of

students placed in programs for autistic (profoundly handicapped)

students, with intellectual ability in the trainable mentally

handicapped range, would differ from scores of students placed in the

trainable mentally handicapped program on scales measuring object

permanence, vocal and gestural imitation, and on a scale used to rate

the behavioral characteristics for identification of the autism

syndrome. Another purpose was to investigate whether there would be

differences within the groups on the abilities to imitate vocally and

gesturally.

Subjects

For the purposes of this study, autistic students consisted of

those who were in programs for autistic (profoundly handicapped) in

the State of Florida based on state criteria for placement in such a

program. All Florida counties must abide by state regulations when

placing students in any of the exceptional education programs.

Specific common criteria have been established to define each group.















As of February, 1987, 449 children in Florida public schools were

classified as autistic (P. Hollis, personal communication, September

3, 1987) and 215 of the 449 attended school in 3 of the 67 counties.

Forty-one counties had no autistic students in exceptional student

education programs. The 23 remaining counties each had fewer than

27 autistic students. Among those counties, the four with greatest

enrollments had 25-27 autistic students in programs. Three of those

four counties (Broward, Duval, and Palm Beach) were chosen for the

study. Broward County had 26 autistic students, Duval had 27, and

Palm Beach had 25. Of the 78 autistic children in the three counties,

36 were between the ages of 5 and 11, 32 were between 12 and 18+

years, and 10 were between 0 and 4 years old.

The psychological services records of all autistic children

between the ages of 5 and 12 years of age in each county were reviewed

by the researcher. Any child with a reported measured IQ between 3 to

5 standard deviations below the mean who had no sensory impairment was

accepted for the study. A total of 13 children were found within this

range. Tests which had been used to determine the intellectual level

were the following:

1. Stanford-Binet Intelligence Scale, Form L-M (6 students)

2. Leiter International Performance Scale (3 students)

3. Cattell Test of Infant Intelligence (3 students)

4. Wechsler Intelligence Scale for Children-Revised (1 student)















In addition to these 13 students, 8 other students were included who

fell in the same range of mental retardation according to

developmental tests, adaptive functioning, and statements by

diagnosticians. Altogether 21 autistic students between the ages of 5

and 12 with intellectual ability reportedly in the same range as

children in trainable programs were found in the three counties.

For the purposes of the study, trainable mentally handicapped

students were those who had been placed in programs for trainable

mentally handicapped (TMH). Of the 5,644 trainable mentally

handicapped students in the State of Florida in February, 1987, 470

were in Broward County, 395 were in Duval County, and 221 were in Palm

Beach County (L. Beard, personal communication, April 15, 1988).

Lists of trainable mentally handicapped students were obtained

from the three county administrators. For each autistic child in the

study, all trainable children of the same gender whose age at the time

of testing would be within + or 6 months of the autistic child were

listed. In some cases, this was only one child. In that case, that

child would be matched with the autistic student. In cases where

there was more than one trainable child of the correct age and gender

for an autistic child, a name was randomly chosen and that trainable

mentally retarded child was matched with the autistic child.

Procedure

Permission to conduct the study was obtained from the research

committees in each county. Permission to work in the schools involved















was obtained from the principals of the individual schools. All seven

principals wrote letters expressing their approval of the study. The

appropriate letter from the principal, a cover letter from the

researcher, and a letter requesting informed consent were sent to the

parents of the 21 autistic students. Nineteen parents returned the

consents by mail. Two parents returned the consent after follow-up

notes were sent from their child's school. Twenty autistic students

were tested. One autistic student, for whom consent had been

obtained, moved out-of-state before being tested.

Cover letters and the informed consent form also were mailed to

the parents of all the trainable matches. Nine parents returned

signed consent forms by mail. Follow-up procedures included second

letters to some parents, a note of reminder to some parents from the

child's school, and personal contact by the researcher in two cases.

One autistic girl was dropped form the study because there was no

girl within 6 months of her age in the TMH program in her county to

serve as her match. One autistic boy was dropped in another county

because no informed consent could be obtained from the parents of any

of the trainable boys of the appropriate age. In the third county, an

autistic girl could only be matched with a trainable boy, and an

autistic boy could only be matched with a trainable girl of the

appropriate ages. These autistic children were retained in the study

because the two cases balanced each other and the number of autistic














boys and girls in the county still was equal to the number of

trainable boys and girls.

