The Science Behind the Growth through Play System

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Synopsis of the current peer-reviewed research on autism treatment, focusing on parent-implemented, relationship-based approaches.

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The Science Behind the Growth through Play System

  1. 1. 
 
 
 
 
 www.relatetoautism.com SCIENCE
BEHIND
 GROWTH
THROUGH
PLAY
SYSTEM
 Empowering
Parents
and
Professionals
 800-340-5978
  2. 2. relatetoautismTM CONTENT 
 Overview...........................................................................................................................................................3
 Current
Neuroscience
and
Autism ................................................................................................. 3
 Approaches
to
Autism
Treatment.................................................................................................. 3
 The
Role
of
Parents ....................................................................................................................... 3
 Autism:
The
View
from
Current
Neuroscience ...................................................................................................4
 Brains
Develop
Through
Dynamic
Interaction
with
the
Environment ............................................. 5
 The
Brain
is
Malleable ................................................................................................................... 5
 Autism
Treatment:
What
Works ........................................................................................................................6
 Naturalistic
Behavioral
Approaches ................................................................................................. 6
 Developmental
Approaches ............................................................................................................. 6
 Convergence..................................................................................................................................... 7
 Comparing
Approaches ................................................................................................................. 7
 Interactive
Style................................................................................................................................ 7
 Curriculum ........................................................................................................................................ 8
 Autism
Treatment
Summary ......................................................................................................... 8
 Parents:
The
Missing
Link ..................................................................................................................................9
 Parents
are
Essential ..................................................................................................................... 9
 Parental
Well‐Being
is
Critical........................................................................................................ 9
 The
Growth
through
Play
System .................................................................................................................... 10
 References ...................................................................................................................................................... 11
 
 
 -2- Relate to Autism, Inc © 2010 all rights reserved
  3. 3. 
 
 
 
 
 www.relatetoautism.com OVERVIEW Current Neuroscience and Autism Neuroscience
has
shown
us
that
autism
is
not
caused
by
a
fundamental
difference
or
deficit
in
brain
structure
as
 previously
assumed.
Instead,
current
research
tells
us
that
autism
is
the
behavioral
level
manifestation
of
a
“miss‐ wired”
brain,
a
brain
with
insufficient
interconnectivity
and
synchronization
among
multiple,
disparate
regions.

 As
a
result
of
this,
children
with
autism
tend
to
focus
on
activities
that
require
minimal
coordination
among
brain
 regions
(e.g.,
reciting
isolated
words
and
details,
or
focusing
on
static
stimuli
and
repetitive
tasks)
and
avoid
 activities
that
required
coordination
of
multiple
brain
regions
(e.g.,
comprehending
stories,
seeing
the
‘big
picture’,
 or
learning
new
tasks
where
previously
learned
rules
don’t
apply.)


 This
focus
in
turn
reinforces
the
parts
of
the
brain
that
facilitate
local
interconnectivity
at
the
expense
of
the
parts
 of
the
brain
that
facilitate
global
interconnectivity;
an
accelerating
feedback
loop.
 The
good
news
is
that
research
has
shown
that
the
feedback
loop
can
be
reversed;
through
various
forms
of
 interaction,
children
can
rewire
their
brains
to
improve
global
interconnectivity
and
their
commensurate
ability
to
 perform
tasks
that
involve
multiple
regions
of
the
brain.
A
converging
body
of
evidence
from
psychology
is
 showing
us
what
types
of
interactions
(with
people
and
objects)
help
reduce
the
core
symptoms
of
Autism
and
 facilitate
increased
social
interaction,
communication
and
range
of
interests.
 Approaches to Autism Treatment While
researchers
work
on
identifying
why
so
many
children
have
miss‐wired
brains,
those
of
us
working
directly
 with
families
affected
by
autism
can
apply
this
understanding
to
helping
children
now.

Based
on
the
neuroscience
 of
autism,
the
effectiveness
of
a
treatment
approach
can
be
gauged
by
its
ability
to
cause
the
desired
change
in
the
 interconnectivity
and
synchronization
of
disparate
regions
of
the
brain.


 There
are
fundamentally
two
schools
of
thought
regarding
autism
treatment,
Behavioralist
Approaches
and
 Developmental
Approaches.
The
most
significant
differences
among
these
approaches
can
be
calibrated
in
terms
 of
prescribed
interactive
style
and
the
criteria
by
which
curricula
are
selected.

