Peer-mediated approaches to promoting children's social interaction: a review

Stakeholder Perceptions of the Acceptability of Peer-Mediated Intervention for Minimally Speaking Preschoolers on the Autism Spectrum

Peer mediated intervention (PMI) is an evidence-based approach to supporting social and communication development for children on the autism spectrum. For PMI to be integrated into everyday practice, it needs to be acceptable to stakeholders. This article engaged with autistic individuals, early childhood educators, parents, and speech and language pathologists on the prospective acceptability of implementing PMI with minimally speaking preschoolers in inclusive preschool settings. Focus groups and semi-structured interviews were conducted. The transcriptions were analyzed qualitatively using reflexive thematic analysis. Stakeholders described PMI as an acceptable intervention approach for this population and provided valuable insights to inform the development and implementation of PMIs. Attention needs to be paid to how to support preschools to adopt a PMI-friendly philosophy.

Effects of a Teacher-Facilitated Peer-Mediated Intervention on Social Play of Preschoolers with Autism

Children with autism often display differences in functional and symbolic play and may experience barriers to social inclusion with peers in preschool settings. Therefore, interventions supporting social play between children with autism and their peers that can be feasibly implemented by teachers in inclusive settings are needed. A teacher-implemented peer-mediated Stay Play Talk (SPT; Goldstein et al. in Top Lang Disord 27(2):182-199, 2007) intervention package targeting the type of play children with autism engage in with peers was implemented using a concurrent multiple baseline design across four participant/peer dyads. Using a cascading coaching model with behavioral skills training, a teacher was trained in intervention strategies and then taught and supported four peers to implement the intervention. In addition to visual analysis, to statistically analyze effects, we calculated effect sizes using the parametric measure standardized mean difference. A functional relation between the intervention and increases in interactive play and initiations and decreases in solitary play was demonstrated across all dyads. Results generalized to novel settings and maintained following withdrawal of teacher support. Results suggest that SPT can be effectively implemented by a teacher to support interactive play between children with and without autism in an inclusive classroom. Implications for future research and clinical practice are discussed.

Psychometric Properties of the Dutch Contextual Assessment of Social Skills (CASS): An Independent Observational Outcome Measure of Social Skills in Autistic Adolescents

The goal of this study was to translate and adapt the original 9-item of the Contextual Assessment of Social Skills (CASS) to a Dutch version and assess its psychometric qualities. Autistic adolescents aged 12 to 18 years (n = 99) took part in a randomized controlled trial. In this study, pre-intervention data were utilized. The original CASS was adapted to ensure cultural relevance and the content validity was assessed. Data was used to assess reliability and structural validity, using confirmatory factor analysis. 4-item were added to the CASS during the adaptation to better align with the objectives of the experimental intervention. The original 9-item had inter-item correlations between .01 and .70. The Cronbach's alpha for the original 4-item total score was moderate (α = .69), while for a 7-item total score, it was high (α = .86). This 7-item total score had a sufficient model fit (Comparative Fit Index = .90). This total score had a significant correlation with the Assertion subscale of the Social Skills Improvement System-Adolescent (SSIS-A) (r = 0.26, p < .01), and the Social Responsiveness Scale-2 (SRS-2) total score (r = - .21, p = .04) indicating sufficient convergent validity. The CASS total score was not correlated with the Repetitive and Restricted Behavior scale of the SRS-2 (r = - .08, p = .43), indicating sufficient divergent validity. The Dutch CASS can be considered a conceptually sound and reliable observational instrument for assessing social conversational skills in Dutch autistic youth. Further evaluation of its feasibility when implemented in practice, outside of clinical research, is needed.Trial registration: Dutch trail register NTR6255 (NL6117) 08/02/2017 https://www.trialregister.nl/trial/6117.

