Dating back to Leo Kanner’s original descriptions of autism in 1943, deficits in social skills were emphasized and today remain one of the defining features of ASD (5th ed.; DSM-V; American Psychiatric Association [APA] 2013). It is viewed as a core feature of ASD (Constantino and Gruber 2005) and is one of the main focuses of treatment (Torres et al. 2003). Social deficits in children with ASD are quite variable (Constantino et al. 2003); but often include eye contact, use of appropriate gestures and facial expressions, and initiating and reciprocating social interactions (Bishop et al. 2007). Difficulties with social skills will impact many important areas of a child’s life, such as making friends, maintaining a job, and building confidence and self-esteem; thus, this is an essential element to the treatment of autism.

Deficits in motor behavior are not a defining feature of ASD, however, researchers have reported that children with ASD often present with delays in motor skills (Dewey et al. 2007; Dyck et al. 2007; Miyahara et al. 1997; Page and Boucher 1998). Specifically, researchers have documented deficits in gross motor skills (Berkeley et al. 2001; Dyck et al. 2007; Jansiewicz et al. 2006; Provost et al. 2007; Teitelbaum et al. 1998), fine motor skills (Berkeley et al. 2001; Dyck et al. 2007; Ghaziuddin and Butler 1998; Lopata et al. 2007; Manjiviona and Prior 1995; Noterdaeme et al. 2002; Page and Boucher 1998; Provost et al. 2007), oral motor skills (Adams 1998; Amato and Slavin 1998; Gernsbacher et al. 2008; Page and Boucher 1998), and visual motor skills (e.g., Kurtz 2006; Lopata et al. 2007; Rosenhall et al. 1988; Scharre and Creedon 1992).

Language deficits are another defining feature of ASD. The language deficits characteristic of ASD are broad and include but are not limited to: delays in speech, making requests, labeling objects, and conversation skills (Tager-Flusberg 1981; Kjelgaard and Tager-Flusberg 2001). Language development allows a child to learn to effectively communicate with and comprehend the communications of others, making it an integral component of human behavior. These skills are directly associated with social interactions, play skills, and many academic skills. Deficits in language skills can adversely impact a child’s life by impeding his or her development in all of these areas. In fact, in some cases, inappropriate behavior develops as a means of communication when appropriate language skills are lacking (see Durand and Merges 2001 and Mancil 2006 for reviews of functional communication training). Given the central role that language skills play in an individual’s ability to effectively communicate, participate in social and play interactions, and succeed academically, it is clear that a large proportion of time must be dedicated to the development of language skills in children diagnosed with ASD.

Deficits in adaptive behavior are not a defining feature of ASD; however, delays in adaptive skills are common for many children with ASD (Carpentieri and Morgan 1996; Liss et al. 2001; Lord and Schopler 1989). Adaptive behavior includes daily living activities such as personal skills (dressing and toileting, etc.), domestic skills (setting and clearing the table, making the bed, etc.), community skills (shopping, restaurants, etc.) and safety skills. Difficulties with adaptive skills will impact an individual’s ability to live independently, become involved in community activities, and participate in a typical classroom setting; thus, it is essential to remediate deficits in adaptive behavior.

Deficits in play skills are a defining feature of ASD . Deficient play skills will impact an individual’s ability to interact with same-age peers, appropriately fill alone and leisure time, and develop skills across a range of domains important for later in life. Through play, children develop and hone critical skills such as confidence, emotional control, fine and gross motor abilities, language, and social competence (Boutot et al. 2005). In children with ASD, play skill deficits manifest as a failure to engage in varied and spontaneous make-believe or social imitative play appropriate to the child’s developmental level (DSM-V; APA 2013). For example, young children with ASD may not show interest in independent play toys such as blocks, shape sorters and musical toys typically preferred by same-age peers, and/or may engage with play items in an inappropriate or restricted manner, such as spinning and gazing at the wheels of toy vehicles, or repetitively viewing scenes from books or television shows .

