According to the Center for Disease Control and Prevenation (CDC) (2015), Autism Spectrum Disorder (ASD) is a developmental disability that causes deficits in social communication/language, social interaction and skills, and behavioral challenges. The Diagnostic Statistic Manual-5 (DSM-5) provides criteria for ASD with specific deficits and actions in three categories: communication, restricted ideas and repetitive behaviors, and social interaction (American Psychiatric Association, 2013). The symptoms must be present in early childhood, which is eight years old or younger, and the symptoms together have to restrict and impair every day functioning for a child to be diagnosed with ASD (American Psychiatric Association, 2013). It is a spectrum disorder because there is a wide range of skills and different symptoms an individual with ASD can have (NIH: Autism Spectrum Disorder, 2015). The severity of the disorder also varies, so some individuals need more services than others, and different levels of treatment are used in the interventions based upon the individual (NIH: Autism Spectrum Disorder, 2015.)
There are many different interventions and teaching procedures used to aid a child to learn and to progress developmentally. Incidental teaching is a method in which the child and adult interact in a natural environment that is not structured, such as free play, where the adult will teach a skill based on the child’s interests (Hart & Risley, 1975). It is a method in which children learn labeling and language in a naturally occurring setting (Hart &Risley, 1975). Incidental teaching is child-selected since the child initiates the interaction based on a request for help from the adult (Hart & Risley, 1975). The request can be either verbal or non verbal, and if the adult chooses so, he/she can partake in incidental teaching and decide the cue and what language behavior the goal is to be obtained, and the steps if the child responds to the cue, or if the child does not respond to it (Hart & Risley, 1975). Incidental teaching is a procedure that aims for the child to learn spontaneous responses to cues in the real world (Hart & Risley, 1975).
It is in this natural environment where children learn to generalize the skills taught and transfer them to other settings and people; therefore, it is a procedure that is effective (Hart and Risley, 1975). Training in settings that are natural, increases the amount of instruction that can be provided to autistic children (McGee, Krantz, Mason, & McClannahan, 1983). Incidental teaching has an appropriate blend of systematic instruction and normalized environment for the child to learn (McGee, Morrier, & Daly, 1999). In addition, the procedure encourages children to make their own choices and aids social initiation since the initiations are being rewarded (McGee et al., 1999).
Incidental Teaching and Verbal Communication
Hart and Risley (1975) stated that the procedure is most common in a pre-school setting, since that is when most of the language is achieved. McGee and Daly (2007) developed a study that evaluated incidental teaching with three preschool aged boys with autism to promote the use of age appropriate social phrases. The study taught the social phrases, “All right” and “You know what?” with prompt fading, and transfer across teachings and settings (McGee & Daly 2007). The results of the study illustrated that the three young boys with ASD acquired the social phrases and were able to generalize the social phrases across different situations (McGee & Daly 2007).
A benefit of incidental teaching is that teachers, parents, or peers can do the instructions, and this influences the generalization of the skills taught, which ultimately improves the child’s learning and quality of life (Hart &Risley, 1975). Incidental teaching can be done without disrupting in the child’s routine, so it is easily done in many environments (McGee et al., 1999). The ability to transfer instructions across different people and settings, allows for more opportunities for the child to maintain the skills taught, and to learn more skills. It is always stated that the more practice one has, the better he/she gets in a particular area of skill, and this is the same for children with ASD. The more opportunities they have to practice, the better they will get in their skills, which will overall effect their social life and quality of life.
Hart and Risley (1975) believe that pre-school is the best age to start incidental teaching; however, it is best to start as early as possible. Since parents can instruct incidental teaching, it could be beneficial to start in a natural home environment. McGee, Morrier, and Daly (1999) completed a study where the participants were toddlers instead of preschool-aged children, and there was a home-based component. The study included both a natural environment of a childcare center and the home of the child (McGee et al., 1999). The study consisted 28 children with ASD who participated in the program for at least months with more than thirty hours a week of planned early intervention through a combination of home based program and a center-based program (McGee et al., 1999). The parents had ten additional hours of hands-on training so they can implement the procedure at home. The study found that, by the time the children left the program to go to preschool, 82% of the toddlers with ASD were verbalizing meaningful words, so majority had functional language going into preschool (McGee et al., 1999).
