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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
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
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
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
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
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 friendships6
Developing Friendships

Reciprocity as the fundamental rule

- MacDonald, 1996

differences that impact peer interaction
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
Strength and challenge:Flashlight Metaphor

Credited to E. Schopfler by G. Mesibov, 2008

attention to narrow focus detail
Attention to narrow focus, detail,

single task vs. multitask,

difficulty with complex processing

joint attention as a foundation for peer interaction
Joint attention as a foundation for peer interaction

Mundy, Sigman & Kasari, 1990; Charman, 2003

ASHA Guidelines, 2006

JA

level of communication and symbolic play skills
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
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
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
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
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
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
Restricted interests

How can we enter into these

restricted interests and expand them?

characteristics of effective interventions
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 interventions19
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
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
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
Visual supports decrease the processing load

Find your friend

allowing child to focus on the “single task”

Mesibov, 2008

emerging and effective practices23
Emerging and Effective Practices

- Odom, et. al., 2003

  • Involving families
  • Peer-mediated intervention
peer intervention programs
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
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 friendship26
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 friendship27
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
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
intervention space camp
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 camp31
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 camp32
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
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
examples of skills asd video glossary

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
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
Joint attention as a foundation for interaction

Early beginnings:

  • Mutual gaze
  • Imitation (early turn-taking)
  • Sharing affect
joint attention as a foundation for interaction38
Joint attention as a foundation for interaction
  • Shifting gaze between an object

and a communication partner

Among typical peers

strategy
Strategy
  • eye gaze shift between object and partner

Positioning, materials management,

object held within eye gaze line

strategy40
Strategy
  • Eye gaze shift between object and a peer

Visual cue:

Eyes on your buddy!

strategy41
Strategy
  • Eye gaze shift between object and a peer
joint attention
Joint attention
  • Pointing to an object
  • Following another’s

point

  • Showing an object
slide43

Strategy

  • Showing an object

Use the characters from the story

to cue for skills

slide44

Strategy

  • Showing an object

Show your friend.

Make sure your friend is looking!

Visual cue:

strategy45
Strategy
  • Showing an object

Verbal & gestural cues

joint attention46
Joint attention
  • Social referencing
strategy47
Strategy
  • Social referencing

?

Visual cue:

Verbal cues: What is your friend thinking?

How is your friend feeling?

joint attention48
Joint attention
  • Theory of mind
joint attention49
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)

asha guidelines 2006 sample goals
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
Reciprocal interactions

What I do has an effect on what you do &

what you do has an effect on what I do.

incorporating your child s motivation into reciprocal interaction
Incorporating your child’s motivation into reciprocal interaction

Koegel, Dyer & Bell, 1987

routines support reciprocal interaction
Routines support reciprocal interaction
  • Routines reduce the cognitive load on the child to interpret multiple stimuli:

allows child to

focus attention

routines support reciprocal interaction58
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
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

routines60
Routines

Develop a predictable sequence

Allowing child to focus on the social interaction

routine and novelty
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 novelty63
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
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
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
play routines and novelty
Play routines and novelty

Support the play routine in multiple modalities

“Free Play”

guiding 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
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
Conversational Routines

Team Mission Planning

conversational routines71
Conversational Routines

Show and Tell- Mostly Tell!

characteristics of potential peers
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 peers73
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
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
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 intervention76
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 intervention77
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
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)
slide79

Provides a predictable routine for play

  • making expectations “clear and explicit”
slide80

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

  • making expectations “clear and explicit”

ADD photo- Story of Friendship>>>>

planning intervention how could you
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

?

slide83

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
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.

slide85

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.

slide86

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
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.