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Peer Interactions: Intervention Strategies for Children with Autism Spectrum Disorders. Amy Thrasher, MA CCC-SLP MA-SLP Candidates: Sarah Cowley, Jill Hoffer , Amelia Faber & Nicole Novak University of Colorado at Boulder amy.thrasher@colorado.edu. Session Objectives.

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Peer Interactions: Intervention Strategies for Children with Autism Spectrum Disorders

Amy Thrasher, MA CCC-SLP

MA-SLP Candidates:

Sarah Cowley, Jill Hoffer, Amelia Faber & Nicole Novak

University of Colorado at Boulder

amy.thrasher@colorado.edu


Session Objectives

  • describe elements of social communication and peer interaction impacted by ASD

  • identify evidence-based practices that support peer interaction and social communication

  • incorporate supports & strategies into an intervention plan for a potential client


Agenda

  • Characteristics

    • 2 examples of evidence-based programs

  • Joint attention

  • Reciprocal interaction and motivation

  • Routines and novelty

  • Characteristics of peers

    • Intervention planning

  • Generalization across settings and conclusion


  • Children first,with unique strengths and needs

    What is your child good at?

    What does your child like to do?

    Memory

    Musical * Artistic

    Loving * Mathematical

    Mechanical *Analytical

    Visual Learner * Script Recall

    Physical * Focused * Funny * Sweet

    Loves or Knows everything about______


    Developing Friendships

    Children with special needs that have friends:

    • engage in more “shared experiences” with peers

    • have reciprocal interactions often

    • suggest more play ideas

    • accept suggestions of other children, follow along

    • accept affection from others, sometimes display affection

    • help other children

    • play for longer periods

      - Strain & Smith, 1996


    Developing Friendships

    Reciprocity as the fundamental rule

    - MacDonald, 1996


    Differences that impact peer interaction

    • Level of communication and symbolic representation (pretend play skills)

    • Social orientation/interaction

    • Restricted interests and behaviors

      State Regulation

      Sensory Perception and Processing Differences


    Strength and challenge:Flashlight Metaphor

    Credited to E. Schopfler by G. Mesibov, 2008


    Attention to narrow focus, detail,

    single task vs. multitask,

    difficulty with complex processing


    Joint attention as a foundation for peer interaction

    Mundy, Sigman & Kasari, 1990; Charman, 2003

    ASHA Guidelines, 2006

    JA


    Level of Communicationand symbolic play skills

    How does your child communicate?

    Is it variable across contexts?

    What, if any,

    pretend play can your child engage in?


    Pretend Play

    Numerous studies:

    children with ASD engage in less pretend play than peers

    - including peers with mental retardation and peers who are matched for receptive & expressive language skills

    Jarrold, 2003


    Access to pretend play

    Much of children’s pretend play focuses on

    “social events”

    Pretend play provides practice for daily social interactions of social initiation and responses

    Sachs, 1984


    The transactional nature of social interaction challenges

    Limited social interaction abilities/orientation

    leads to

    limited social experience

    Wetherby & Prizant, 2000


    The transactional nature of social communication challenges

    Interventions focused on social responsiveness can be used to boost overall social and language skills and interrupt this self-perpetuating cycle.

    Sachs, 1984


    Social Orientation

    Interested

    • Approaches peers

    • “Unique” approach

    Passive

    • May watch

    • Can be lead to join

    Not yet engaged

    • Wanders among

    • Seems unaware of

    Adapted from Wing & Gould (1979)

    and Schuler & Wolfberg (2000)


    Restricted interests

    How can we enter into these

    restricted interests and expand them?


    Characteristics of Effective Interventions:

    • early entry into an intervention program

    • intensive instructional programming for a minimum of

      25 hours a week, 12 months a year

    • use of systematically planned teaching opportunities in developmentally appropriate educational activities toward identified objectives

    • Systematic observation, documentation and analysis

      National Research Council (2001)


    Characteristics of Effective Interventions

    • either explicitly or implicitly teach engagement. (engagement is defined as sustained attention to an activity or person)

    • one-to-one or very small group instruction to meet individualized goals in relatively brief periods of time

    National Research Council, 2001


    Inclusive environments

    “To the extent that it leads to the acquisition of children’s educational goals, young children with an autistic spectrum disorder should receive specialized instruction

    in a setting in which ongoing interactions occur

    with typically developing children.”

