Training mildly handicapped peers to facilitate changes in the social interaction skills of autistic children

A Survey of Nondisabled Employees' Attitudes toward Supported Employees with Mental Retardation

A survey was administered to 212 co-workers of supported employees with mental retardation. The purpose of the survey was to assess the perceptions and experiences of nondisabled employees with co-workers with mental retardation. Results suggest that contact in the workplace does not significantly affect the attitudes of nondisabled employees regarding the social and vocational competence of individuals with mental retardation. Results also indicate that the attitudes of nondisabled employees are not significantly affected by the level of mental retardation experienced by their supported employment co-workers. The results also suggest that the majority of contact between nondisabled employees and supported employees concentrated on task performance; very little contact between employees was reported during breaks at work and after work hours. These results are discussed in light of their implications for supported employment providers.

The Relationship between Stereotypic Behavior and Peer Social Interaction for Children with Severe Disabilities

The purpose of this study was to examine the collateral relationship between engagement in social interaction with peers and the occurrence of stereotypic behavior for two children with severe disabilities. Peers without disabilities were taught to make social initiations to two children with autism and other severe disabilities who engaged in high rates of stereotypic behavior. When the peers made social initiations and the children with disabilities increased their engagement in social interaction, collateral decreases occurred in their stereotypic behavior. Within an ABAB design, the functional relationship between these variables was demonstrated. Implications of these findings for designing interventions for promoting social integration and their possible effects on stereotypic behavior are noted.

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.

Do behavioural approaches teach children with autism to play or are they pretending?

Play is, by definition, internally motivated, flexible, spontaneous and voluntary. Yet some researchers claim to have taught children with autism to play using behavioural interventions that are heavily structured, repetitive and make use of external reinforcements. In the current systematic review, we examine the extent to which these claims are supported by the evidence presented by the researchers themselves. We conclude that the most effective behavioural interventions have been those which have built on children's existing abilities or have relied on the motivating nature of activities themselves rather than on external rewards. We discuss the problems inherent in distinguishing between behavioural and cognitive change in children's play and highlight generalization as a poorly understood but focal process. Finally, we discuss the value of teaching children with autism play behaviours when these are not characterized by the defining qualities of play as a disposition.

Effective Behavioural Strategies for the Defining Characteristics of Autism

The following review paper describes the outcomes of data-based behavioural intervention strategies for the defining characteristics of autistic disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). The results of relevant evaluations of behaviour analytic procedures are reviewed for each of the four potential areas of difficulty under each of the main criteria for autistic disorder, which are: (a) impairment in social interaction, (b) impairment in communication, and (c) restrictive, repetitive, and stereotyped patterns of behaviour, interests, and activities (DSM-IV). The current areas of research activity as well as those domains that have received comparatively little attention by behavioural researchers are identified, and suggestions for future research are discussed.

Effects of Peer-Mediated Implementation of Visual Scripts in Middle School

Although research has investigated the impact of peer-mediated interventions and visual scripts on social and communication skills in children with autism spectrum disorders, no studies to date have investigated peer-mediated implementation of scripts. This study investigated the effects of peer-implemented scripts on a middle school student with autism, intellectual impairments, and speech-language impairment via a multiple baseline single-case research design across behaviors. The target student demonstrated improvements in three communicative behaviors when implemented by a trained peer; however, behaviors did not generalize to use with an untrained typically developing peer.

Generalization Procedures in Training Interventionists for Individuals With Developmental Disabilities

The literature pertaining to training staff, parents, and peers to implement interventions for individuals with developmental disabilities was reviewed for training procedures that incorporated strategies to promote generalization. The search engines for the Journal of Applied Behavior Analysis and Pubmed© were used to find relevant studies. Studies met the inclusion criteria if they sufficiently operationalized their training procedure, took data on individual trainees’ performance, and used a single-subject experimental design. The training procedures were coded for generalization procedures as per Stokes and Baer. Of the 54 studies, 46 considered used procedures to promote generalization. The most prevalent generalization procedures were use of common stimuli, followed by using sufficient exemplars and mediated generalization. Studies demonstrated empirical support for these procedures producing generalized use of newly acquired direct-care skills. The remaining generalization procedures cited in Stokes and Baer were absent or far less prevalent. Future research should explore the use of these procedures and their effectiveness as a technology to bring about generalized responding of interventionists’ skills.