Children's peer relationships, well-being, and academic achievement: the mediating role of academic competence

The present study aimed to explore the interplay among two indicators of children's school peer relationships (i.e., peer acceptance and perceived number of friends) and two significant life domains (i.e., global life satisfaction and academic achievement). We also explored the potential mediating role of the perceived academic competence in these relations. Participants were 650 Romanian primary school students (45.7% boys), aged between 9 and 12 years old (M_age = 10.99). Path analysis showed a direct positive effect of perceived number of friends on children's life satisfaction, as well as a direct positive effect of peer acceptance on academic achievement. Moreover, perceived academic competence mediated the links between each of the two indicators of peer relationships and children's both life satisfaction and achievement. Several implications in the educational contexts are discussed.

A pairwise randomised controlled trial of a peer-mediated play-based intervention to improve the social play skills of children with ADHD: Outcomes of the typically-developing playmates

To examine the effectiveness of a play-based intervention for improving social play skills of typically-developing playmates of children with ADHD. Children (5–11 years) were randomised to an intervention (n = 15) or waitlisted control group (n = 14). The Test of Playfulness was scored by a blinded rater. Between-group statistics compared the change of the intervention (10-week intervention) and waitlisted control (10-week wait) groups. Change in the intervention group following intervention was significantly greater than the change in the waitlisted control group. When combining data from the groups, playmates’ (n = 29) mean ToP scores improved significantly following intervention, with a large effect pre- to post-intervention and pre-intervention to follow-up. Typically-developing playmates of children with ADHD benefited from participation in a peer-mediated intervention.

The feasibility of implementing autism intervention methods in formal education settings welcoming refugee and asylum-seeking children: A systematic review of the literature

Given the significant amount of time that refugee and asylum-seeking children (RASC) spend in schools, these institutions play an important role in their lives and represent an ideal environment in which to help them to adapt to their host society. The present study aimed to draw attention to the possibility of transferring intervention methods designed for children with ASD to formal education settings welcoming newly arrived RASC to support their adaptation to their new school environment. For this purpose, a systematic review was undertaken to assess the feasibility of implementing three specific ASD intervention methods (i.e., TEACCH, PECS, and PMI) in schools welcoming RASC. While the review did not reveal previous attempts to implement and evaluate ASD intervention methods with newcomer RASC, 21 records were uncovered providing preliminary evidence in support of this idea. Hypothesized strengths and limitations, as well as considerations about implementation, are discussed.

Enhancing Executive Functions Through Social Interactions: Causal Evidence Using a Cross-Species Model

It has long been theorized that humans develop higher mental functions, such as executive functions (EFs), within the context of interpersonal interactions and social relationships. Various components of social interactions, such as interpersonal communication, perspective taking, and conforming/adhering to social rules, may create important (and perhaps even necessary) opportunities for the acquisition and continued practice of EF skills. Furthermore, positive and stable relationships facilitate the development and maintenance of EFs across the lifespan. However, experimental studies investigating the extent to which social experiences contribute causally to the development of EFs are lacking. Here, we present experimental evidence that social experiences and the acquisition of social skills influence the development of EFs. Specifically, using a rat model, we demonstrate that following exposure to early-life adversity, a socialization intervention causally improves working memory in peri-adolescence. Our findings combined with the broader literature promote the importance of cultivating social skills in support of EF development and maintenance across the lifespan. Additionally, cross-species research will provide insight into causal mechanisms by which social experiences influence cognitive development and contribute to the development of biologically sensitive interventions.

Treatment Effects in Social Cognition and Behavior following a Theater-based Intervention for Youth with Autism

This randomized clinical trial ( www.clinicaltrials.gov ID# NCT02276534) examined the impact of a peer-mediated, theater-based social skills intervention, SENSE Theater®, on social cognition and behavior in 77 youth (ages 8-16) with high-functioning autism spectrum disorder. Analysis of Covariance models revealed that post-treatment, the experimental group (n = 44) performed significantly better than the controls (n = 33) on NEPSY theory of mind (verbal) subtest, demonstrated increased neural evidence of memory for faces, and engaged in more cooperative play and verbal interaction with novel peers. The study extends previous findings showing that SENSE Theater® contributes to improvement in social cognition and behavior.