Interactive
styles
vary
from
highly
 directive
to
highly
responsive.

Curricula
selection
varies
from
age‐appropriate
criteria
to
developmentally
 appropriate
criteria.

 The Role of Parents The
rapidly
escalating
number
of
cases
of
autism
has
made
the
previous
practitioner‐centered
model
of
autism
 treatment
impractical
in
most
regions.

To
be
effective,
children
require
intensive,
daily
input
from
emotionally
 attuned
and
developmentally
informed
adults.

 With
professional
guidance,
parents
can
become
the
best
therapists
and
program
coordinators
for
their
children
 with
autism.
 Relate to Autism, Inc © 2010 all rights reserved -3-
  4. 4. relatetoautismTM AUTISM: THE VIEW FROM CURRENT NEUROSCIENCE Autism
results
from
a
poorly
connected
and
poorly
synchronized
brain.
 The
most
robust
finding
in
the
neuro‐anatomy
regarding
autism
is
that
people
with
autism
have
increased
brain
 volume.
This
increased
brain
volume
is
composed
primarily
of
cerebral
white
matter,
the
material
that
 interconnects
different
regions
of
the
brain.
Cerebral
white
matter
can
be
divided
into
an
outer
zone
containing
 the
radiate
compartment
(the
material
that
interconnects
local
brain
regions)
and
an
inner
zone
containing
sagittal
 and
bridging
system
compartments
(that
interconnect
distant
regions
of
the
brain).
In
autism,
enlargement
is
 localized
to
the
radiate
white
matter,
whereas
inner
zone
 white
matter
compartments
showed
no
volume
 differences
from
controls.
In
other
words,
people
with
 autism
have
brains
wired
in
a
way
that
favors
local
 communication
over
global
communication.
 In
people
with
autism,
this
pattern
of
increased
local
 interconnectivity
and
decreased
global
interconnectivity
is
 even
more
pronounced
in
pre‐frontal
areas,
the
areas
of
 the
brain
that
are
typically
most
globally
interconnected
as
 they
are
responsible
for
integrating
information
from
 multiple
brain
regions
for
higher‐order
or
abstract
processing
(see
Herbert,
2005).

 Brain
areas
that
are
under‐connected
do
not
process
information
in
a
manner
that
is
synchronized
with
other
brain
 areas,
a
process
that
is
necessary
for
processing
multi‐sensory
information.

Most
recent
reviews
suggest
that
the
 symptoms
of
autism
may
therefore
be
the
result
of
brains
that
are
under‐connected
and
poorly
synchronized
(see
 Gepner
&
Féron,
2009).
 In
the
absence
of
strong
global
interconnectivity
and
synchronization,
tasks
that
require
integration
of
dynamic
 information
from
multiple
channels
(such
as
social
interaction,
communication
and
abstract
reasoning)
are
very
 challenging
for
people
with
autism.

Whereas
tasks
that
involve
processing
of
more
static
information
from
 minimal
channels
comes
more
easily
due
to
the
relatively
stronger
localized
interconnectivity.
 Strengths
of
People
with
Autism
 Challenges
for
People
with
Autism
 Activities
that
require
minimal
coordination
among
 Activities
that
require
significant
coordination
among
 regions
of
the
brain
 regions
of
the
brain
 • Encapsulated
cognitive
strengths,
such
as
 • Higher‐order
processing
challenges,
such
as
story
 hyperlexic
(isolated)
word
reading
or
focusing
on
 comprehension
 individual
details
(rather
than
the
bigger
picture)
 • Novel
tasks
which
require
new
processes
 • Hyper‐focus
on
static
stimuli,
such
as
physical
 because
previously
learned
rules
don’t
apply
 objects
or
highly
repetitive
tasks
 • Shifting
to
new
tasks
or
strategies
 • Tasks
that
require
learning
rules
 • Activities
such
as
social
interaction
that
involve
 • Sticking
to
and
completing
repetitive
tasks
 integration
of
multi‐sensory,
dynamic
stimuli,
in
 • Excellence
in
visuo‐spatial
or
memory
tasks
 particular,
eye
movements,
facial
expressions
 and
speech
sounds.
 -4- Relate to Autism, Inc © 2010 all rights reserved
  5. 5. 
 