    National Research Council, 2001


    Emerging and Effective Practices

    Odom, S. L., Brown, W. H., Frey, T., Karasu, N., Lee Smith-Canter, L., & Strain, P. S. (2003). Evidence-Based Practices for Young Children With Autism: Contributions for Single-Subject Design Research. Focus on Autism and Other Developmental Disabilities, 18(3), 166-175.

    • Visual supports


    Visual supports decrease the processing load

    Find your friend

    allowing child to focus on the “single task”

    Mesibov, 2008


    Emerging and Effective Practices

    - Odom, et. al., 2003

    • Involving families

    • Peer-mediated intervention


    Peer Intervention Programs

    “Peer intervention programs for children with ASD have been in the forefront of best practice to support the social interaction needs of this population and have been the focal point of extensive research.”

    “…effectiveness can be judged by whether the implementation has provided a clear change and improvement in the child’s sociocommunicative abilities.”

    - Prendeville, Prelock & Unwin, 2006


    Intervention: Story of Friendship

    • Children with ASD and their typical peers (10 total)

    • preschool through 1st or 2nd grade

    • Builds a familiar pretend play routine through repeated retellings and re-enactments of a story


    Intervention: Story of Friendship

    • Developed from The Storybook Journey: Pathways to Literacy through Story and Play, McCord 1995

    • University of Colorado at Boulder and

      Creekside Elementary School at Martin Park

      as an afterschool program

    • Scholarships through Scottish Rite Foundation


    Intervention: Story of Friendship

    Begins with engaging families to:

    • Assess unique profiles of skills

    • Identify specific, measurable objective: joint attention

    • Identify motivations and interests

    • Identify potential peer


    Story of Friendship: intervention format

    1 x per week for 8-10 sessions or

    Intensive summer program: 4 x per week for 2 weeks

    • Support state regulation

    • Story circle

    • Buddy time

    • Free play

    • Songs and goodbye


    Story of Friendship


    Intervention: Space Camp

    • Children with ASD (high-functioning/verbal) and their typical peers (10 total)

    • Ages groups: 6-9 years or 8-12 years

    • Utilizes high interest area of SPACE for joint projects and for field trips


    Intervention: Space Camp

    • “Intensive” summer program at CU Boulder’s Speech Language Hearing Center

    • Field trips to Fiske Planetarium and Sommers-Bausch Observatory to promote generalization of skills

    • Scholarships funded through Scottish Rite Foundation


    Intervention: Space Camp

    Begins with engaging families to:

    • Assess unique profiles of skills

    • Identify specific, measurable objective:

      joint attention or social reciprocity

    • Identify motivations and interests

    • Identify potential peer


    Space Camp: intervention format

    • Support state regulation

    • Team Mission Planning

    • Team Mission

    • Choice time

    • Show and tell projects and goodbye

    • 2 hour sessions, 4 x per week for three weeks


    Objectives: Joint attention as a foundation for peer interaction

    JA


    http://firstwords.fsu.edu/

    http://www.autismspeaks.org/

    Examples of skills:ASD Video Glossary

    Wetherby, A., Goldstein, H., Cleary, J., Allen, L., & Kublin, K. (2003).  Early identification of children with communication delays:  Concurrent and Predictive Validity of the CSBS Developmental Profile.  Infants and Young Children, 16, 161-174.


    ASHA Guidelines, 2006:Sample intervention goals based on core challenges in ASD.

    Joint attention- Prelinguistic stages

    • Orienting toward people in the social environment

    • Shifting gaze between people and objects

    • Pairing communication gestures with gaze and/or physical contact when requesting and protesting as culturally appropriate

    • Directing another's attention for the purposes of sharing an interesting item or event

    • Sharing positive affect

    • Initiating social routines


    Joint attention as a foundation for interaction

    Early beginnings:

    • Mutual gaze

    • Imitation (early turn-taking)

    • Sharing affect


    Joint attention as a foundation for interaction

    • Shifting gaze between an object

      and a communication partner

    Among typical peers


    Strategy

    • eye gaze shift between object and partner

    Positioning, materials management,

    object held within eye gaze line


    Strategy

    • Eye gaze shift between object and a peer

      Visual cue:

    Eyes on your buddy!