Improving Social Cohesion in Educational Environments Based on A Sociometric-Oriented Emotional Intervention Approach

Sociometric-oriented approaches have been applied the last years in numerous cases and domains, targeting at the improvement of social groups’ characteristics for achieving personal and team-based objectives. Considering the existing approaches and the published results, in the current study, a set of emotional intervention activities based on a sociometric-oriented approach were designed and implemented with the clear objective to augment social cohesion within members of a social group in primary school students. Petrides’ trait emotional model was used to identify the emotional profile of the experimental and control group members, while the set of implemented activities was based on Bisquerra’s emotional competencies model. Sociometrics were used to evaluate the initial, intermediate and final level of social cohesion of both groups. Based on the realized statistical analysis and the produced evaluation results, useful insights with regards to the social group indicators that mainly affect the social cohesion levels are extracted and presented. It should be noted that the detailed study was based on the exclusive usage of open-source Information and Communication Technologies (ICT) tools for supporting educational needs.

Peer Inclusion in Interventions for Children with ADHD: A Systematic Review and Meta-Analysis

Objective

To assess the effectiveness of peer inclusion in interventions to improve the social functioning of children with ADHD.

Methods

We searched four electronic databases for randomized controlled trials and controlled quasi-experimental studies that investigated peer inclusion interventions alone or combined with pharmacological treatment. Data were collected from the included studies and methodologically assessed. Meta-analyses were conducted using a random-effects model.

Results

Seventeen studies met eligibility criteria. Studies investigated interventions consisting of peer involvement and peer proximity; no study included peer mediation. Most included studies had an unclear or high risk of bias regarding inadequate reporting of randomization, blinding, and control for confounders. Meta-analyses indicated improvements in pre-post measures of social functioning for participants in peer-inclusive treatment groups. Peer inclusion was advantageous compared to treatment as usual. The benefits of peer inclusion over other therapies or medication only could not be determined. Using parents as raters for outcome measurement significantly mediated the intervention effect.

Conclusions

The evidence to support or contest the efficacy of peer inclusion interventions for children with ADHD is lacking. Future studies need to reduce risks of bias, use appropriate sample sizes, and provide detailed results to investigate the efficacy of peer inclusion interventions for children with ADHD.

“Can I Play with You?” Peer Culture in Inclusive Preschool Programs

Peer culture reflects the unique social worlds children construct out of everyday experiences with one another. This study explored the peer cultures of children with diverse abilities, backgrounds, and needs—focusing on 10 children with significant disabilities—in six inclusive preschool programs. Using a multi-method approach that included both qualitative and quantitative measures, themes were generated that portrayed how children with disabilities (1) expressed the desire to participate in peer culture through a range of social-communicative and symbolic behavior; (2) experienced inclusion in peer culture by coordinating social activity and establishing reciprocal relationships; and (3) experienced exclusion from peer culture through different forms of neglect, social-communicative breakdown, conflict, and rejection. Case vignettes and quotes serve to support and illustrate themes. The findings are discussed in terms of related sociocultural influences, implications for educational practice, and future directions in research.

Increasing the Social Behavior of Young Children with Autism Using Their Obsessive Behaviors

This study systematically asked whether individual topics or themes on which children with autism perseverated across a variety of settings (often called obsessions) could be used to create the theme for a socially appropriate game. Data collected within the context of a multiple baseline design revealed very low levels of social interaction during play periods in the baseline condition. In contrast, when the children with autism were taught a socially appropriate game (e.g., one child who perseverated on maps was taught a tag game played on a giant outline of a US map), the percent of social interactions increased dramatically and continued to be high during follow-up measures. Generalization measures indicated that following intervention, the children also demonstrated increases in social interaction during other play activities. The results are discussed in terms of incorporating obsession themes into common games to create intrinsically reinforcing appropriate activities for increasing social interactions, and in relation to developing activities that capitalize on the child with autism's interests, so that the child is a valued member of the peer group.