Deficits in executive functioning are not a defining feature of ASD; however, researchers have documented delays in executive functioning skills for some children with ASD (Pennington and Ozonoff 1996). Executive function refers to the cognitive processes used in goal-directed behavior such as planning and organizing, initiating a task, attending properly (attending to the correct stimuli, sustaining attention toward a goal, multitasking, shifting attention between tasks, etc.), using inhibition to stay focused, working memory, monitoring performance, problem solving, and demonstrating flexibility by the willingness to generate alternative solutions and plans as needed (Dawson and Guarre 2004). This is an important developmental area for children with ASD because it is these types of skills that allow children to regulate themselves. Specifically, these are the skills that help them to organize themselves and make plans to reach goals that require them to forgo immediate rewards for long-term rewards, determine what stimuli are important to attend to versus ignore, and manage their emotions and performance so that they can work as effectively and efficiently as possible.

Deficits in cognition are not a defining feature of ASD according to the DSM-V (APA 2013); however, children with ASD have been reported to often present with delays in cognitive skills (Baron-Cohen et al. 2000). Deficits in this area have been reported to exist both in understanding the mental states of oneself (metacognition) and others (social cognition; also sometimes referred to as perspective taking; Baron-Cohen et al. 1985; Baron-Cohen et al. 2000; Leekam and Perner 1991; Ozonoff and Miller 1995). Understanding mental states such as one’s thoughts, desires, intentions, beliefs, emotions, and preferences, to name a few, is important for developing a strong perspective-taking repertoire essential for successful social interactions. For example, development of this type of repertoire has been suggested to play an important role in many social behaviors such as pretense, sharing, turn taking, self-consciousness, self-reflection, persuasion, empathy, and deception (Frith et al. 1994; Howlin et al. 1999; Lalonde and Chandler 1995).

Deficits in academic behavior are not a defining feature of ASD according to the DSM-V (APA 2013); however, some children with ASD display academic learning difficulties. Researchers have reported that learning disabilities are prevalent among children with ASD (Mayes and Calhoun 2006; Montes and Halterman 2006). For instance, Mayes and Calhoun reported that 67 % ( = 124) of the children they evaluated with ASD also displayed a learning disability. Difficulties with academic skills will impact an individual’s ability to independently participate in and complete academic assignments at school. The academic skills deficits displayed by children with ASD vary from child to child and may include delays in reading, math, spelling, and written expression.

To guarantee the assessment of every skill typically observed from infancy through the child’s chronological age, a comprehensive assessment must be used. When a comprehensive assessment is not available, it becomes necessary to use a battery of assessments to ensure that no skills are overlooked and all areas of human functioning are assessed. Data collected during the comprehensive assessment or battery of assessments will be used to formulate a well-balanced and individualized treatment curriculum.

EIBI treatment should begin as early as possible with a goal of successful integration into a classroom; therefore, assessments selected should be suitable for use with very young children (i.e., 6 months or less) up to first or second grade (approximately 7 or 8 years old). Items within the assessment(s) should be age appropriate for the child being assessed and should progress by age of typical development. Ideally, assessments will be age-normed or at least provide developmental markers grounded in empirical research .

Programs based on a functional analytic approach have yielded effective treatment outcomes for young children with ASD (Perry et al. 2008). Since a child might use the same behavior in many different ways, determining the function of the behavior is considered as important as what the behavior looks like. By considering both behavior function and topography, assessment results in the formulation of an individualized curriculum that is developmentally and functionally appropriate for each child’s strengths and areas of need. This is particularly relevant in the assessment of language. Specifically, Sundberg and Michael (2001) suggest that greater gains could be observed if the use of Skinner’s (1957) functional behavioral approach to language was more widespread.