LEGO therapy and the social use of language programme: an evaluation of two social skills interventions for children with high functioning autism and Asperger Syndrome

LEGO therapy and the Social Use of Language Programme (SULP) were evaluated as social skills interventions for 6-11 year olds with high functioning autism and Asperger Syndrome. Children were matched on CA, IQ, and autistic symptoms before being randomly assigned to LEGO or SULP. Therapy occurred for 1 h/week over 18 weeks. A no-intervention control group was also assessed. Results showed that the LEGO therapy group improved more than the other groups on autism-specific social interaction scores (Gilliam Autism Rating Scale). Maladaptive behaviour decreased significantly more in the LEGO and SULP groups compared to the control group. There was a non-significant trend for SULP and LEGO groups to improve more than the no-intervention group in communication and socialisation skills.

Social-skills treatments for children with autism spectrum disorders: an overview

Marked advances in the treatment of children with autism spectrum disorders (ASDs) has occurred in the past few decades, primarily using applied behavior analysis. However, reviews of trends in social skills treatment for children with ASDs have been scant, despite a robust and growing empirical literature on the topic. In this selective review of 79 treatment studies, the authors note that the research has been particularly marked by fragmented development, using a range of intervention approaches and definitions of the construct. Modeling and reinforcement treatments have been the most popular model from the outset, with most studies conducted in school settings by teachers or psychologists. Investigators have been particularly attentive to issues of generalization and follow-up. However, large-scale group studies and comparisons of different training strategies are almost nonexistent. These trends and their implications for future research aimed at filling gaps in the existing literature are discussed.

Assessment and treatment of autism

Physicians are often the first health care professionals to encounter children that display symptoms associated with developmental disorders such as autism. Unfortunately, there is lack of information regarding what strategies physicians should adopt in treating these symptoms and where they should look to refer individuals who present with severe symptoms of autism. This paper provides some preliminary information regarding the current behavioral assessment and treatment strategies in order to help physicians identify and make appropriate recommendations for successful treatment when working with autistic children. The essential components of successful treatment for autism are outlined; some preliminary treatment methodologies that physicians can recommend parents or caregivers attempt are also highlighted. In addition, the current behavioral treatment strategies used for acquisition of social skills and language are covered as well as methodologies for the reduction of maladaptive behavior in children with autism.

Promoting social communication in high functioning individuals with autistic spectrum disorders

This article reviews a range of social communication interventions that have been developed for students with autism at the preschool, school age, and adolescent level. Adult-mediated and peer-mediated methods that use highly structured, child-centered, and hybrid methods are examined. Programs that provide information on generalization and maintenance are identified. A set of recommendations for programs that would seem to be most appropriate for students with Asperger syndrome is presented.

Measures in intervention research with young children who have autism

In this paper, the outcome measures used in intervention research with young children with autism were analyzed. Two types of literature were reviewed: reports evaluating specific intervention practices and reports of complete intervention programs. A description of the types of measures used in each literature source and measurement practices reported were analyzed and described. In addition, the intervention program literature was reviewed to determine whether factors that may mediate outcomes were measured. Finally, the literature was reviewed to identify instances in which multiple risk and opportunity factors were analyzed to account for variations in outcomes.

Communication intervention for children with autism: a review of treatment efficacy

Empirical studies evaluating speech and language intervention procedures applied to children with autism are reviewed, and the documented benefits are summarized. In particular, interventions incorporating sign language, discrete-trial training, and milieu teaching procedures have been used successfully to expand the communication repertoires of children with autism. Other important developments in the field stem from interventions designed to replace challenging behaviors and to promote social and scripted interactions. The few studies of the parent and classroom training studies that included language measures also are analyzed. This article seeks to outline the extent to which previous research has helped identify a compendium of effective instructional practices that can guide clinical practice. It also seeks to highlight needs for further research to refine and extend current treatment approaches and to investigate more comprehensive treatment packages.

