Jennifer Buxton Libbey Horton George Mason University

1. A Social Communication Reciprocal Play Intervention for Children with Autism and other Communication Deficits Jennifer Buxton Libbey Horton George Mason University

2. Literature Review A moderate amount of research exists on peer-mediated facilitation of Augmentative and Alternative Communication systems (AACs) to improve social communication of adults. However, according to the research specific to the use of Speech Generating Devices (SGDs), Trottier, Kamp, and Mirenda (2011), reported that no research exists on interventions combining the peer-mediated use of an SGD to increase social communication for elementary aged children. Further, no empirical research exists testing the effects with the family in the natural home environment. The possible benefit of combining play in a social communication intervention for children with an Autism Spectrum Disorder (ASD) is supported by Helfin’s (2007) who posited that teaching play has a direct impact on the acquisition of language and affects social development suggesting (p. 280).

3. Purpose & Research Question Purpose The purpose of this single subject study was to test the effects of peer-mediated use of an SGD, specifically an iPad, to increase the social communication and reciprocal play skills of a child with Autism and limited verbal ability. The main goals of the intervention were to: • Increase socialization and social communication • Increase reciprocal play skills • Increase use of an SGD in the home environment • Decrease maladaptive behaviors associated with the targeted skills Research Question What effects does a social communication reciprocal play intervention utilizing a peer-mediated SGD have on the Prompted and spontaneous social communication, reciprocal play skills, and maladaptive behaviors of a child with autism?

4. Definition of Terms Augmentative and Alternative Communication Device (AAC) – A functional device, electronic or non-electronic, that helps non-speaking or minimal speakers effectively communicate by supplementing speech and/or writing. Examples of AAC systems include: Picture Exchange Cards (PECS), Speech Generating Devices (SGDs), sign language, vocalizations and gestures, communication books/boards, etc. Speech Generating Device(SGD) - An SGD is one of the many types of AAC systems. It is a digital device that provides synthesized or digitized voice output and can involve services such as graphics, text-based flash cards, or voice recordings to enhance an individual’s communication (Heflin, 2007, p. 247). Social Communication - Social communication involves the types of communication necessary to appropriately participate in social activities. Reciprocal Play – Reciprocal play is play involving turn taking and sharing.

5. Examples of AAC Systems

6. Benefits of SGD Use • Acts as an intermediary relieving the social aspect of communication • Reduce the pressure of speech development as the sole means of communication • Reduce behaviors related to communicative frustration • Psycho-social benefits as a result of better understanding others and being better understood • Provides means for language comprehension that relies on recognition rather than memory • Provides visual and auditory information in a familiar, clear, precise, static, and predictable form • May be utilized in a variety of settings • Adjustable levels of complexity to meet differentiated needs • May stimulate brain development and symbol learning

7. Research Methodology Research Design Single Subject Case Study Participant 9 year old Caucasian male diagnosed with Autistic Disorder, Speech Language Impairment, and cleft palate Measures -Parental interview using informal inventories -Review of educational and behavioral reports -Baseline/intervention data sheets tracking use of prompted and spontaneous speech, turn taking ability, and maladaptive behaviors

8. Overview of Intervention Procedure One of three games (scrabble, dominoes, and checkers) were chosen by the participant. The participant’s mother or sister mediated game play (with adjusted rules) using an iPad programmed with terminology specific to the intervention. Positive reinforcement (token economy) was used based on turn taking. Prompting was employed as needed to keep participant engaged and take turns. A visual timer was also used to inform participant about time remaining in each session and for each reward break. There were a total of 29 data points; six baseline and 23 intervention (10 without/13 with a SGD).

9. Data Analysis Qualitative Data Information from the informal inventories was summarized and presented based on the major categories of the interview and assessment. Quantitative Data Percentages and totals per round were calculated for all dependent variables Results were graphed and visual analysis was used to examine trends and draw conclusions from the results. - Each game play round was graphed as a different data point for a total of 29 data points. - The Percentage of Non-overlapping Data (PND) was calculated to further support conclusions (Scruggs and Mastropieri, 2001). - PND was not used to analyze Communication because the SGD was not available for all data points, and increases would be better analyzed and interpreted based on data trends.

10. Results – Prompted Speech Note.CA = Communicative Acts – verbalizations, gestures, and SGD activations used for social communication. SGD = Speech Generated Device. Baseline Per Round - Range – 0, Average - 0 Intervention without SGD Per Round - Range – 0-1, Average - 0 Intervention with SGD Per Round - Range – 4-15, Average – 9.1

11. Results – Spontaneous Speech Note.CA = Communicative Acts – verbalizations, gestures, and SGD activations used for social communication. SGD = Speech Generated Device. Baseline Per Round - Range – 0, Average - 0 Intervention without SGD Per Round - Range – 0, Average - 0 Intervention with SGD Per Round - Range – 1-4, Average – 1.2

12. Results – Turn Taking Note.Percentage = calculated because the number of total turns per round varied, Rounds = Turn taking activity to earn each reward. Baseline Per Round – Range – 0-25%, Average – 9% Intervention Per Round – Range – 0-100%, Average – 65% PND 75% - 18 points above baseline of 25%

13. Results – Maladaptive Behaviors Note.Behaviors = head/leg hitting, wrist/knee biting, teeth grinding, whining, yelling, banging head on the floor, hitting floor with hand, and leaving the game, Rounds = Turn taking activity to earn each reward. Baseline Per Round – Range – 0-100%, Average – 65% Intervention Per Round – Range – 0-10%, Average – 2.6% PND 75% - 18 points above baseline of 25%

14. Discussion Social Communication When the SGD was introduced there was an immediate increase in prompted and spontaneous speech. By the end of the intervention, the participant occasionally used SGD and verbalization to spontaneously communicate with family and researcher. This evidence supports Kluth’s (2010) assertion that students using SGDs may benefit by gaining access to a voice (p. 125). Reciprocal Play 75% PND was impressive due to the short duration and other limitations of the intervention. Maladaptive Behaviors 75 % PND indicates significant decrease in maladaptive behaviors using a SGD.

15. Limitations - Short duration of the study created a number of other limitations including lack of sufficient time to: Adequately plan for the intervention Pair with the participant to develop a relationship with the participant Observe and identify the participant’s strengths and weaknesses Observe average time on non-preferred tasks to avoid unnecessary frustration Allow for baseline stabilization - Treatment fidelity was not measured to ensure proper intervention implementation

16. Implications and Future Research In the short duration of the intervention, the overall gains in social communication, reciprocal play skills, and decreased maladaptive behaviors are extremely promising. Interventions with a longer overall duration including more time to plan the intervention, pair with the participant, allow for baseline stabilization, and span a longer timeframe have the potential for even more significant gains.

17. Contact Information Jennifer Buxton jenbuxton@rome.com Libbey Horton ehorton1@gmu.edu