 
 
 
 www.relatetoautism.com Brains Develop Through Dynamic Interaction with the Environment As
infants
interact
with
the
world
of
people
and
objects,
their
brains
organize
and
wire
themselves
to
support
 adaptive
behavior.

A
child
who’s
brain
does
not
easily
process
multi‐sensory
dynamic
information
requiring
 integration
will
interact
with
people
and
objects
in
atypical
ways.

This
may
be
very
subtle
at
first
but
begins
to
 become
noticeable
by
twelve
to
eighteen
months
of
age
when
major
communication
milestones
are
missed.

 As
an
infant
spends
less
time
processing
multi‐sensory,
social
information
and
subsequently
more
time
processing
 less
complex
(usually
non‐social)
information,
he
misses
out
on
the
“social
education”
being
gained
by
his
typically
 developing
peers
(see
Mundy
and
Acra,
2007).
 As
time
goes
on,
this
child’s
developmental
trajectory
becomes
increasingly
removed
from
that
of
his
or
her
more
 typical
peers.

The
altered
patterns
of
interaction
with
the
world
lead
to
the
development
of
neural
circuitry
that
 supports
more
of
the
behavior
symptomatic
of
autism
in
a
rapidly
accelerating
feedback
loop.
 The Brain is Malleable Much
research
has
been
published
over
the
last
two
decades
to
tell
us
that
our
brains
are
malleable
and
that
 neurons
re‐wire
their
connections
in
response
to
our
interactions
with
our
environment
(Doidge,
2007).


 A
recent
fMRI
(functional
Magnetic
Resonance
 Imaging)
study
captured
images
of
white
matter
 growing
to
form
more
typical
connectivity
 between
previously
under‐connected
brain
 regions
in
children
with
learning
difficulties.
After
 intensive
reading
instruction
these
children
 showed
increased
white
matter
connectivity
and
 significantly
improved
reading
ability
(Keller
&
 Just,
2009).
 Studies
such
as
this
and
others
indicate
that
by
 regularly
and
consistently
providing
children
with
 autism
input
that
stimulates
processing
of
 dynamic,
multisensory
information,
we
can
help
them
to
rewire
their
brains
in
a
way
that
improves
global
 interconnectivity
and
synchronization.
 To
effect
significant
neurological
change,
autism
interventions
must:
impact
how
a
child
interacts
with
his
or
her
 physical
and
social
environment
by
providing
focused,
intensive
multisensory
input
and
stimulation
on
a
regular
 (daily)
basis.
 Relate to Autism, Inc © 2010 all rights reserved -5-
  6. 6. relatetoautismTM AUTISM TREATMENT: WHAT WORKS Autism
treatment
is
a
dynamic
and
evolving
field
with
many
approaches
that
vary
in
many
ways.
However,
at
a
 high
level
each
of
these
approaches
falls
into
one
of
two
categories:
Behavioral
and
Developmental.
The
most
 recent
evolution
of
the
Behavioral
Approaches
as
known
as
Naturalistic
Behavioral
Approaches.
 Naturalistic Behavioral Approaches Autism
treatment
began
in
the
1960s
with
behavioral
based
models
that
evolved
into
what
we
now
know
as
 Applied
Behavior
Analysis
(ABA).
These
approaches
are
based
on
the
assumptions
of
learning
theory,
that
all
 voluntary
behaviors
(e.g.
play,
social
interaction
and
communication)
are
learned
and
maintained
through
 antecedents
(what
happens
before
the
behavior)
and
consequences
(what
happens
after).

New
skills
are
taught
 through
manipulation
of
the
antecedents
and
systematic
application
of
reinforcement
of
targeted
behaviors.

Early
 behavioral
approaches
were
highly
structured
and
adult
directed
(e.g.
 Naturalistic
Behavior
Approaches

 Lovaas,
1973)
and
include
the
use
of
discrete‐trial
training.

Since
then
 • Incidental
teaching

 the
field
has
evolved
to
improve
child
outcomes
and
generalization
of
 • Milieu
teaching

 skills.

Newer
versions
of
behavioral
treatments
are
employing
more
 • Natural
language
paradigm
 naturalistic
environments
and
more
child‐centered
approaches.
 • Pivotal
Response
Training
 Developmental
Approaches

 Research
on
both
the
earlier
structured
ABA
programs
(Rogers
and
 Vismara,
2008)
and
the
later
naturalistic
approaches
(Schreibman,
 • SCERTS
 • Denver
Model
 2005)
have
found
positive
outcomes
for
about
half
the
children
 • Floortime
/
DIR
 involved.