Interventions that facilitate socialization in children with autism

Social dysfunction is perhaps the most defining and handicapping feature of autism. Improved social functioning has long been considered one of the most important intervention outcomes. A variety of social interventions have been designed, empirically examined, and published in the autism literature. Children with autism have been found to be responsive to a wide variety of interventions aimed at increasing their social engagement with others, both adults and peers. Successful strategies employing peer-mediated approaches and peer tutoring have involved typically developing peers. Furthermore, several studies have demonstrated that social engagement directly affects other important behaviors like language, even when these behaviors are not specifically targeted by the teaching program. Thus, while an area of severe involvement, social behavior is also responsive to intervention.

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.

Interaction among preschoolers with and without disabilities: effects of across-the-day peer intervention

We examined the effects of a peer-mediated intervention package that taught typically developing children to be more aware of communicative attempts to classmates with disabilities, to use a small set of facilitative strategies ("Stay, play, talk"), and to distribute strategy use across the school day. A multiple baseline design across subjects was instituted with two cohorts of preschool children. Following baseline observations, a total of 8 target children with moderate development disabilities were eventually paired with trained peers who received "buddy training." One trained peer were taught facilitative strategies and encouraged to use them during classroom activities, consistent improvements in social interaction on the part of the trained peers and target children were demonstrated. Similar or more frequent interactions were demonstrated when trained peers were reassigned to different target children during generalization probes. In addition, treatment effects were revealed when comparing sequential analyses applied to the specific communicative behaviors across experimental conditions, in changes in target children's sociometric ratings, and in social validity judgments of videotapes from before and after treatment. This peer intervention approach has promise for improving the communicative interaction and social integration of children with disabilities attending inclusive preschools.

Teaching preschool age autistic children to make spontaneous initiations to peers using priming

Children with autism rarely initiate social interactions with their peers. Currently available interventions have not increased autistic children' spontaneous initiations in natural settings without extensive teacher involvement. A "priming" strategy consisting of a low demand, high reinforcement session prior to the regular school activity was used to increase the spontaneous social initiations of 2 preschool age autistic boys to typically developing peers in a regular preschool classroom. Peers were also trained to independently respond to initiations. Implications for developing practical ways to improve autistic children's social functioning in regular school settings are discussed.

Classwide peer tutoring: an integration strategy to improve reading skills and promote peer interactions among students with autism and general education peers

A multiple baseline design across subjects with a reversal was used to examine the effects of classwide peer tutoring relative to traditional reading instruction on reading skills and social interaction time for 3 high-functioning students with autism and their typical peers in integrated, general education classrooms. Traditional reading instruction consisted largely of teacher-led instruction with individual student participation and seat work. Classwide peer tutoring consisted of 25 to 30 min of well-specified instruction in which tutor-learner pairs worked together on a classwide basis on reading fluency and comprehension skills. All students participated in 15- to 20-min unstructured free-time activities immediately following reading instruction. Results of reading assessments demonstrated that classwide peer tutoring increased reading fluency and correct responses to reading comprehension questions for students with autism and their peers. The procedure further increased the total duration of free-time social interactions for students with autism and typical peers, with individual variation in performance.

Assessing acceptance and social skills with peers in childhood. Current issues

This article reviews current strategies for assessing social skills with peers in childhood, highlighting contemporary unresolved issues in identifying children who need intervention, selecting target behaviors, and assessing treatment outcome. Sociometric measures of peer acceptance are also considered. Although many current measures of social skills have adequate evidence of reliability and convergent validity, assessment could benefit from (a) increased documentation that the content of measures assesses important skills in relating to peers, (b) improved methods for assessing social behavior in specific interpersonal situations, and (c) more empirical evidence that indirect assessment methods (self-report, peer assessment, and teacher report) and analogue observations reflect in vivo behavior.

Teaching children with autism to initiate to peers: effects of a script-fading procedure

A script that was systematically faded from end to beginning was used to teach peer initiations about recently completed, current, and future activities. The effectiveness of the script-fading procedure was assessed via a multiple baseline design across 4 children with autism. During baseline, the children seldom initiated to peers, although all had previously acquired some functional expressive language and sometimes spontaneously addressed adults. When the script was introduced, peer initiations increased, and as the script was faded, unscripted initiations increased. With the minimal written prompts available in the final fading steps, initiations generalized to a different setting, time, teacher, and activity; and for 3 of the 4 children, peer initiations were maintained at a 2-month follow-up. After the script was faded, the participants' levels of peer initiations were within the same range as a normative sample of 3 nondisabled youngsters. The script-fading procedure enabled children with severe social and verbal deficits to practice context-specific, peer-directed generative language that was not prompted by adults or peer confederates.

