The Core De cits of Autism

and
Essential for Living

Patrick McGreevy and Troy Fry

authors of Essential for Living

According to the Diagnostic and Statistical Manual of the American Psychiatric Associ-
ation, 5th. Edition (DSM 5), the three core deficits of autism spectrum disorder are:

1. impaired communication, for example,

a. poorly integrated verbal and nonverbal communication,
b. abnormalities in eye contact and body language,
c. deficits in understanding and use of gestures, and
d. a total lack of facial expressions and nonverbal communication;

2. impaired reciprocal social interaction, for example,

a. difficulties adjusting behavior to suit various social contexts,
b. difficulties in sharing imaginative play or in making friends,
c. a lack of interest in interacting with peers;

3. restricted, repetitive and stereotyped patterns of behaviors or interests,

for example,
a. stereotyped or repetitive motor movements, use of objects, or speech,
b. insistence on sameness, inflexible adherence to routines, or ritualized patterns
of verbal or nonverbal behavior
c. highly restricted, fixated interests that are abnormal in intensity or focus,
d. hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects
of the environment

Essential for Living (McGreevy, Fry, & Cornwall, 2013) is a comprehensive assessment
and curriculum based on B. F. Skinner’s analysis of verbal behavior (Skinner, 1957), along
with research and conceptual advancement provided by Carbone (2013, 2019),
Lowenkron (2006), McGreevy (1986, 2009), Michael (2000), Miguel (2016), Sundberg
(2014), Sundberg and Michael (2001), Palmer(1998, 2008), Schlinger (2008), Schlinger
and Blakely (1987), and many others.

In recent months, comments and suggestions have circulated that Essential for Living
may not adequately address the ‘core deficits of autism’. Au contraire, Essential for
Living (McGreevy, Fry, & Cornwall, 2013) is a curriculum-based assessment instrument,
which was specifically designed to focus on skill deficits that significantly affect the
extent to which a child can function effectively without problem behavior in their
home, school, day care, and other environments within their community, ‘with a special
emphasis’ on the core deficits of autism (CDA). Tables 1, 2, and 3 each depict one of
the core deficits of autism (CDA) and the specific skills from Essential for Living (EFL) that
‘directly address’ examples of that deficit.
fi
 Table 1
The Core Deficits of Autism (CDA)
and
Sections and Skills from Essential for Living (EFL)
which Directly Address those Deficits

Core Deficits of Autism

(CDA) Sections and Skills from Essential for Living (EFL)
which Directly Address these Core De cits
Impaired Communication

poorly integrated Chapter 6. Determining if a child can Chapter 6. Selecting, confirming,

verbal and nonverbal use spoken words effectively or if an and maintaining an effective
communication alternative, non-verbal method of verbal or non-verbal method of
speaking is necessary [this task is speaking [this task is often accom-
often accomplished by a speech- plished by a speech-language
language pathologist and a pathologist and a behavior
behavior analyst using the Vocal analyst using the Vocal Profiles
Profiles section of Essential for Living] Section and the Alternative
no other instrument directly addresses Methods of Speaking Section of
this deficit Essential for Living]
no other instrument directly
addresses this deficit

Skill R7. Makes requests for highly Skills R22, R23, R27, and R30-31.
preferred snack foods, drinks, non- Makes requests in other contexts
food items, or activities that can be [without problem behavior]
made frequently and immediately
available [without problem behavior]

abnormalities in eye Skill R19. Makes a generalized Skill R24. Faces or looks toward an
contact and body request for an audience, followed by audience as the learner makes a
language requests for items or activities in R7 generalized request for that
and R8 [without problem behavior] audience, followed by requests for
items or activities in R7-8 and
R22-23 [without problem behavior]

Skill R52. Makes a request to notice Skill R65. Makes requests for others
something or someone [without to respond more or less rapidly
problem behavior] [without problem behavior]

deficits in understanding Skill T-BHI5. Tolerates touch, physical Skills MM1-MM10. Reaches, points,
and use of gestures guidance, or physical prompts touches, grasps, places, and
[without problem behavior] releases items [without problem
behavior]

Skills Im1-Im2. Imitates motor Skills M1-M13. Matches and sorts

movements with and without items items in multiple contexts

a total lack of facial Skill R21. Politely refuses access to Skill R28. Says “thank you” when
expressions and nonverbal preferred items or activities requests are honored [without
communication [without problem behavior] problem behavior]

Skill R33. Makes a second and a third Skill R76. Makes requests that
generalized request for an audience include 2 items which learners
after the first or second request was ‘need’ in order to complete a
ignored [without problem behavior] required activity [without problem
behavior]
fi
 Table 2
The Core Deficits of Autism (CDA)
and
Sections and Skills from Essential for Living (EFL)
which Directly Address those Deficits

