Peer Interactions: Intervention Strategies for Children with Autism Spectrum Disorders

1. 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

2. 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

3. 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

4. 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______

5. 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

6. Developing Friendships Reciprocity as the fundamental rule - MacDonald, 1996

7. 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

8. Strength and challenge:Flashlight Metaphor Credited to E. Schopfler by G. Mesibov, 2008

9. Attention to narrow focus, detail, single task vs. multitask, difficulty with complex processing

10. Joint attention as a foundation for peer interaction Mundy, Sigman & Kasari, 1990; Charman, 2003 ASHA Guidelines, 2006 JA

11. 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?

12. 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

13. 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

14. The transactional nature of social interaction challenges Limited social interaction abilities/orientation leads to limited social experience Wetherby & Prizant, 2000

15. 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

16. 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)

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

18. 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)

19. 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

20. 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

21. 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

22. Visual supports decrease the processing load Find your friend allowing child to focus on the “single task” Mesibov, 2008

23. Emerging and Effective Practices - Odom, et. al., 2003 • Involving families • Peer-mediated intervention

24. 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

25. 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

26. 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

27. 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

28. 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

29. Story of Friendship

30. 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

31. 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

32. 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

33. 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

34. Objectives: Joint attention as a foundation for peer interaction JA

35. 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.

36. 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

37. Joint attention as a foundation for interaction Early beginnings: • Mutual gaze • Imitation (early turn-taking) • Sharing affect

38. Joint attention as a foundation for interaction • Shifting gaze between an object and a communication partner Among typical peers

39. Strategy • eye gaze shift between object and partner Positioning, materials management, object held within eye gaze line

40. Strategy • Eye gaze shift between object and a peer Visual cue: Eyes on your buddy!

41. Strategy • Eye gaze shift between object and a peer

42. Joint attention • Pointing to an object • Following another’s point • Showing an object

43. Strategy • Showing an object Use the characters from the story to cue for skills

44. Strategy • Showing an object Show your friend. Make sure your friend is looking! Visual cue:

45. Strategy • Showing an object Verbal & gestural cues

46. Joint attention • Social referencing

47. Strategy • Social referencing ? Visual cue: Verbal cues: What is your friend thinking? How is your friend feeling?

48. Joint attention • Theory of mind

49. 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)

50. Success!Inviting a partner into joint attention!