Variables

One group of variables in this study included three of the

sensorimotor domains which are part of the stage ordered postulated

sequences of behavior posited by Piaget (1936). The domains chosen

were object permanence, vocal imitation, and gestural imitation.

The second group of variables studied was made up of behavioral

characteristics. Included were the 15 items frequently used to

identify autistic children (Schopler et al., 1986). These variables

were relating to people; imitation; emotional response; body use;

object use; adaptation to change; visual response; listening response;

taste, smell, and touch response and use; fear or nervousness; verbal

communication; nonverbal communication; activity level; level and

consistency of intellectual functioning; and general impressions.

Instruments

Once subjects had been chosen and permission obtained from their

parents, the children were administered the Uzgiris and Hunt Scales of

Infant Psychological Development. The methods of administration,

recording, and scoring developed by Dunst (1980) were followed and his

Summary Record Form was used. The Uzgiris and Hunt Scales are

Piagetian based scales that measure underlying intellectual processes.

Object permanence and gestural and vocal imitation were the domains

included in the study.















The Imitation scales from the Psychoeducational Profile (PEP)

developed by Schopler and Reichler were also used with each child.

For those students who successfully imitated words on the previous two

tests, the Sentence Imitation scale of the Test of Language

Development-Primary (TOLD-P) was also used. In it the child was asked

to repeat sentences.

The Childhood Autism Rating Scale (CARS) was completed by each

child's teacher. The CARS was used to assess the behavioral

characteristics usually associated with autism.

Qualifications of Test Administrators

The Uzgiris and Hunt Scales were administered in all three

counties by the researcher, a certified school psychologist. The

portions that were used of the PEP and the TOLD-P were also

administered by the researcher. At the time of the study, she was

employed as a school psychologist in Broward County, Florida.

To improve skills in administration of this test, the researcher

studied films published by the University of Illinois Press on

administration of the Uzgiris and Hunt Scales. She had used the

Childhood Autism Rating Scale (CARS), the Psychoeducational Profile

(PEP), and the Test of Language Development-Primary (TOLD-P) in her

work as the school psychologist in an exceptional student center.

The teachers who completed the Childhood Autism Rating Scale

(CARS) were all employed by the school boards of their various















counties. They were all trained by the researcher in the use of the

CARS. Some teachers had previous experience using the CARS and were

familiar with it.

Analysis

The data were analyzed in two parts. First, the estimated

developmental ages (EDA) on the Object Permanence, Vocal Imitation,

and Gestural Imitation scales of the Uzgiris and Hunt Scales and the

scores on the CARS and the PEP were compared for the autistic and

trainable groups using dependent sample t tests and the Wilcoxon

Matched-Pairs Signed-Ranks Test. The same would have been done for

the TOLD-P, but there were too many scores of zero for it to be

analyzed statistically.

In the second part of the analysis, the Vocal Imitation EDAs of

the autistic group were compared to the Gestural Imitation EDAs of the

group (Uzgiris and Hunt Scales) using dependent sample t tests and the

Wilcoxon Matched-Pairs Signed-Ranks Tests (subjects serving as their

own controls). The same was done for the trainable group's Vocal and

Gestural EDAs on the Uzgiris and Hunt. The parametric analysis was

carried out using an SAS computer package. The nonparametric

statistical analysis was done by hand.


















CHAPTER IV
ANALYSIS OF RESULTS



The purpose of this study was to investigate whether students

placed in programs for the autistic (profoundly handicapped) in the

State of Florida, with intellectual ability in the trainable

mentally handicapped range, would score differently from students

placed in the trainable mentally handicapped program on scales

measuring object permanence, vocal and gestural imitation, and the

behavioral characteristics usually associated with autistic children.

Another element of the study was to determine if there were any

significant differences within either group (autistic or trainable)

between vocal or gestural imitation abilities. All autistic children

in the three counties who met the criteria and for whom consent and a

match could be obtained were included. The trainable students were a

stratified random sample chosen to match the autistic students on the

basis of county, age (within 6 months), gender, and general

intellectual level (between three and five standard deviations below

the mean).

Data were collected on 36 students in three Florida counties.

The Uzgiris and Hunt Scales of Infant Psychological Development

(Visual Pursuit and the Permanence of Objects, Vocal Imitation, and














Gestural Imitation scales), the Psychoeducational Profile (PEP)

(Imitation scale), the Test of Language Development-Primary (TOLD-P)

(Sentence Imitation scale), and the Childhood Autism Rating Scale

(CARS) were utilized.