A major strength of an EIBI assessment instrument is a direct link between the identification of specific behaviors to teach and curricular targets. Behavior analytic interventions are based on operationally defined target behaviors; however, many assessments only yield quotients or overall scores within different domains or skill areas that are not directly linked to curriculum plans. Such assessments may not provide enough specific information to guide the design of an individualized behavioral treatment curriculum. Clinicians are left to interpret quotients or overall scores, and continued assessment is often needed to determine exactly what to teach within each skill domain. For example, an assessment may reveal deficits in independent play skills but will not identify any particular types of independent play to target (e.g., symbolic play, construction play, functional pretend play, etc.) or any specific components of play that the child is struggling with (e.g., imitation of play movements, narrating play, joining and initiating play, etc.) .

Assessments should identify skill deficits and strengths within each skill domain. This will help clinicians prioritize treatment targets and determine which skills should be taught first. For example, an assessment may reveal that a child can independently ask for preferred items using one-word phrases but does not use modifiers (e.g., “big,” “more,” etc.). A starting point for the expansion of manding (requesting) behavior might be teaching the child to add simple modifiers to one-word phrases. Identifying strengths and interests can also help guide teaching strategies. For example, if the child is a strong sight-reader, a clinician might incorporate written prompts into teaching procedures.

It is critical that assessments can be used to track child progress over time. EIBI programs are grounded in ongoing measurement and analysis of treatment effects. Repeated administration of an assessment will contribute to a comprehensive picture of changes in a child’s learning. Ideally, the administration of assessments should be cost-effective, time efficient and relatively easy to administer repeatedly, while presenting a reliable and valid picture of the child’s individual skills at any given time. An assessment that is complicated or cumbersome to administer, expensive and/or time consuming, with results that are difficult to interpret, is less likely to be administered by clinicians regularly and less useful for tracking child progress and treatment effectiveness .

Assessments should be able to be administered using both direct and indirect methods. Direct assessment or direct observation is generally considered the ideal method of measurement within ABA programs (Cooper et al. 2007). The benefit of direct observation is that it provides direct information regarding the behaviors or skills that a child actually displays, rather than relying on third-person reports about what a child may have done or be able to do. However, there are also a number of limitations associated with direct observation. In many treatment settings, direct observations may be impractical. To be certain that direct observation yields a representative sample of behavior, direct observation requires objectively defined behaviors to be observed systematically during scheduled intervals and durations by trained observers (Sigafoos et al. 2008). Further, since direct observation is reliant on human observers, only a few behaviors can be assessed at any one time if reliable results are to be achieved (Matson 2007). To observe and assess every skill that emerges from birth up to the child’s chronological age, across all areas of human development, would take a great deal of time and effort (especially in the case of an older child), making direct observation of these skills unrealistic in most clinical settings. Given these limitations, clinicians may not be able to rely solely on direct observation to obtain a fully comprehensive skill assessment .

One of the first factors to consider is whether the child exhibits any severe challenging behaviors that need immediate attention, in particular, any that might affect the safety of the child and others. In the event that the child is engaging in severe challenging behaviors to a level that impedes the ability to teach the child skills, treatment programs will initially focus on the reduction of severe problem behaviors and teaching alternative, replacement behaviors before starting to focus on other skills .

The child’s level of functioning and the presence or absence of basic skills is also a major consideration when planning areas to target. Clinicians should consider the importance of one skill over another, focusing on establishing basic functional skills before working on less functional skills. For example, typically one will prioritize skills such as communicating basic wants and needs, following simple instructions, engaging in basic independent activities (to occupy time appropriately during the day) and performing basic self-care tasks such as feeding and toileting.

It is also important to consider the child’s acquisition rate when prioritizing skills of focus. For children who learn more slowly or struggle to master skills, one might consider introducing fewer targets at once or to concentrate on foundational skills rather than more complex skills. The amount of time it will take to master a skill and how likely clinicians are to be successful in establishing a skill are important variables to consider when optimizing the use of limited resources. Some skills will be more difficult to establish than others. If a skill will take a child a long time to master, this could impact the teaching of other important skills. For example, if a child struggles with establishing new skills, introducing more difficult abstract concepts such as colors or prepositions is likely less of a priority than teaching other skills such as choices or developing basic receptive and expressive language skills .