    Strategy

    • Eye gaze shift between object and a peer


    Joint attention

    • Pointing to an object

    • Following another’s

      point

    • Showing an object


    Strategy

    • Showing an object

    Use the characters from the story

    to cue for skills


    Strategy

    • Showing an object

    Show your friend.

    Make sure your friend is looking!

    Visual cue:


    Strategy

    • Showing an object

    Verbal & gestural cues


    Joint attention

    • Social referencing


    Strategy

    • Social referencing

    ?

    Visual cue:

    Verbal cues: What is your friend thinking?

    How is your friend feeling?


    Joint attention

    • Theory of mind


    Joint attention

    Theory of Mind

    allows for the development of

    Pragmatic Skills:

    awareness of others’ reactions and making adjustments to our own actions

    (social reciprocity)


    Success!Inviting a partner into joint attention!


    ASHA Guidelines, 2006: sample goals

    Social reciprocity

    Emerging language stages

    • Increasing frequency of communication across social contexts and interactive partners

    • Maintaining interactions by taking turns

    • Providing contingent responses to bids for interaction initiated by others

    • Recognizing and attempting to repair breakdowns in communication


    Reciprocal interactions

    What I do has an effect on what you do &

    what you do has an effect on what I do.


    Reciprocal interaction involves a shared focus or event

    Yoder & McDuffie, 2006


    Reciprocal Interaction = Shared Experience


    Reciprocal Interaction = Shared Experience


    Incorporating your child’s motivation into reciprocal interaction

    Koegel, Dyer & Bell, 1987


    Routines support reciprocal interaction

    • Routines reduce the cognitive load on the child to interpret multiple stimuli:

      allows child to

      focus attention


    Routines support reciprocal interaction

    • Provide clear roles and responsibilities

    • Provide predictability

    • Child can predict, plan, and produce a response

    • Familiarity and predictability of routines reduce anxiety

    • Repetition allows for practice of skills

      Kashinath, Woods & Goldstein, 2006

      Woods & Wetherby, 2003


    Routines

    “The use of routines is a widely accepted intervention strategy for children with Autism Spectrum Disorders”

    Routines can be incorporated into daily life

    Wetherby & Prizant, 1998


    Routines

    Develop a predictable sequence

    Allowing child to focus on the social interaction


    Hello, Hello, Hello

    Hello, and how are you?I’m fine.Me, too.We’re fine. And how are you?


    Routine and Novelty

    • Build routines and then add novelty

    • Element of novelty = teachable moment

    • Children come to “expect the unexpected”

      within a secure routine

    • Children begin to learn to cope with change


    Routine and Novelty

    • Repeat the routine to practice the skill

    • Vary the routine to generalize the skill

    • Incorporate portions of the routine

    • throughout the day to generalize the skill


    Routine and Novelty:Expanding into pretend play

    • Build a routine (pretend play schema)

    • Add novelty to the routine: a different ending, different props, a new character

    • Support the child through the novelty that the peer creates within the play routine

    • Replay the pretend play routine in as many ways as you can create!


    Play Routines in Story of Friendship

    • The story sequence supports the child’s actions in pretend play

    • The story “script” supports the child’s language in pretend play

    • The pictures or props from the story can serve as visual supports


    “What a cool cave!” exclaimed Eli.


    Play routines and novelty

    Support the play routine in multiple modalities

    “Free Play”


    Guiding play

    • Build a play routine incorporating the child’s interests

    • Recognize & interpret children’s communicative signals

    • Ascribe communicative intent to actions

    • Comment and offer suggestions

    • Provide visual and verbal cues

      Prendeville, Prelock & Unwin, 2006 Prizant, Wetherby & Rydell, 2000

      Wolfberg & Schuler, 1999


    Routines in Space Camp

    • Conversational routines are practiced with explicit cues in “Team Mission Planning”

      and “Show and Tell”

    • Joint projects routines support joint attention and social reciprocity during “Team Missions”


    Conversational Routines

    Team Mission Planning


    Conversational Routines

    Show and Tell- Mostly Tell!