An illustration of the characteristics of the subjects in the

study can be found in Table 1. The autistic students ranged in age

from 5 years 1 month to 12 years 11 months. The trainable students

ranged from 5 years 7 months to 13 years 3 months. There were 10

males and 8 females in each group. Broward County had 5 males and 0

females per group, Duval County had 4 males and 4 females per group,

and Palm Beach County had 1 male and 4 females per group.

These data were gathered between July 1, 1987, and January 26,

1988. All direct testing was conducted by the examiner. A rating

scale was completed by each child's teacher.

In this study, two groups with a decided number of contrasts were

being compared. The contrasts were first tested using dependent

sample t statistics. Each hypothesis was evaluated at alpha equal .05

level of significance.

Significance tests using a t statistic involve the assumption

that populations are approximately normally distributed and variances

are homogeneous, however, the t statistic is "robust with respect to

violation of both assumptions provided the number of observations in

the samples is equal" (Kirk, 1982, p. 100).














Table 1

Characteristics of Subiects


Characteristic Group
Autistic Trainable


Mean age at testing 115 months 117 months

Number of white students 14 11

Number of black students 01 07

Number of Hispanic students 03 00

Number of males 10 10

Number in Broward County 05 05

(male 5, female 0)

Number in Duval County 08 08

(male 4, female 4)

Number in Palm Beach County 05 05

(male 1, female 4)


Because there were significant differences in standard deviations

between the two groups for each instrument, nonparametric procedures

were also utilized on the data to see if they would corroborate the

findings of the t tests. The use of nonparametric statistics was

supported for several reasons. Siegel and Castellan (1988) stated











75



that "if the sample size is very small, there may be no alternative to

using a nonparametric statistical test unless the nature of the

population distribution is known exactly" (p. 35). The possible

ordinal quality of the data also supported the use of nonparametric

statistics. According to Siegel (1956), with ordinal scaling,

hypotheses should be tested by using nonparametric statistical tests,

and the median is the most appropriate statistic for describing the

central tendency of scores in an ordinal scale.

The Wilcoxon Matched-Pairs Signed-Ranks tests was the

nonparametric procedure used to compare the groups on each instrument.

It was also the procedure used to compare each group's Uzgiris and

Hunt Vocal Imitation scores with its Uzgiris and Hunt Gestural

Imitation scores. For the within groups analysis, each subject was

used as his or her own control. The Wilcoxon employs both the

magnitude and the direction of the differences (Marascuilo &

McSweeney, 1977). Zero difference scores were dropped from the total

number. Tied differences were handled using the midrank procedure.

The assumption that the two populations in the study are symmetrically

distributed may have been violated. If so, the null hypotheses could

be erroneously accepted or rejected because of differences in shape

rather than differences in means and medians.

Choice of analysis was difficult because of the small number of

pairs. Since the data may have violated one assumption for the















dependent sample t test or another assumption for the Wilcoxon, both

procedures were used. The fact that significant differences were

found for the same contrasts using both parametric and nonparametric

analyses lends added credence to the findings.

Contained in Table 2 are the scores earned by the autistic

students and in Table 3 the scores earned by the trainable students.

An initial is used for each county (B = Broward, D = Duval, P = Palm

Beach). Age was rounded to the next highest month (at 15 or 15+

days). EDA is the abbreviation for "estimated developmental age" on

the Uzgiris and Hunt Scales. The score for the PEP and the TOLD-P

were total number imitated correctly. Other abbreviations not

previously used are VPPO = Visual Pursuit and the Permanence of

Objects (or Object Permanence), VI = Vocal Imitation, and GI =

Gestural Imitation. Table 4 contains the dependent sample t test

analysis between groups, Table 5 contains the Wilcoxon Matched-Pairs

Signed-Ranks Analysis between groups, and Table 6 contains the

significance levels for both analyses for each of the first six

hypotheses.

Research Hypothesis 1

The first hypothesis was that there are no differences in

performance between autistic children and trainable mentally

handicapped children on the Visual Pursuit and the Permanence of

Objects scale of the Uzgiris and Hunt Scales of Infant Psychological

Development.