Promoting reciprocal interactions via peer incidental teaching

This study evaluated peer incidental teaching as a strategy for increasing reciprocal peer interactions by children with autism. Three typical preschoolers were trained as peer tutors for 3 young children with autism. During a classroom free-play session, peer tutors used incidental teaching to obtain verbal labels of preferred toys by children with autism. A multiple baseline across the 3 target children showed replicated positive effects of the intervention. Adult supervision and assistance were then faded systematically, with resulting maintenance of increased reciprocal interactions. Multiple measures of the extent and limits of generalization suggested that 1 child increased interactions in free-play periods throughout the day, but none of the children showed increases at lunch. Teacher and peer ratings supported the social validity of positive findings.

Effects of self-evaluation on preschool children's use of social interaction strategies with their classmates with autism

This study investigated effects of a self-evaluation procedure on preschool children's use of social interaction strategies among their classmates with autism. Three triads of children (comprised of 1 trained normally developing peer, 1 untrained peer, and 1 child with autism) participated. A multiple baseline design across subjects was used to demonstrate that peers who were taught facilitative strategies increased their use of strategies only after the self-evaluation intervention was introduced. Improvements in social behavior of children with autism was associated with peers' increased strategy use. Untrained peers demonstrated little change in their social behavior. Treatment effects were replicated when trained peers were asked to use self-evaluation with other children with autism during other play times. Self-evaluation procedures enhanced the use of social interaction strategies on the part of normally developing peers during social skills interventions.

Teaching social skills to students with autism to increase peer interactions in an integrated first-grade classroom

We investigated the use of social skills groups to facilitate increased social interactions for students with autism and their nonhandicapped peers in an integrated first-grade classroom. Social skills groups consisted of training students and peers in initiating, responding, and keeping interactions going; greeting others and conversing on a variety of topics; giving and accepting compliments; taking turns and sharing; asking for help and helping others; and including others in activities. Training occurred during the first 10 min of 20-min play groups, four times per week. Using a multiple baseline across subjects design, results demonstrated increases in the frequency of, time engaged in, and duration of social interactions, as well as the responsivity of students and peers to each other. Results were maintained when students were monitored and given feedback on social performance in play groups and during follow-up.

Training social initiations to a high-functioning autistic child: assessment of collateral behavior change and generalization in a case study

The present case study used a multiple treatment design to assess the effects of two interventions--peer social initiations and target child initiations--on the social and disruptive behavior of a high-functioning autistic child. Intervention included initiation training and videotaped feedback highlighting successful and unsuccessful initiations. During Interventions 1 and 2, nonhandicapped peers were trained to initiate social interaction with the autistic child, resulting in an increase in social interaction which dramatically decreased in a reversal phase. Social interaction quickly increased again in Intervention 3 when the autistic child was trained to initiate interaction using the same procedures. During Interventions 1 and 2 no decrease in the autistic child's disruptive behaviors was observed; however during Intervention 3 these behaviors decreased to a low rate. Social validation, generalization, and maintenance of these behavior changes are discussed.

A practical strategy for ongoing reinforcer assessment

There is a need for practical methods of reinforcer assessment that systematically track ongoing changes in clients' preferences. In this study, the effects of a time-efficient reinforcer assessment package were evaluated in a multiple baseline across 3 preschoolers with autism, comparing individualized item selections by experienced teachers with children's presession preferences for items of various sensory qualities. Systematic assessment of children's reinforcers for correct responding virtually eliminated nontargeted maladaptive behaviors, as well as yielding expected improvements in accuracy. The powerful side-effects of potent reinforcers underline the importance of increased attention to reinforcer assessment in research and practice.

