Peer Interactions: Intervention Strategies for Children with Autism Spectrum Disorders

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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_at_colorado.edu
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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

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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

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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______
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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

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Developing Friendships

• Reciprocity as the fundamental rule
• - MacDonald, 1996

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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

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Strength and challengeFlashlight Metaphor
Credited to E. Schopfler by G. Mesibov, 2008
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Attention to narrow focus, detail,
single task vs. multitask, difficulty with
complex processing
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Joint attention as a foundation for peer
interaction

• Mundy, Sigman Kasari, 1990 Charman,
  2003
• ASHA Guidelines, 2006

JA
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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?
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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

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Access to pretend play

•  
• Much of childrens pretend play focuses on
• social events
• Pretend play provides practice for daily social
  interactions of social initiation and responses
• Sachs, 1984

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The transactional nature of social interaction
challenges

• Limited social interaction abilities/orientation
• leads to
• limited social experience
• Wetherby Prizant, 2000

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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

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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)
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Restricted interests
How can we enter into these restricted interests
and expand them?
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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)

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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
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Inclusive environments
To the extent that it leads to the acquisition
of childrens 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
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Emerging and Effective Practices

• Visual supports

• 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.

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Visual supports decrease the processing load
Find your friend
allowing child to focus on the single
task Mesibov, 2008
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Emerging and Effective Practices

• Involving families
• Peer-mediated intervention

• - Odom, et. al., 2003

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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 childs sociocommunicative
  abilities.
• - Prendeville, Prelock Unwin, 2006

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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

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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

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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

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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

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Story of Friendship
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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

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Intervention Space Camp

• Intensive summer program at CU Boulders Speech
  Language Hearing Center
• Field trips to Fiske Planetarium and
  Sommers-Bausch Observatory to promote
  generalization of skills
• Scholarships funded through Scottish Rite
  Foundation

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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

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Space Camp intervention format

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

• Support state regulation
• Team Mission Planning
• Team Mission
• Choice time
• Show and tell projects and goodbye

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Objectives Joint attention as a foundation for
peer interaction
JA
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Examples of skillsASD Video Glossary
http//firstwords.fsu.edu/ http//www.autismspea
ks.org/

• 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.

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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

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Joint attention as a foundation for interaction

• Early beginnings
• Mutual gaze
• Imitation (early turn-taking)
• Sharing affect

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Joint attention as a foundation for interaction

• Shifting gaze between an object
• and a communication partner

Among typical peers
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Strategy

• eye gaze shift between object and partner

Positioning, materials management, object held
within eye gaze line
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Strategy

• Eye gaze shift between object and a peer
• Visual cue

Eyes on your buddy!
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Strategy

• Eye gaze shift between object and a peer

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Joint attention

• Pointing to an object
• Following anothers
• point
• Showing an object

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Strategy

• Showing an object

• Use the characters from the story
• to cue for skills

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Strategy

• Showing an object

• Show your friend.
• Make sure your friend is looking!

Visual cue
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Strategy

• Showing an object

Verbal gestural cues
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Joint attention

• Social referencing

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Strategy

• Social referencing

?
Visual cue Verbal cues What is your friend
thinking? How is your friend feeling?
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Joint attention

• Theory of mind

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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)

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Success!Inviting a partner into joint attention!
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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

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Reciprocal interactions
What I do has an effect on what you do what
you do has an effect on what I do.
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Reciprocal interaction involves a shared focus
or event

• Yoder McDuffie, 2006

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Reciprocal Interaction Shared Experience
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Reciprocal Interaction Shared Experience
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Incorporating your childs motivation into
reciprocal interaction
Koegel, Dyer Bell, 1987
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Routines support reciprocal interaction

• Routines reduce the cognitive load on the child
  to interpret multiple stimuli
• allows child to
• focus attention

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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

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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

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Routines

• Develop a predictable sequence
• Allowing child to focus on the social interaction

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Hello, and how are you? Im fine.Me,
too. Were fine. And how are you?
Hello, Hello, Hello
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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

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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

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Routine and NoveltyExpanding 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!

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Play Routines in Story of Friendship

• The story sequence supports the childs actions
  in pretend play
• The story script supports the childs language
  in pretend play
• The pictures or props from the story can serve as
  visual supports

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• What a cool cave! exclaimed Eli.

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Play routines and novelty

• Support the play routine in multiple modalities
• Free Play

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Guiding play

• Build a play routine incorporating the childs
  interests
• Recognize interpret childrens 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

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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

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Conversational Routines
Team Mission Planning
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Conversational Routines
Show and Tell- Mostly Tell!
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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

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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

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Who are these potential peers?

•  

Teacher recommendations Siblings of other
children with needs Cousins Neighbors Friends
of friends Other service providers children
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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.

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Story of Friendship and Space Campevidence-based
practices in autism intervention

• Systematic observation, documentation and analysis

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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

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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)

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• Provides a predictable routine for play
• making expectations clear and explicit

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• Provides a predictable routine for play, joint
  projects and conversation-
• making expectations clear and explicit

ADD photo- Story of Friendshipgtgtgtgt
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Planning intervention How could you

• Engage family in identifying motivating
  activities
• Identify appropriate objective, given childs
  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

?
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Generalization of skills beyond intervention
session
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• Dear , Monday,
  May 13, 2008
• Would you like to come to Space Camp with me?
  Its 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
  observatorys telescopes. One of them we got to
  look inside and it showed the mountains close up,
  but upside down. I think youd really want to
  come here.
• Sincerely,

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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 childrens social behavior. Journal of
  Applied Behavior Analysis, 20 (3), 243 252.
•  
• MacDonald, K. (1996). What do Children Want? A
  Conceptualisation of Evolutionary Influences on
  Childrens Motivation in the Peer Group.
  International Journal of Behavioral Development,
  19.1, 5373.

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• Mesibov, G. (2008, September 29). The Unique
  Profiles of Individuals with ASD The TEACCH
  Model. Presentation at The Childrens 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). Childrens 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.
  251277). 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.

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• 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. 17). 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.

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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.