Table 2

Performance of Autistic Subjects


County Gender Age CARS U-H U-H U-H PEP TOLD-P
VPPO VI GI
EDA EDA EDA


5-1

5-2

6-10

7-4

7-5

8-3

9-2

9-6

10-1

10-2

10-6

10-8

11-0

11-4

12-4

12-5

12-10

12-11


45

35.5

39

35

31

27.5

45.5

48.5

25

52

35.5

48.5

37

47.5

49

50

36

48.5















Table 3

Performance of


Trainable Subiects


County Gender Age CARS U-H U-H U-H PEP TOLD-P
VPPO VI GI
EDA EDA EDA


5-7

5-7

7-0

7-0

7-3

8-8

8-10

9-9

9-10

10-6

10-8

10-10

11-1

11-8

12-6

12-6

12-9

13-3


24.5

48.5

35.5

23

18

41

26

22.5

21.5

35

32

29

22

27

16

39.5

37

19.5
















Table 4


Dependent Sample t Test


Analysis Between Groups


Group and Test Mean Standard Standard Probability
for Deviation Error of
Groups for Groups Mean
Difference


Autistic VPPO (U-H) 16.33 7.55
Trainable VPPO (U-H) 19.44 4.90 2.04 .15

Autistic VI (U-H) 12.61 9.57
Trainable VI (U-H) 20.28 3.88 2.14 .002

Autistic GI (U-H) 15.33 8.04
Trainable GI (U-H) 21.17 4.23 2.01 .01

Autistic PEP 3.39 3.01
Trainable PEP 6.28 2.02 .71 .0008

Autistic TOLD-P *
Trainable TOLD-P *

Autistic CARS 40.89 8.38
Trainable CARS 28.75 9.02 3.09 .001


*Not analyzed because of excess


number of zero scores.
















Table 5

Wilcoxon Matched-Pairs Signed-Ranks Analysis


Group
Test Autistic Trainable Probability
Median Median


Object Permanence (U-H) 18.0 22.0 Not able to
reject at .05

Vocal Imitation (U-H) 13.0 23.0 .01

Gestural Imitation (U-H) 16.0 23.0 .05

PEP Imitation 3.5 6.0 .01

TOLD-P *

CARS 42.0 26.5 .01


*Not analyzed because of excess number of zero scores.















Table 6

Significance Levels for Each Hypothesis


Hypothesis Dependent Sample Wilcoxon
t Test Probability Probability


1 Object Permanence .15 Not able to
Autistic/Trainable reject at .05

2 Vocal Imitation .002 .01
Autistic/Trainable

3 Gestural Imitation .01 .05
Autistic/Trainable

4 PEP Imitation .0008 .01
Autistic/Trainable

5 TOLD-P Sentence Imitation *
Autistic/Trainable

6 Childhood Autism Rating Scale .001 .01
Autistic/Trainable

7 Autistic Group .0172 .05
Vocal/Gestural Imitation

8 Trainable Group .4336 Not able to
Vocal/Gestural Imitation reject at .05















The results of dependent sample t tests and the Wilcoxon

Matched-Pairs Signed-Ranks Test statistical analyses both revealed

that the difference between the two groups failed to reach

significance at the p < .05 level for the Visual Pursuit and the

Permanence of Objects scale of the Uzgiris and Hunt Scales of Infant

Psychological Development. Therefore, the null hypothesis was not

rejected.

The autistic students had a median EDA of 18 months and a mean

of 16.33 months. The trainable students had a median of 22 months and

a mean of 19.44 months. Seven of the 18 autistic students had reached

the highest stage and achieved the concept of object permanence.

Seven of the trainable students had achieved the object permanence

concept.

Research Hypothesis 2

The second hypothesis was that there are no differences in

performance between autistic children and trainable mentally

handicapped children on the Development of Vocal Imitation scale of

the Uzgiris and Hunt Scales of Infant Psychological Development. Use

of the dependent sample t tests revealed significant differences (2 <

.002) and the use of the Wilcoxon revealed significant differences

(p < .01) between the autistic children and the trainable children on

the Development of Vocal Imitation scale of the Uzgiris and Hunt

Scales of Infant Psychological Development. Thus the null hypothesis

was rejected.














The trainable students had significantly higher scores than the

autistic students. The median EDA of the trainable group was 23

months and the mean was 20.28 months. The median EDA of the autistic

group was 13 months. The autistic mean was 12.61 months. Eleven

of the trainable students reached the highest level (imitates at least

four novel words). Only seven of the autistic students reached the

highest level.