    Characteristics of potential peers

    • “Easy going” temperament

    • Accepting of differences in communication/play

    • Seem to enjoy the “sharing of experience”

      more than playing rigidly by rules or competing

    • Teachers can “spot” them


    Characteristics of potential peers

    Able to model of all aspects of behavior, including communication, play and social strategies

    Prendeville, et al, 2006

    “Socially competent” sensitive and responsive to others in a social context & able to maintain positive contact

    Wolfberg, 2003


    Who are these potential peers?

    Teacher recommendations

    Siblings of other children with needs

    Cousins

    Neighbors

    Friends of friends

    Other service providers’ children


    Story of Friendship and Space Camp: evidence-based practices in autism intervention

    • Begins with families (home visit, interview)

    • Objective based on pivotal skill:

    • joint attention/social reciprocity with a peer

    • Individualized, specific, measurable objective:

    • Ex: “Riley will shift his gaze between an object and a peer

    • 8 times within a 10 minute reciprocal interaction

    • given visual cues.”


    Story of Friendship and Space Camp:evidence-based practices in autism intervention

    • Systematic observation, documentation and analysis


    Story of Friendship and Space Camp: evidence-based practices in autism intervention

    • Natural setting for children

    • Inclusion with typical peers!

    • High teacher: child ratio

    • Predictable Routine

    • Short periods of activity

    • Visual schedule/ visual supports


    Story of Friendship: evidence-based practices in autism intervention

    Storybook Journey approach

    (see McCord, 1995) supports:

    • Relative strengths in visual skills (pictures and props from story can support interaction)

    • Strengths in using rote memory or use of scripts (initially use language from the story, then increase spontaneous language)


    • Provides a predictable routine for play

    • making expectations “clear and explicit”


    • Provides a predictable routine for play, joint projects and conversation-

    • making expectations “clear and explicit”

    ADD photo- Story of Friendship>>>>


    Planning interventionHow could you:

    • Engage family in identifying motivating activities

    • Identify appropriate objective, given child’s unique profile

    • Identify potential friend as peerUse

    • Develop multi-modal supports to allow the children to engage with a peer in a routine:

      • Opening routine

      • Brief periods of supported peer interaction

      • Closing routine

    • Design documentation system within dynamic interactions

    ?


    Generalization of skills beyond intervention session


    Dear , Monday, May 13, 2008

    Would you like to come to Space Camp with me? It’s pretty fun! I have been there last year. One time, we got to go to a nearby observatory and we got to go inside. We got to look in some of the observatory’s telescopes. One of them we got to look inside and it showed the mountains close up, but upside down. I think you’d really want to come here.

    Sincerely,


    References

    ASHA Guidelines. American Speech-Language-Hearing Association. (2006). Guidelines for Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders Across the Life Span [Guidelines]. Available from www.asha.org/policy.

    Charman T. (2003). Why is joint attention a pivotal skill in autism? Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences. (2007)358(1430), 315-24.

    Grandin, T. , (2007, August 8). My experiences with Learning, Language, Sensory problems and Visual Thinking. Keynote Presentation at USAAA Autism and Asperger International Conference, Denver, Colorado.

    Greenspan, S. I., & Weider, S. (1998). The child with special needs: Encouraging intellectual and emotional growth. New York: Addison-Wesley.

    Jarrold, C. (2003). A review of research into pretend play in autism. Autism 7(4). 379-390.

    Kashinath, S., Woods, J., Goldstein, H. (2006). Enhancing Generalized Teaching Strategy Use in Daily Routines by Parents of Children with Autism. Journal of Speech, Language, and Hearing Research, 49, 466-485.

    Koegel, R. L., Dyer, K., & Bell, L. K. (1987). The influence of child-preferred activities on autistic children’s social behavior. Journal of Applied Behavior Analysis, 20 (3), 243 – 252.

    MacDonald, K. (1996). What do Children Want? A Conceptualisation of Evolutionary Influences on Children’s Motivation in the Peer Group. International Journal of Behavioral Development,19.1, 53–73.


    Mesibov, G. (2008, September 29). The Unique Profiles of Individuals with ASD: The TEACCH Model. Presentation at The Children’s Hospital, Aurora, Colorado.

    Mundy, P., Sigman, M., & Kasari, C. (1990). A longitudinal study of joint attention and language development in autistic children. Journal of Autism and Developmental Disorders, 20(1), 115-128.