Generalization
and
maintenance
of
skills
has
been
found
to
 • Responsive
Teaching
 improve
when
parents
are
trained
in
supporting
behavioral
 
 techniques
(Ingersoll
and
Gergans,
2007).
 Developmental Approaches Another
group
of
treatments
has
emerged
in
parallel
since
the
1980s,
these
are
known
as
developmental
 approaches.

These
treatments
emerged
from
a
combination
of
Piagetian
developmental
theory
and
 psychoanalysis
(e.g.
Greenspan
and
Lourie,
1981)
and
social‐pragmatic
theories
of
language
development
(Bruner,
 1983).

They
are
based
on
the
core
assumptions
that:
 • Social‐communication
skills
are
learned
in
a
similar
developmental
sequence
by
all
children
regardless
of
 their
ability
 • Children
learn
primarily
through
affect‐laden
relationships
with
responsive
primary
caregivers
 Being
newer,
less
research
has
been
performed
on
developmental
approaches
than
behavioral
approaches.

 Studies
that
have
assessed
the
efficacy
of
developmental
approaches
have
found
positive
results
(e.g.
Aldred,
et
al,
 2004;
Kasari
et
al,
2008;
Gerber,
2003;
Mahoney
and
Perales,
2003;
Dawson
and
Galpert,
1990).

 -6- Relate to Autism, Inc © 2010 all rights reserved
  7. 7. 
 
 
 
 
 www.relatetoautism.com Convergence These
two
fields
of
autism
treatment
have
developed
over
the
past
twenty
years
largely
independently
of
one
 another
due
to
differing
philosophical
backgrounds.

However,
recently,
people
representing
either
perspective
are
 coming
to
mutual
recognition
of
the
commonalities
in
implementation.
As
a
result,
new
hybrid
approaches
are
 emerging.

 Positive
results
are
being
found
in
approaches
such
as
Enhanced
Milieu
Teaching
(Kaiser
and
Hester,
1994),
 Responsivity
Training
and
Pre‐linguistic
Milieu
Training
(Yoder
and
Warren,
2002),
Parent‐mediated
Approaches
 (Ingersoll
and
Dvortcsak,
2006)
and
most
recently
the
randomized
control
trial
of
the
Early
Start
Denver
Model
 (Dawson,
et
al,
2009).

 Comparing Approaches Although
developmental
and
naturalistic
behavioral
approaches
to
autism
come
from
different
philosophies
and
 research
traditions,
in
practice
there
is
little
difference
in
their
general
implementation
(Ingersoll,
2010).
The
 primary
differences
can
be
calibrated
in
terms
of:
 • Interactive
Style:
The
manner
in
which
an
adult
works
with
a
child
 • Curriculum:
The
criteria
by
which
goals,
metrics
and
activities
are
selected
 Interactive Style Although
most
practitioners
engage
children
in
a
variety
of
ways,
Interactive
Style
can
be
divided
into
to
 fundamental
categories:
a
Directive
Style
and
a
Responsive
Style.

These
are
characterized
below.
 
 A
Directive
Style
 A
Responsive
Style
 
• Emphasis
on
adult
initiations
and
child
responses
 • Allowing
a
balance
of
child
and
adult
initiations
 • Teaching
episodes
focus
on
adult‐selected
 and
responses
 
 objects,
activities
or
topics
 • Teaching
episodes
focus
on
child‐selected
objects,
 
• Emphasis
on
goal
achievement
and
task
 activities
or
topics
 accomplishment
 • Emphasis
placed
on
affect
and
emotion‐sharing
 
 • Prompting
or
direct
requesting
of
target
 • Pausing
or
indirect
invitations
for
child
to
perform
 
 behaviors
from
child
 target
behaviors
 • Higher
ratio
of
imperative
(“Give
me
the
truck”)
 • Higher
ratio
of
declarative
(“What
a
nice
truck!”)
 