Using Single and Multiple Peers to Promote Social Interaction of Preschool Children with Handicaps

An alternating treatment design, nested within a withdrawal of treatment, single-subject design was used in this study to examine the differential treatment effects of employing single and multiple peers to promote the social interactions of two handicapped preschoolers. During a baseline phase, few social interactions occurred for the handicapped children. As single and multiple confederate peers (in different intervention sessions) directed social initiations to the handicapped children, the social responses of those handicapped children increased substantially. Spontaneous social initiating also increased, to a lesser extent than social responding, for one of the handicapped children. Social responses decreased for both children during the withdrawal of treatment phase of the study, and increased again during the final intervention phase. Differential treatment results were generally not found. Both types of peer-initiation interventions produced marked increases in the handicapped children's social interactions with nonhandicapped peers.

Providing Services to Preschool-aged Children

The importance of the early childhood years in a child's growth and development cannot be overemphasized. During these years growth is rapid and the foundations for later sensory, motor, cognitive, physical, language and social-emotional development are laid. Some of our most prominent and respected scientists, theoreticians and scholars have emphasized these critical early years (Bloom, 1964; Bronfenbrenner, 1975; Bruner, 1969; Hunt, 1961; White, 1975) and evidence gathered during the last thirty years supports their early work.

Social Play and Autistic Spectrum Disorders

The article considers the nature of the presumed social play deficit in autistic spectrum disorders (ASDs). The nature of play and its typical development is outlined and discussed in relation to play development in ASDs. It is suggested that social play is a confluence of two strands of development that are affected in autism: social and emotional development, and the cognitive development of play. It is shown that social play develops in a transactional way and in ASDs initial social difficulties prevent the development of social interaction, with its role in eliciting and enriching spontaneous play. At the same time, cognitive and affective difficulties prevent the play of children with autism developing to the extent of attracting other children and being of a complexity from which social play might develop. This cycle of impoverished play opportunities for children with ASDs may be broken through direct teaching and there are encouraging models of teaching social play with some success.

Supporting Children on the Autism Spectrum in Peer Play at Home and School

The article focuses on integrated play groups (IPGs) as a model to support children with ASD in play with typically developing peers/siblings, and its recent adoption with children in a home and school setting in Taiwan. The first part provides a brief overview of the IPG model and its essential features. The second part reports on a pilot investigation that combined quantitative and qualitative methods to examine the effects of participation in IPGs on the symbolic and social play of two early elementary-aged children with autism. Preliminary findings suggest that each child made notable gains in reciprocal social interaction and symbolic/pretend play while participating in play groups. Implications are discussed in terms of play’s role in enhancing socialization, imagination and peer cultural inclusion.

Improvement in Social Competence Using a Randomized Trial of a Theatre Intervention for Children with Autism Spectrum Disorder

The efficacy of a peer-mediated, theatre-based intervention on social competence in participants with autism spectrum disorder (ASD) was tested. Thirty 8-to-14 year-olds with ASD were randomly assigned to the treatment (n = 17) or a wait-list control (n = 13) group. Immediately after treatment, group effects were seen on social ability, (d = .77), communication symptoms (d = -.86), group play with toys in the company of peers (d = .77), immediate memory of faces as measured by neuropsychological (d = .75) and ERP methods (d = .93), delayed memory for faces (d = .98), and theory of mind (d = .99). At the 2 month follow-up period, group effects were detected on communication symptoms (d = .82). The results of this pilot clinical trial provide initial support for the efficacy of the theatre-based intervention.

Biobehavioral profiles of arousal and social motivation in autism spectrum disorders

BACKGROUND

Children with autism spectrum disorder (ASD) are impaired in social communication and interaction with peers, which may reflect diminished social motivation. Many children with ASD show enhanced stress when playing with other children. This study investigated social and stress profiles of children with ASD during play.