Incidental teaching is a procedure that meets the needs for an inclusive group of toddlers and preschool aged children who have ASD and who are typically developed (McGee et al., 1999). Incidental teaching is a method that can use typical peers to aid the advancement of language and development with children who have ASD, but since it is in a more natural setting it diminishes the social barriers. In addition, it is a method that provides intensive instruction for children with ASD, but it also allows the children to be engaged in age-appropriate play with their peers (McGee et al., 1999). Hart and Risley (1975) discussed that peers in a naturalistic setting can also provide the instruction. This could not only aid the advancement of verbal skills with autistic children, but it could also promote social interaction.
McGee and Daly (2007) discussed that there is evidence that incidental teaching and stimulus-fading techniques can enhance autistic children’s communication in a socially meaningful way. A study was done that evaluated peer incidental teaching as a way to increase peer interactions by children with ASD (McGee, Almeida, Sulzer-Azaroff, and Feldman, 1992). The study gave a typical child something to say that would elicit a response from their peer with ASD (McGee et al., 1992). Three typical preschoolers were trained and paired with three children with ASD in a natural free play environment (McGee et al., 1992). There was adult supervision that was systematically faded throughout the sessions, which resulted in increase reciprocal interactions among the peers (McGee et al., 1992). Evidence showed that peer incidental teaching was effective in improving and enhancing reciprocal interactions among children with autism and their typical peers (McGee et al., 1992).
Expansion of Incidental Teaching Methods
Incidental teaching is the most common among speech and verbal words and phrases. It is proven to help a child engage with toys, respond in social settings, social tolerance of peers, and imitation of peers (McGee et al., 1999). Hart and Risley (1975) discussed that children were able to develop compound sentences on their own based on the teaching procedures of incidental teaching. Incidental teaching encourages the use of conversational language because of the use in generalized settings with different people (McGee & Daly, 2007).
It is evident how successful incidental teaching is in the realm of functional language interactions. However, McGee, Krantz, and McClannahan (1986) completed an extension of incidental teaching procedures of Hart and Risley (1975) to teach reading instruction for autistic children. The study consisted of two autistic children, one who was five years old, and another who was thirteen years old (McGee et al., 1986). The study used visual discriminations of printed stimuli in response to auditory cues within the activity and the measurements were based on maintenance of sight-word reading skills, generalizations of visual discriminations to a reading understanding task, and a transfer of stimulus materials and response modes (McGee et al., 1986).
There was a three level prompt system with a stimulus fading strategy where the teacher presented the word card(s) between the child and the item, after the child made an initiation (McGee et al., 1986). Generalization probes occurred throughout the baseline and after every fifth session, along with changes in the types of stimuli (McGee et al., 1986). For example, changes in the font style and font size were made on the card (McGee et al., 1986). The results exhibited that incidental teaching yields generalization to functional reading and comprehension skills; therefore, indicating that incidental teaching is a valid procedure to use for other skills other than vocal communication (McGee et al., 1986). McGee et al. (1983) discussed that incidental teaching is a procedure that can teach language skills and other adaptive skills concurrently. These skills could include meal preparation, leisure activities, or self-care skills (McGee et al., 1983).
Incidental teaching is a very popular procedure among communication and has been proven very effective. It expands on the child initiation, so it is a good method for the child to understand the context of the word and/or phrase. However, not all children with autism make initiations that show clearly what they prefer or want, so it is difficult to use incidental teaching. Therefore, McGee et al. (1983) developed a modified incidental teaching procedure that is based on the principles of the standard incidental procedure, but it is aimed to increase the receptive language skills of autistic children who have severe language delays. The children who have severe language delays do not initiate interaction by language or gestures (McGee et al., 1983).