    National Research Council. (2001). Educating children with autism. Washington, DC: National Academy Press, Committee on Educational Interventions for Children with Autism, Division of Behavioral and Social Sciences and Education.

    Odom, S. L., Brown, W. H., Frey, T., Karasu, N., Lee Smith-Canter, L., & Strain, P. S. (2003). Evidence-Based Practices for Young Children With Autism: Contributions for Single-Subject Design Research. Focus on Autism and Other Developmental Disabilities, 18(3), 166-175.

    Prizant, B., Wetherby, A., & Rydell, P.J. (2000). Communication issues for young children with autism spectrum disorders. In A. Wetherby & B. Prizant (Eds.), Autism spectrum disorders: A transactional developmental perspective (pp. 193-224) Baltimore: Brookes.

    Sachs, J. (1984). Children’s play and communicative development. In R. Schiefelbusch & J. Pickar (Eds.), The acquisition of communicative competence. Baltimore: University Park Press.

    Schuler, A. L., & Wolfberg, P. J. (2000). Promoting peer play and socialization: The art of scaffolding. In A. M. Wetherby & B. M. Prizant (Eds.), Autism spectrum disorders: A transactional developmental perspective (pp. 251–277). Baltimore: Brookes.

    Shore, S & Paradiz, V. (2007, August 11). Personal Experiences on the Autism Spectrum and Challenges Surrounding Communication and Socialization. Presentation at USAAA Autism and Asperger International Conference, Denver, Colorado.


    Strain, P. S., Smith, B. J. (1996). Developing social skills in young children with special needs. Preventing School Failure, 41.1.

    Wetherby, A., Goldstein, H., Cleary, J., Allen, L., & Kublin, K. (2003).  Early identification of children with communication delays:  Concurrent and Predictive Validity of the CSBS Developmental Profile.  Infants and Young Children, 16, 161-174.

    Wetherby, A., Prizant, B. (1998). Communicative, Social/Affective, and Symbolic Profiles of Young Children with Autism and Pervasive Developmental Disorders. American Journal of Speech-Language Pathology, 7, 79-91.

    Wetherby, A. M., & Prizant, B. M. (2000). Introduction to autism spectrum disorders. In A. M. Wetherby & B. M. Prizant (Eds.), Autism spectrum disorders: A transactional developmental perspective (pp. 1–7). Baltimore: Brookes.

    Wing, L., & Gould, J. (1979). Severe impairments of social interaction and associated abnormalities in children: Epidemiology and classification. Journal of Autism and Developmental Disorders, 9(1), 11-29.

    Wolfberg, P.J., & Schuler, A. L. (1999). Fostering peer interaction, imaginative play, and spontaneous language in children with autism. Child Language Teaching & Therapy, 15(1). 41-52.

    Woods, J., Wetherby, A. (2003). Early Identification of and Intervention for Infants and Toddlers Who Are at Risk for Autism Spectrum Disorder. Language, Speech, and Hearing Services in Schools, 34, 180-193.

    Yoder, P. & McDuffie, A. (2006). Teaching young children with autism to talk. Seminars in Speech and Language, 27 (3), 161 – 171.


    For more ideas on reciprocal interaction games, social communication and/or peer interaction…

    DIR/Floortime

    http://www.floortime.org

    Greenspan, S. & Weider, S. (2006) Engaging Autism: Helping Children Relate, Communicate and Think with the DIR Floortime Approach, De Capo Press

    More Than Words

    http://www.hanen.org/

    Sussman F. (1999) More than Words: Helping Parents Promote Communication and Social Skills in Children with Autism Spectrum Disorders. Toronto, Ontario: The Hanen Centre.

    RDI

    http://www.rdiconnect.com/

    Gutstein, S. & Sheely, R. (2002). Relationship Development Intervention Activities for Young Children.

    The SCERTS Model

    http://www.scerts.com/

    Prizant, P., Wetherby, A. M., Rubin, E., Laurent, A. C. , Rydell, P. J. (2005) The SCERTS® ModelA Comprehensive Educational Approach for Children with Autism Spectrum Disorders, Brookes.

    Social Thinking

    http://www.socialthinking.com/

    Winner, M.G. (2007) Thinking About You Thinking About Me. Think Social Publishing, Inc.


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