METHODS

We utilized a peer interaction paradigm in a natural playground setting with 66 unmedicated, prepubertal, children aged 8-12 years [38 with ASD, 28 with typical development (TD)]. Salivary cortisol was collected before and after a 20-min playground interaction that was divided into periods of free and solicited play facilitated by a confederate child. Statistical analyses included Wilcoxon rank-sum tests, mixed effects models, and Spearman correlations to assess the between-group differences in social and stress functioning, identify stress responders, and explore associations between variables, respectively.

RESULTS

There were no differences between the groups during unsolicited free play; however, during solicited play by the confederate, significant differences emerged such that children with ASD engaged in fewer verbal interactions and more self-play than the TD group. Regarding physiological arousal, children with ASD as a group showed relatively higher cortisol in response to social play; however, there was a broad range of responses. Moreover, those with the highest cortisol levels engaged in less social communication.

CONCLUSIONS

The social interaction of children with ASD can be facilitated by peer solicitation; however, it may be accompanied by increased stress. The children with ASD that have the highest level of cortisol show less social motivation; yet, it is unclear if it reflects an underlying state of heightened arousal or enhanced reactivity to social engagement, or both.

Peer-mediated theatrical engagement for improving reciprocal social interaction in autism spectrum disorder

The hallmark characteristic of autism spectrum disorder (ASD) is poor reciprocal social communication. Interventions designed to improve this core deficit are critically needed. Social skills interventions such as direct training, peer mediation, and video modeling have contributed to improvements in various social skills in children with ASD. This paper reviews existing social competence interventions available for children with ASD while highlighting hypothesized critical components for advancing, maintaining, and generalizing skills, which include (1) peer mediation, (2) active learning, and (3) implementation in supportive, natural contexts. As a framework for these approaches, this conceptual paper describes SENSE Theatre, a novel intervention that combines trained peers that facilitate the performance-based theatrical treatment delivered in a supportive, community-based environment. A review of previous research shows early feasibility, setting the stage for more rigorous studies to aid in developing a standardized intervention package.

Improvement in social deficits in autism spectrum disorders using a theatre-based, peer-mediated intervention

Social Emotional NeuroScience Endocrinology Theatre is a novel intervention program aimed at improving reciprocal social interaction in youth with autism spectrum disorder (ASD) using behavioral strategies and theatrical techniques in a peer-mediated model. Previous research using a 3-month model showed improvement in face perception, social interaction, and reductions in stress. The current study assessed a 2-week summer camp model. Typically developing peers were trained and paired with ASD youth (8-17 years). Social perception and interaction skills were measured before and after treatment using neuropsychological and parental measures. Behavioral coding by reliable, independent raters was conducted within the treatment context (theatre) and outside the setting (playground). Salivary cortisol levels to assess physiological arousal were measured across contexts (home, theatre, and playground). A pretest-posttest design for within-group comparisons was used, and prespecified pairwise comparisons were achieved using a nonparametric Wilcoxon signed-rank test. Significant differences were observed in face processing, social awareness, and social cognition (P < 0.05). Duration of interaction with familiar peers increased significantly over the course of treatment (P < 0.05), while engagement with novel peers outside the treatment setting remained stable. Cortisol levels rose on the first day of camp compared with home values yet declined by the end of treatment and further reduced during posttreatment play with peers. Results corroborate previous findings that the peer-mediated theatre program contributes to improvement in core social deficits in ASD using a short-term, summer camp treatment model. Future studies will explore treatment length and peer familiarity to optimize and generalize gains.

Social gating and pedagogy: mechanisms for learning and implications for robotics

It seems self-evident that human responsiveness to social input enhances learning, yet the details of the social forces at play are only beginning to come into focus. Recent research on language and cognitive development in preschoolers and infants illuminates mechanisms such as social gating and natural pedagogy, and specific ways in which they benefit learning. We review such advances and consider implications of this research for designing robotic systems that can harness the power of social forces for learning.