Core Deficits of Autism

(CDA) Sections and Skills from Essential for Living (EFL)
which Directly Address these Core De cits
Impaired reciprocal
social interaction

difficulties adjusting Skill R9. Waits after making requests for Skill R10. Accepts the removal of
behavior to suit various each of the items and activities in R7 access to 10 items or activities by
social contexts & R8 for gradually increasing periods a person in authority [without
of time [without problem behavior] problem behavior]

Skill R13. Makes transitions from Skill R15. ‘Accepts no’ after
preferred items and activities to making requests for items and
required tasks [without problem activities that were taught and
behavior] are often honored (R7, R8, & R14)
[without problem behavior]

Skill LR1. Holds and maintains contact Skill LR2. Moves toward and sits
with the hand of an instructor, care next to an instructor, care provider,
provider, or parent when directed to or parent when directed to do so
do so [without problem behavior] [without problem behavior]

Skill R17. Makes very forceful and Skill R18. Makes a generalized
repeated requests for a stranger, an request for help in a threatening
intruder, a person teasing, or dangerous situation, by yelling
threatening, bullying, or instigating a “help”, screaming, or otherwise
fight, or a person making sexual making contact with an audi-
advances to ‘go away’ ence, calling ‘9-1-1’, or activating
a medical alert device

difficulties in sharing Skill R12. Shares or takes turns obtain- Skill R34. Makes a generalized
imaginative play or in ing access to each of the items and request for affection
making friends activities in R7 & R8 with an instructor,
care provider, parent, or peer [without
problem behavior]

a lack of interest in Skill T-BHI1-3. Tolerates the presence Skill T-BHI8-10. Tolerates various
interacting with peers of an unfamiliar peer [without interactions toward or with peers
problem behavior] [without problem behavior]

Skill R35. Makes a generalized request Skill R44. Makes requests for 5
for companionship [without problem items or activities from R7, R8,
behavior] R22-23, R27, and R30-31 from
each of three peers [without
problem behavior]

Skill R45. Honors requests from peers Skill R46. Responds appropriately
[without problem behavior] to the unauthorized removal of
access to 5 preferred items or
activities from R7, R8, R22-23, R27,
or R30-31 by peers [without
problem behavior]
fi
 Table 3
The Core Deficits of Autism (CDA)
and
Sections and Skills from Essential for Living (EFL)
which Directly Address those Deficits

Core Deficits of Autism

(CDA)
Sections and Skills from Essential for Living (EFL)
restricted, repetitive and which Directly Address these Core De cits
stereotyped patterns of
behaviors or interests

stereotyped or repetitive Chapter 11. Teaching Protocol 1 and Skills LR12-LR16. Follows Directions
motor movements, use of Skill R7. Transferring echoic [a.k.a., and Completes Routine Activities
objects, or speech echolalic] spoken words to [without engaging in repetitive
spontaneous spoken-word requests motor movements with or without
This teaching protocol and skill R7 objects]
permit children with echoic spoken These skills and accompanying
words to learn to make spontaneous teaching procedures are used to
spoken-word requests. control the occurrence of repetitive,
stereotyped patterns of behavior
with or without objects.

insistence on sameness, T-SIT8. Tolerates variations in verbal Events LRND1-13. Recognizing,

inflexible adherence to instructions and steps in task Retrieving, Relocating, Naming,
routines, or ritualized completion [without problem Describing, and Following
patterns of verbal or behavior] Directions to Complete Activities
nonverbal behavior with variations in verbal directions
and steps to task completion

highly restricted, fixated Skills LR12-LR16. Follows Directions Skill R8. Requests the opportunity
interests that are abnormal and Completes Routine Activities to entertain themselves or to
in intensity or focus [without engaging in restricted and reduce anxiety by making
fixated interests] stereotypic movements with highly
These skills and teaching procedures preferred items or engaging in
are used to control the occurrence of highly preferred stereotypic
repetitive, stereotyped patterns of activities [provided after following
behavior that result in access to directions and completing routine
restricted and fixated interests. activities without engaging in
restricted and fixated interests]

hyper- or hypo-reactivity to Skills LR12-LR16. Follows Directions Skill R8. Requests the opportunity
sensory input or unusual and Completes Routine Activities to entertain themselves or to
interest in sensory aspects [without interacting with unusual reduce anxiety by making
of the environment sensory aspects of the environment] stereotypic movements with highly
These skills and teaching procedures preferred items or engaging in
are used to control the occurrence of highly preferred stereotypic acti-
repetitive, stereotyped patterns of vities [provided after following
behavior that result in access to directions and completing routine
unusual sensory aspects of the activities without interacting with
environment. unusual sensory aspects of the
environment]
fi
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