 to
declarative
(“What
a
nice
truck!”)
adult
 to
imperative
(“Give
me
the
truck”)
adult
language
 
 language
use
 use
 • Adult
behavior
goal‐directed
 • Adult
behavior
sensitive
to
child’s
developmental
 
 level
and
current
state
of
sensory‐regulation
 
 No
approach
to
autism
treatment
prescribes
one
or
the
other
of
these
interactive
styles
exclusively.
However,
 various
approaches
tend
align
more
with
one
than
the
other
in
a
manner
consistent
with
the
goals
of
the
 treatment
program.
Notably,
a
responsive
style
of
interaction
has
been
found
to
increase
children’s
social,
 emotional,
communicative
and
cognitive
development
in
numerous
studies
(Trivette,
2003).
 Relate to Autism, Inc © 2010 all rights reserved -7-
  8. 8. relatetoautismTM Curriculum Another
significant
difference
among
various
treatment
approaches
lies
in
the
criteria
by
which
a
curriculum
(a
set
 of
goals,
activities
and
metrics)
is
established
for
a
specific
child.

Criteria
for
the
selection
of
curricula
fall
in
to
 basic
categories:
 • Age
Appropriate:
activities
and
goals
determined
by
a
child’s
chronological
age
 • Developmentally
Appropriate:
activities
and
goals
determined
by
typical
developmental
sequence
 Research
in
child
development
has
shown
that
children
with
autism
follow
a
developmental
path
similar
to
that
of
 typically
developing
children.

However,
children
with
autism
are
delayed
in
their
progress
along
this
path
(not
 deficient
as
previously
assumed).

Studies
have
found
this
to
be
the
case
for
such
key
social
development
areas
as
 expressive
language
(Tager‐Flusburg,
et
al,
1990),
imitation
(Rogers
et
al.,
2008)
and
symbolic
play
(Lifter,
et
al,
93).

 Typically,
the
set
of
skills
being
taught
to
a
child
is
 age‐appropriate
(defined
by
his
or
her
 chronological
age).

A
child
at
age
four
is
taught
one
 set
of
skills
and
a
child
at
age
seven
another.

 Children
with
autism
often
skip
developmental
 steps
making
it
difficult
to
learn
skills
defined
by
 their
age.
Therefore,
teaching
children
with
autism
 skills
that
are
developmentally
appropriate
(i.e.,
 skills
defined
by
the
typical
sequence
of
 developmental
steps
rather
than
chronological
age)
 allows
for
faster
learning
and
a
more
enjoyable
 learning
experience
for
both
child
and
adult.

For
example,
teaching
verbal
language
skills
to
a
child
not
yet
using
 gestures
is
not
developmentally
appropriate
(regardless
of
his
age)
as
all
typical
children
develop
gestural
 communication
before
verbal
language.
 Furthermore,
ongoing
research
is
identifying
a
few
“pivotal”
skills
on
which
many
other
skills
depend.

Acquisition
 of
theses
skills
impacts
wider
areas
of
development.
For
example,
teaching
symbolic
play
skills
or
joint
attention
 skills
produces
increases
in
expressive
language
even
when
expressive
language
is
not
directly
targeted
(Kasari
et
 al,
2008).
 Autism Treatment Summary Modern
approaches
to
autism
treatment
can
be
divided
into
two
basic
categories,
Naturalistic
Behavioral
 Approaches
and
Developmental
Approaches.

Although
philosophically
different,
in
practice
these
two
schools
of
 thought
are
on
a
convergence
path.

Across
these
categories,
various
approaches
to
autism
treatment
can
be
 distinguished
in
terms
of
their
prescribed
Interactive
Style
and
Curriculum.

Interactive
styles
vary
from
highly
 directive
to
highly
responsive.

Selection
of
curricula
varies
from
curricula
that
are
age‐appropriate
to
curricula
 that
are
developmentally
appropriate.
 -8- Relate to Autism, Inc © 2010 all rights reserved
  9. 9. 
 
 
 
 
 www.relatetoautism.com THE MISSING LINK Parents are Essential To
access
its
innate
neuroplasticity
(changeability)
a
disconnected,
unsynchronized
brain
requires
regular
 engagement
in
motivating,
meaningful,
affect‐laden
activities
with
a
more
advanced
social
partner.
 The
National
Research
Council
(2001)
recommended
that
parents
be
included
in
their
children’s
treatment.