Social skills interventions for individuals with autism: evaluation for evidence-based practices within a best evidence synthesis framework

This paper presents a best evidence synthesis of interventions to increase social behavior for individuals with autism. Sixty-six studies published in peer-reviewed journals between 2001 and July 2008 with 513 participants were included. The results are presented by the age of the individual receiving intervention and by delivery agent of intervention. The findings suggest there is much empirical evidence supporting many different treatments for the social deficits of individuals with autism. Using the criteria of evidence-based practice proposed by Reichow et al. (Journal of Autism and Developmental Disorders, 38:1311-1318, 2008), social skills groups and video modeling have accumulated the evidence necessary for the classifications of established EBP and promising EBP, respectively. Recommendations for practice and areas of future research are provided.

Peer-mediated teaching and augmentative and alternative communication for preschool-aged children with autism

BACKGROUND

The aim of this study was to assess the effectiveness of two communication interventions for preschool-aged children with autism.

METHOD

Six typically developing peers were taught to implement peer-mediated naturalistic teaching, with and without a speech generating device (SGD), during play sessions with 3 classmates with autism in three preschools. Generalisation probes were conducted during mealtimes at the preschools. A multiple baseline design was used to assess the outcomes of the two intervention conditions.

RESULTS

All 3 children with autism increased their communicative behaviours immediately following the introduction of the two interventions, and generalised these increases to mealtime interactions with their peers. However, only 1 child maintained these increases in communication.

CONCLUSION

These results provide preliminary evidence for the effectiveness of combining peer-mediated naturalistic teaching with the use of SGDs for preschool-aged children with autism. Suggestions for improving the maintenance of intervention effects are provided.

Peer interactions of autistic children and adolescents

Two observational studies of verbal, high-functioning children and adolescents with autism; nonautistic, behaviorally disordered youngsters of equivalent verbal skills and chronological age; and verbal age-matched normally developing students during integrated summer day camps are reported. In the first study, observations were made of spontaneous peer interaction and play over the course of 2 weeks of day camp. The eight autistic subjects were consistently more likely to not be interacting and less likely to be engaged in any purposeful activity than the 16 other children. During the 2 weeks, time interacting and purposeful activity increased overall. In the second study, the quality of spontaneous peer-directed initiations was observed during free time in similar day camps the following summer. The 11 autistic children and adolescents produced fewer initiations than did the 20 other children and were less likely to smile or coordinate several behaviors with eye contact during an initiation. Autistic subjects were consistently more likely not to receive a response to their initiation than the other groups, although there was no identifiable relationship between the quality of the initiation and the likelihood of it receiving a response.

Inclusion of pupils with autism: the effect of an intervention program on the regular pupils' burnout, attitudes and quality of mediation

An intervention program aimed at the improvement of the quality of inclusion of pupils with autism in a regular fourth grade classroom (average age of 9 years) was applied with 23 pupils. Two pupils with autism were included from first grade. The regular pupils displayed signs of burnout stemming from the inclusion. The aim of the study was to examine the effect of a specially designed intervention program on the regular pupils' level of burnout, attitude to the pupils with autism, and the quality of their mediation. Three questionnaires covering these variables were administered twice, at the beginning and at the end of the intervention program. The findings showed less burnout at the end of the program, significant improvement in the quality of mediation and more positive attitudes towards pupils with autism. Significant correlations were found between burnout, quality of tutoring and positive attitudes towards pupils with autism.

Effective/efficient mental health programs for school-age children: a synthesis of reviews