Research Hypothesis 3

The third hypothesis was that there are no differences in

performance between autistic children and trainable mentally

handicapped children on the Development of Gestural Imitation scale of

the Uzgiris and Hunt Scales of Infant Psychological Development. The

autistic group and the trainable group were differentiated using t

tests (p < .01) and using the Wilcoxon analysis (p < .05) on the basis

of scores on the Development of Gestural Imitation Scale of the

Uzgiris and Hunt Scales of Infant Psychological Development. The null

hypothesis, therefore, was rejected.

The trainable group scored significantly higher than the autistic

group. The trainable EDA median was 23 months and the autistic EDA

median was 16 months. The trainable EDA mean was 21.17 and the

autistic mean was 15.33. Fourteen of the 18 trainable students had

reached the highest level (imitates three invisible gestures without















object). Only 8 of the 18 autistic students had reached the highest

level.

Research Hypothesis 4

The fourth hypothesis was that there are no differences in

performance between autistic children and trainable mentally

handicapped children on the Imitation scale of the Psychoeducational

Profile (PEP). The autistic and trainable group scores were

significantly different on the Imitation scale of the

Psychoeducational Profile (PEP). Results using the dependent sample

t tests were significant at < .0008. Results using the Wilcoxon

were significant at 2 < .01. Thus the null hypothesis was rejected.

The trainable students scored significantly higher than the

autistic students on the Imitation scale of the Psychoeducational

Profile (PEP). The median number of correct imitations for the

trainable group was 6 and the median number for the autistic group was

3.5. The mean for trainable students was 6.28 and the mean for

autistic students was 3.39. All of the trainable students imitated at

least two items correctly and one trainable student had 10 correct

imitations. Five of the autistic students failed to imitate any of

the PEP items correctly.

Research Hypothesis 5

The fifth hypothesis was that there are no differences in

performance between autistic children and trainable mentally















handicapped children on the Sentence Imitation scale of the Test of

Language Development-Primary (TOLD-P). Only 5 of the 18 autistic

students imitated even the first sentence on the TOLD-P (five words).

Three autistic students could imitate more than the first sentence.

Only 3 of the 18 trainable students imitated the first sentence on the

TOLD-P (five words). Two trainable students could imitate more.

Because of the large number of zero scores (28 of 36), these results

were not analyzed statistically.

Research Hypothesis 6

The sixth hypothesis was that there are no differences in

performance between autistic children and trainable mentally

handicapped children on the Childhood Autism Rating Scale (CARS). The

dependent sample t test indicated significant differences (2 < .001)

and the Wilcoxon analysis indicated significant differences (2 < .01)

between the autistic and trainable students on the Childhood Autism

Rating Scale (CARS). The null hypothesis was rejected.

The autistic students were rated significantly higher than the

trainable students on the characteristics associated with autism as

measured by the CARS. The median score for the autistic group was 42

and for the trainable group was 26.5. The mean for the autistic group

was 40.89 and the mean for the trainable group was 28.75.

Eleven autistic students were rated by the CARS as severely

autistic and 11 of the trainable students were rated as non-autistic.














Five autistic students and four trainable students were rated as

mildly-moderately autistic on the CARS. Two autistic students were

rated as non-autistic and three trainable students were rated as

severely autistic.

Research Hypothesis 7

The seventh hypothesis was that there are no differences in

performance between the Development of Vocal Imitation scale and the

Development of Gestural Imitation scale of the Uzgiris and Hunt

Scales of Infant Psychological Development for autistic children.

The autistic children earned scores significantly different on the

Development of Vocal Imitation and the Development of Gestural

Imitation scales of the Uzgiris and Hunt Scales of Infant

Psychological Development when analyzed using the dependent sample

t test and the Matched-Pairs Signed-Ranks test (t test K < .0172,

Wilcoxon < .05). Hypothesis seven therefore was rejected.

The autistic students scored significantly higher on Gestural

Imitation than on Vocal Imitation on the Uzgiris and Hunt Scales

(median of 16 for gestural and median of 13 for vocal). The mean for

Gestural Imitation was 15.33 and the mean for Vocal Imitation was

12.61.