A peer-mediated intervention with clinic-referred socially isolated girls. Generalization, maintenance, and social validation

Peer-mediated interventions have been widely employed with seriously impaired autistic and handicapped children to modify social withdrawal. This study extends the literature by examining the impact of a peer intervention on the interactions of developmentally normal, socially isolated girls. Two to three actual classroom peers were trained to serve as helpers to initiate and maintain interactions with the subjects. The intervention was introduced sequentially across 2 girls in a multiple-baseline design, and a within-subject ABA withdrawal design was used to assess maintenance. Behavioral observations during recess periods indicated that both children's positive social interactions with peer helpers and other classmates were increased significantly during intervention and were maintained in return-to-baseline conditions and at 4-month follow-up. Increases in positive social interactions of both subjects generalized to a second recess setting, in which intervention was not introduced. Subjects' interactions in both recess settings reached levels comparable to those of social-comparison groups of peers. Teacher and self-report ratings suggested that both girls had fewer social problems and experienced less loneliness and dysphoria as a result of the intervention.

Promoting autistic children's peer interaction in an integrated early childhood setting using affection activities

Group affection activities were used to increase the interaction of three autistic children with their nonhandicapped peers in an integrated early childhood setting. Peer interaction increased during free play when the affection activities were conducted, but not when similar activities without the affection component were used. This interaction included initiations by both the autistic and nonhandicapped children, with reciprocal interactions occurring more frequently with nonhandicapped peers who had participated in the affection activities.

Increasing social interactions of severely handicapped autistic children

A peer-initiation training procedure was implemented across multiple peer trainers to investigate social interactions between severely withdrawn autistic children and their nonhandicapped peers. For one subject, substantial increases in spontaneous interactions with training and nontraining peers occurred after the peer-initiation procedure was applied across two training exemplars. Spontaneous social interactions continued even after the training procedure was removed. Although experimental control was established with the second subject during training, spontaneous interactions during nontraining periods were primarily with training peers. The results contribute to an emerging data base on the social interactions of autistic and severely withdrawn handicapped children and on peer-initiation training procedures.

The influence of child-preferred activities on autistic children's social behavior

One of the characteristics of autistic children is severe social avoidance behavior. We assessed whether the type of activity (child-preferred vs. activities that were arbitrarily determined by an adult) engaged in during an interaction was correlated with the amount of social avoidance behaviors these children exhibit. Results revealed a negative correlation between appropriate child-preferred activities and social avoidance behavior. Additional analyses revealed that (a) social avoidance behaviors could be manipulated within a reversal design, and would predictably decrease when the children were prompted to initiate appropriate child-preferred activities; and (b) these procedures could be used to teach children to initiate child-preferred activities in community settings, resulting in reductions in social avoidance responses even after the therapist's prompts were completely removed. These data suggest that the manipulation of task variables may influence the severe social unresponsiveness that is characteristic of autistic children.

An extension of incidental teaching procedures to reading instruction for autistic children

In an extension of incidental teaching procedures to reading instruction, two autistic children acquired functional sight-word reading skills in the context of a play activity. Children gained access to preferred toys by selecting the label of the toy in tasks requiring increasingly complex visual discriminations. In addition to demonstrating rapid acquisition of 5-choice discriminations, they showed comprehension on probes requiring reading skills to locate toys stored in labeled boxes. Also examined was postteaching transfer across stimulus materials and response modalities. Implications are that extensions of incidental teaching to new response classes may produce the same benefits documented in communication training, in terms of producing generalization concurrent with skill acquisition in the course of child-preferred activities.

A direct prompting strategy for increasing reciprocal interactions between handicapped and nonhandicapped siblings

We investigated the effects of a sibling training procedure, consisting of direct prompting and modeling, on the occurrence of reciprocal interactions between nonhandicapped and handicapped siblings. Data were obtained for training, generalization, and follow-up. Results of a multiple-baseline design across three pairs of siblings showed that: direct prompting of interactions was an effective strategy for increasing reciprocal interactions between handicapped and nonhandicapped siblings; the training procedure resulted in increased levels of initiations and responsiveness to initiations; reciprocal interactions between siblings generalized to larger play groups or across settings; reciprocal interactions between handicapped subjects and untrained, nonhandicapped peers increased without direct training; the siblings' levels of interactions were maintained at 6 mo follow-up; and these findings were judged socially valid by the siblings' parents.