The prevalence of mental health problems, some of which seem to be occurring among younger cohorts, leads researchers and policy-makers to search for practical solutions to reduce the burden of suffering on children and their families, and the costs to society both immediate and long term. Numerous programs are in place to reduce or alleviate problem behaviour or disorders and/or assist positive youth development. Evaluated results are dispersed throughout the literature. To assess findings and determine common elements of effective children's services, a literature search was undertaken for evidence-based evaluations of non-clinical programs for school-age children. Prescriptive comments aim to inform service-providers, policy-makers and families about best practices for effective services such as: early, long-term intervention including reinforcement, follow-up and an ecological focus with family and community sector involvement; consistent adult staffing; and interactive, non-didactic programming adapted to gender, age and cultural needs. Gaps are identified in our understanding of efficiencies that result from effective programs. Policy implications include the need to develop strategies for intersectoral interventions, including: new financing arrangements to encourage (not penalize) interagency cooperation and, to ensure services reach appropriate segments of the population; replication of best practices; and publicizing information about benefits and cost savings. In many jurisdictions legislative changes could create incentives for services to collaborate on service delivery. Joint decision-making would require intersectoral governance, pooling of some funding, and policy changes to retain savings at the local level. Savings could finance expansion of services for additional youth.

Peer interaction and loneliness in high-functioning children with autism

Social interaction with peers and the understanding and feelings of loneliness were examined in 18 high-functioning children with autism and 17 typically developing children matched for IQ, chronological age, gender, and maternal education. Observations were conducted on children's spontaneous social initiations and responses to their peers in natural settings such as recess and snack time, and children reported on their understanding and feelings of loneliness and social interaction. Overall, children with autism revealed a good understanding of both social interaction and loneliness, and they demonstrated a high level of social initiation. However, they spent only half the time in social interactions with peers compared with their matched counterparts, and they interacted more often with a typically developing child than with another special education child. Despite the intergroup differences in frequency of interaction, a similar distribution of interactions emerged for both groups, who presented mostly positive social behaviors, fewer low-level behaviors, and very infrequent negative behaviors. Children with autism reported higher degrees of loneliness than their typical age-mates, as well as a lower association between social interaction and loneliness, suggesting their poorer understanding of the relations between loneliness and social interaction. Research and practice implications of these findings are discussed.

Partner Influences on the Social Pretend Play of Children With Language Impairments

Purpose: This study examined the social pretend play and conversational behaviors of children with language impairment (LI) in dyadic interactions with peers.

Method: The participants (aged 4;3 [years;months] to 6;2) were 3 boys with LI and 4 with typical language development (LN). In this multiple embedded case study, hypotheses regarding the sophistication of verbal interaction and social pretend play were developed and tested with respect to two cases. Each case consisted of five interactions—four involving a child with LI in dyadic play with peers (2 LI, 2 LN), and the last involving the 2 LN peers. The dyad types for each case were LI, mixed, and LN. Within each case, LI dyads were expected to perform less well than mixed dyads, who were, in turn, expected to perform less well than the LN dyad on measures of verbal interaction and social pretend play. Also, greater conversational success was expected in social pretend play than in other forms of play for all dyads.

Results: For both cases, the results for verbal sophistication generally conformed to expectations for the dyad types. In contrast, social pretend play behaviors were inconsistent with expectations across dyads and cases. In all dyads, social pretend play yielded greater conversational success than other forms of play. The quality of play varied as a function of partner characteristics, such as responsiveness, theme knowledge, verbal skill, and adaptability.

Clinical Implications: Clinicians are cautioned to ensure that evaluations of play in children with LI encompass multiple aspects of both play and conversation, as well as observation of children with multiple partners. Likewise, in planning interventions, it may be important to address both play and verbal behaviors and to incorporate opportunities for interaction with multiple partners.

Interventions to facilitate social interaction for young children with autism: review of available research and recommendations for educational intervention and future research

The purpose of this paper is to review the knowledge available from aggregated research (primarily through 2000) on the characteristics of social interactions and social relationships among young children with autism, with special attention to strategies and tactics that promote competence or improved performance in this area. In its commissioning letter for the initial version of this paper, the Committee on Educational Interventions for Children with Autism of the National Research Council requested "a critical, scholarly review of the empirical research on interventions to facilitate the social interactions of children with autism, considering adult-child interactions (where information is available) as well as child-child interactions, and including treatment of [one specific question]: What is the empirical evidence that social irregularities of children with autism are amenable to remediation?" To do this, the paper (a) reviews the extent and quality of empirical literature on social interaction for young children with autism; (b) reviews existing descriptive and experimental research that may inform us of relations between autism and characteristics that support social development, and efforts to promote improved social outcomes (including claims for effectiveness for several specific types of intervention); (c) highlights some possible directions for future research; and (d) summarizes recommendations for educational practices that can be drawn from this research.