Research Hypothesis 8

The eighth hypothesis was that there are no differences in

performance between the Development of Vocal Imitation scale and the














Development of Gestural Imitation scale of the Uzgiris and Hunt Scales

of Infant Psychological Development for trainable mentally handicapped

children. A significant difference was not found between the

trainable children's scores on the Development of Vocal Imitation

scale and the Development of Gestural Imitation scale of the Uzgiris

and Hunt using either the t statistic or the Wilcoxon Matched-Pairs

Signed-Ranks Test. Consequently the null hypothesis was not rejected.

The trainable students scored very much alike on the Gestural

Imitation scale and the Vocal Imitation scale of the Uzgiris and Hunt.

Ten pairs scored the same, achieving the highest possible score.

Therefore, the tests were based on differences in only eight pairs.

The median for each scale was 23, the highest possible score.

The mean for Vocal Imitation was 20.28 and the mean for Gestural

Imitation was 21.17. The fact that a significant difference was not

found may not indicate that no difference existed. If the scales had

included higher levels of imitation, the scores might have differed as

they did in the autistic group.


















CHAPTER V
DISCUSSION



This study was an investigation to determine whether students

placed in programs for autistic (profoundly handicapped) with

intellectual ability in the trainable mentally handicapped range,

would score differently from students placed in trainable mentally

handicapped programs on scales measuring object permanence, vocal and

gestural imitation, and on scales used by educators to determine

presence of the autism syndrome. The vocal and gestural imitation

scores within each group (autistic and trainable) were also

investigated. The autistic children were compared to children from

their same counties. A trainable match was chosen for each autistic

child. The match was the same gender (with two exceptions which

balanced the total number) and the same age (within six months).

The Uzgiris and Hunt Scales of Infant Psychological Development

(Visual Pursuit and the Permanence of Objects, Vocal Imitation, and

Gestural Imitation scales), the Psychoeducational Profile (PEP)

(Imitation scale), the Test of Language Development-Primary (TOLD-P)

(Sentence Imitation Scale), and the Childhood Autism Rating Scale

(CARS) were used. Eighteen autistic children and 18 trainable

children in Broward, Duval, and Palm Beach Counties in Florida were

studied.















Data were analyzed to determine if significant differences

existed between the two groups on any of the instruments used.

Parametric and nonparametric procedures were chosen. The dependent

sample t test was the parametric analysis. The Wilcoxon Matched-Pairs

Signed-Ranks test was the nonparametric analysis. Both procedures

were used to analyze differences between the autistic and trainable

groups. The Vocal and Gestural Imitation scale scores (Uzgiris and

Hunt Scale) for each group (autistic and trainable) were also

compared with both procedures to see if there were differences within

either group on performance of the two kinds of imitation.

Results

For those children placed in programs for autistic (profoundly

handicapped) and for those the same gender and age and in the same

counties who were placed in programs for the trainable mentally

handicapped, a significant difference was found between the autistic

and trainable groups on vocal imitation as measured by the Uzgiris and

Hunt Scales. The trainable students imitated vocally better than

their autistic counterparts. Three of the autistic children did not

vocalize at all. They only responded to a voice. Eight autistic

children did not imitate familiar words. All 18 trainable children

could imitate familiar words. Over half of the trainable students

could imitate at least four novel words.

The trainable children were also significantly better able to

imitate gesturally (according to the Uzgiris and Hunt Scale) than the














autistic children. Fourteen of the 18 trainable students could

imitate three invisible gestures without an object, but only 8 of the

18 autistic students could do so. The failure to imitate gestures did

not appear to be a failure to attend to the gestures. Two children

did attend to the gestures performed by the adult, but did not perform

any gestures. All others performed some act in response.

When vocal and gestural imitation were combined on the very brief

Imitation scale of the Psychoeducational Profile (PEP), there was

still a significant difference between the autistic and trainable

groups. The trainable students again scored significantly higher than

the autistic students. There are five motor imitation tasks on the

PEP and five vocal imitation tasks. Five of the 18 autistic subjects

did not perform any of the PEP imitations. Fourteen of the 18

autistic subjects did only half (or fewer) of the 10 imitations. All

of the trainable children did at least two imitations and only five

trainable children did only half (or fewer). Two of the autistic

children performed two motor imitation tasks but no vocal imitation

ones. One autistic child performed one vocal imitation task but no

motor imitation task. One trainable child performed three vocal

imitation tasks but no motor tasks. All other trainable children

performed at least one imitation task in each area (motor and vocal).

The shortest sentence on the Sentence Imitation Scale of the Test

of Language Development-Primary (TOLD-P) contains five words. Only




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