Clinicians should consider how useful or functional a skill is for the child compared to other skills (i.e., how likely it is for the skill to be maintained in the natural environment) as well as how many opportunities the child will have to use the skills learned. Only targets that are likely to produce reinforcement in the child’s natural environment once treatment ends should be selected, since these are the skills that are most likely to be maintained and benefit the child in the long term (the “relevance of behavior rule”; Ayllon and Azrin 1968).

As well as considering the functionality of a skill, clinicians should consider “social validity” or “social significance” of selected targets (i.e., how acceptable or important a particular behavior is to consumers) (Cooper et al. 2007). Skills that will produce immediate benefits to the child, as opposed to skills that might produce benefits at some time in the future should be considered. For example, working on requesting (manding) would be prioritized over working on ordering numbers from 1 to 20.

When choosing targets, it is important to consider the child’s chronological age and the developmental progression of skills; typically clinicians will teach skills associated with a younger age first and work upwards. Clinicians should also always keep in mind what is age appropriate for the child (i.e., what activities and materials/objects his or her same-age peers use and desire as well as places they frequent). The concept or philosophy of “normalization” has become increasingly important in the treatment of persons with developmental delays (Nirje 1985). Normalization emphasizes helping people with disabilities to socially and physically integrate into mainstream society as far as possible (Cooper et al. 2007). This can be a challenge when a child’s abilities are severely impaired, but clinicians should do their best to consider chronological age appropriateness.

Identify whether particular behaviors or skills are prerequisites to other important skills and whether skills taught at one point in time will facilitate the mastery of other skills later. Such skills should be prioritized for treatment. For example, nonvocal imitation, eye contact, stimulus orienting and compliance are necessary for learning many other skills.

Within the field of behavior analysis, two concepts highlight the benefits of taking a building block approach to skill acquisition: pivotal skills (Koegel and Koegel 1988) and behavioral cusps (Rosales-Ruiz and Baer 1997). Pivotal skills are considered behaviors, that once acquired, result in changes in other functional, untrained behaviors. When pivotal areas are strengthened, improvement in autonomy, self-learning, and generalization of new skills will follow (Koegel et al. 1999) . For example, increasing a child’s ability to initiate interactions with others may result in increased use of language and the emergence of other response classes such as asking questions (Koegel et al. 2003). Joint attention could also be considered a pivotal skill since its development may contribute to improvement in many other untargeted social and language behaviors (Jones et al. 2006). Koegel et al. (2003) highlight the benefits of working on pivotal skills to both the child and the clinician. For the child, targeting pivotal skills may shorten treatment, make learning more efficient, and provide new repertoires of behavior and increased contact with reinforcers. For the clinician, teaching time could be decreased and increased generalization achieved.

Skills from different curricular areas should ideally connect or complement each other where possible, with communication and socialization goals being interwoven into all lessons across curricula. For example, when developing independent play skills and teaching the child to complete a variety of task completion activities such as puzzles or shape sorters, the child might also be working on developing fine motor skills needed to effectively manipulate play items, using an activity schedule, initiating or requesting play activities, making play choices, and so on.

The number of therapy hours available and the potential duration of intervention will impact the selection of curricular targets. Clinicians who are working against a time limit (for example the child starting school or access to limited funding) will prioritize skills that the child and family most need to achieve within this time. A greater number of available therapy hours will allow for more skill targets to be addressed. In our practice, we typically select 15 to 20 targets for children receiving 30 h of therapy per week, and between 20 and 25 targets for children receiving 40 h of therapy per week. For children receiving less therapy hours, we usually select fewer skill targets to address at any one time—generally no more than ten targets for 15 h of therapy per week.

The individual who will be delivering therapy is a further factor to consider when designing a treatment plan. Therapy may be delivered by a team of therapists, volunteers, teacher’s aides, family members and so on, all of whom will have different skill sets and expectations. Different team members will thus require varying levels of training and supervision. Some may require substantial time and effort to ensure they are able to implement certain lessons effectively. If time and resources for training and supervision and expertise is limited, clinicians may need to prioritize more simple lessons over more complex ones.