Treating childhood shyness and related behavior: empirically evaluated approaches to promote positive social interactions

Behavioral and cognitive-behavioral strategies, including exposure, social skills training, and peer-mediated approaches, used to treat childhood shyness and related impairments are described. In addition, relevant outcome studies published within the past 20 years are evaluated, and limitations regarding the generalization, maintenance, and social validity of the reported treatment gains are addressed. Although the interventions reviewed have demonstrated short-term merit in ameliorating social and emotional impairments, such as problematic peer relations and internalizing difficulties, there currently is a lack of evidence to support the social validity and long-term generalization and maintenance of such behavioral gains. Thus, recommendations for future research are made, including the need to (a) assess the social validity of treatment outcomes, (b) utilize important socialization agents (e.g., parents, teachers, peers), and (c) conduct prevention research and longitudinal outcome studies.

Teaching social skills to people with autism

The treatment of social skills deficits remains one of the most challenging areas in meeting the needs of people with autism. Difficulties in understanding social stimuli, in initiating and responding to social bids, and in appreciating the affect that is intrinsic to social interactions can be baffling for people with autism. Researchers and practitioners of applied behavior analysis have tried a variety of strategies for teaching social skills. This article examines a range of useful procedures for teaching social skills to people with autism, including skills that are adult mediated, peer mediated, and child-with-autism mediated. The authors also consider the potential of classwide interventions in inclusive settings, pivotal response training, and the use of scripts to teach social initiations.

The attitudes of teachers in Scotland to the integration of children with autism into mainstream schools

Around 4600 school-age children in Scotland fall within the spectrum of autistic disorders, of whom 780 have been identified in schools. This study sought the views of 23 specialist and 49 mainstream teachers, 22 with experience of autism, 27 without. They were questioned about the advantages and disadvantages of integration into mainstream for autistic children, their own ability to cope and predictors of success. Questionnaires were issued to special units and to mainstream primary and secondary schools. A minority of mainstream respondents believed children with autism should be integrated where possible. Mainstream teachers with experience of autism showed more confidence to deal with the children than those without experience. Many expressed concerns about effects on mainstream pupils but most were willing to undertake more training. Specialist teachers were more positive, although they acknowledged possible disadvantages for both groups of children and stressed that the success of integration depends on the individual child.

Enhancing social skills of kindergarten children with autism through the training of multiple peers as tutors

Many students with autism are being served in inclusive settings. Early intervention programs, traditionally home-based, are beginning to create center-based options which incorporate typically developing peers. One of the arguments for the use of inclusive programs is that students with autism will benefit from their exposure to and interactions with typical peers. Unfortunately, research suggests that in inclusive settings, typical peers and peers with autism do not always interact without prompting from an adult. This study used an ABAB design to determine if a peer buddy approach in which all students were trained to interact in dyads would increase non-adult-directed interactions. Data collected on the students with autism indicate that the peer buddy approach significantly increased their appropriate social interactions. Follow-up data on one of the students indicates generalization of appropriate social interactions to a new classroom.

The influence of nonhandicapped peers on the social interactions of children with a pervasive development disorder

This study investigated whether or not children with autism or a related pervasive developmental disorder (PDD) can benefit from regular opportunities to interact with a normally developing peer, matched as to sex and age. An experimental design with random assignment of subjects to treatment and control groups was used to demonstrate the impact of this peer-mediated intervention. In the treatment group, we found significant improvements in the social behavior of the children with PDD. Several gains were also generalized to interactions with an unfamiliar nonhandicapped peer, to interactions with another child with PDD, and to the large school setting. In the untreated control group, no positive changes were observed. Results suggest that children with PDD can develop peer relations if appropriate social contexts are made available for them.