Two children were both in a Teaching Family Model group home and both have been institutionalized there for a little over seven years (McGee et al., 1983). One of the participants was fifteen years old, and the other participant was twelve years old (McGee et al., 1983). Incidental teaching occurred daily in the kitchen for a 45-minute session in the kitchen during preparation for lunches (McGee et al., 1983). The teacher would ask the student, “Are you ready to make sandwiches?” or a similar question to inquire readiness (McGee et al., 1983). When the child looked at the teacher without any off task or self-stimulatory behavior, the teaching procedure was initiated and the incidental teaching began (McGee et al., 1983). There was also generalization in the study across settings, just as standard incidental teaching, but only modified to aid the severe deficits in the children. The results yielded benefits that are similar to that of standard incidental teaching procedures because if the rapid acquisition and the promotion of generalization (McGee et al., 1983).
At times it is difficult to use prompts when teaching children with ASD new skills because they can be prompt dependent; however, it is difficult to not use any prompts because they are needed to teach the skill. Incidental teaching is a procedure, which aids the children to learn the skills in a natural environment, but there also isn’t a need for continual prompts (Hart and Risley, 1975). McGee et al. (1999) showed that incidental teaching generates less prompt dependency because the teacher prompts them to elaborate on that initiation, rather than starting with a word that was chosen randomly by the teacher that does not hold the child’s interest. It is important to have at least a prompt level system in placed in order to maintain a procedure that is not prompt dependent (McGee et al., 1986). Incidental teaching also generalizes across different settings and people without prompt dependence. The study completed by McGee and Daly (2007) showed that the social phrases learned in their study by the three autistic boys were transferred across different periods and situations without prompts. According to McGee et al. (1999) the strong interest and favor to incidental teaching was due to the need to overcome the generalization issue that occurred in other behavioral interventions.
As mentioned earlier, incidental teaching is a procedure is reinforcing because the child initiates the intervention based on their own interest, and receives the reinforce when the child attempts to follow the instructor’s prompt. Incidental teaching is also an intervention that promotes lasting and impactful results because it is an intervention that is early, it also can be done in a variety of settings with different people, it can have family involvement, the procedure can include peers, and it is fun for the child since it initiated by the child (McGee et al., 1999). Since it is child selected, it drives the child’s motivation, which ultimately assists the child to learn.
Limitations
Incidental teaching is a procedure that has shown a lot of progress in children, especially in vocalization. However, the teaching procedure is mainly an intervention that focuses on verbal communication and can be limiting to certain children with ASD, especially those who are severe. McGee et al. (1983) modified the standard incidental teaching for autistic children with severe language deficits shown evident progress in the subjects. However, the setting was more contrived and it was not based on the interests of the child. In addition, many studies mentioned that it is beneficial for the child to initiate, but it becomes challenging to use incidental teaching past a certain age because then the interests start to become narrower and more depleted.
It is also difficult to find a “perfect” intervention for ASD because it is a spectrum disorder, so the signs and symptoms vary among children. Therefore, each child is at a different level of severity, and each level of severity needs more or less assistance. It is going to be easier for high functioning children with ASD to learn how to have verbal communication that is socially functional than it would be for lower functioning children with ASD. It is also dependent upon the parents and the services of the child that determines the success of an intervention. Some parents do not have as much time to practice instructional teaching at home, so the procedure may only be done once or twice a week with therapy appointments. For example, McGee et al. (1999) had a home-based component in their study where to parents did an addition ten hours a week of teaching with their child, so that is also a contributing factor to the children’s progress. In addition, if a child does not have therapists that are educated adequately for the procedure, then the child will not have as much progress. This procedure, like many others in the field of ASD, is very dependent on outside factors to make it successful.
Overall, incidental teaching has many more benefits than limitations. It is a procedure that motivates the children and is an intervention that has a low probability of prompt dependency, which can be dangerous in interventions. The main component of incidental teaching that also makes it notable is that it has evidence to support the generalization across settings and people without prompts because those two components tend to be challenging among other interventions (McGee et al., 1999).