Siller
 and
Sigman
(2002)
found
that,
when
mothers
were
naturally
more
responsive,
their
children
with
autism
made
 significantly
greater
improvements
in
joint
attention
and
language
over
periods
of
one,
ten
and
sixteen
years
than
 did
children
whose
mothers
were
less
responsive.
 A
review
of
thirteen
separate
studies
found
that
 caregiver
responsive
style
of
interaction
facilitated
 significant
improvements
in
cognitive
and
emotional‐ social
development
for
children
with,
or
at
risk
of,
 developmental
delays
(Trivette,
2003).
 Parents
are
essential
to
the
social,
emotional,
 communication
and
cognitive
development
of
their
 children.
Numerous
studies
have
found
that
parents
 can
be
trained
to
effectively
deliver
interventions
for
 their
children
(e.g.
Ingersoll,
2007;
Solomon,
et
al.,
2007;
Solomon,
2008).

Given
the
lack
of
qualified
professional
 providers
and
the
alarming
incidence
rate
of
autism,
and
other
neurobiological
disorders
of
childhood,
the
role
of
 parents
as
primary
therapists
cannot
be
underestimated.
 Parental Well-Being is Critical Parents
of
children
with
autism
have
been
found
to
suffer
more
stress
than
parents
of
children
with
other
 diagnoses
or
those
who
are
developing
typically
(Estes,
2009).


 A
parent’s
emotional
state
affects
their
child
 The
Growth
through
Play
System
supports
parents
 through
every
interaction.

In
fact,
the
positive
 to
help
them:
 benefit
of
professionally
delivered
treatments
is
 • Gain
emotional
resolution
about
the
diagnosis
 reduced
for
children
whose
parents
have
the
 • Reduce
stress
and
increase
well‐being
 highest
stress
levels
(Osborne
et
al,
2008).

 • Adapt
their
parenting
style
to
facilitate
their
 Parents
who
have
come
to
an
emotional
resolution
 child’s
development
 about
their
child’s
diagnosis
are
more
likely
to
use
 • Identify
pivotal
social‐communication
milestones
 a
joyful,
playful,
supportive
and
responsive
 for
their
child
 parenting
style
with
their
children
(Wachtel
and
 • Engage
their
child
in
joyful,
meaningful,
 Carter,
2008).
 reciprocal
interactions
to
increase
child
learning
 Relate to Autism, Inc © 2010 all rights reserved -9-
  10. 10. relatetoautismTM THE GROWTH THROUGH PLAY SYSTEM The
Growth
through
Play
System
(GPS)
is
designed
to
optimize
the
rewiring
of
a
child’s
brain
to
facilitate
improved
 global
interconnectivity
and
synchronization
by
focusing
on
intensive,
multisensory,
interactive
activities
that
 stimulate
high
levels
of
inter‐region
brain
activity.

The
system
helps
parents
and
practitioners
to
identify
pivotal
 developmental
steps
that
a
child
has
missed
and
then
prescribes
activities
that
can
be
conducted
by
parents
with
 the
child
in
a
responsive
interactive
manner
to
help
the
child
fill
developmental
gaps.
 By
focusing
on
missing
pivotal
skills
and
developmental
steps,
the
GPS
indirectly
addresses
other
missing
or
 challenged
skills
that
depend
on
the
pivotal
skills
making
those
skills
easier
to
acquire
and
develop.
 The
GPS
is
focused
on
enabling
and
empowering
parents
as
primary
therapists
in
their
child’s
treatment
program
 by
providing
simple
and
easy‐to‐implement
guidelines
relative
to
curriculum
and
interactive
style.
It
considers
 parental
well‐being
to
be
a
critical
success
factor
in
child
development.
 For
more
information
on
the
scientific
foundations
of
the
Growth
through
Play
System
or
about
relate
to
 autism,
please
visit
www.relatetoautism.com
or
write
us
at
support@relatetoautism.com.
 GETTING STARTED • To
learn
more
visit
www.relatetoautism.com
and
sign
up
for
a
free
trial
30‐day
membership

 • Read
“The
relate
to
autism
Member
Tools”
 • Read
“The
Growth
through
Play
System
for
Parents”
 
 - 10 - Relate to Autism, Inc © 2010 all rights reserved
  11. 11. 
 
 
 
 
 www.relatetoautism.com REFERENCES
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C.,
Gree,
J.,
Adans,
C.(2004)A
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 Dawson,
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Rogers,
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Smith,
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 Estes,
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Zhou,
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Autism,
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 - 12 - Relate to Autism, Inc © 2010 all rights reserved

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