Teaching Social Skills to Children with Autism

1. Autism EBP Group You don’t make friends with iPads

2. Autism EBP 2015

3. Peer Training Clinical Question: In children with an Autism Spectrum Disorder, does teaching their peers social skills lead to increased social interactions

4. The friendship algorithm

5. What we found…. • 17 papers. • 6 were eliminated due to age of participants, age of research or relevance to clinical question. So far, we’ve reviewed… • Banda, D. R., Hart, S. L., & Liu-Gitz, L. (2010). Impact of training peers and children with autism on social skills during center time activities in inclusive classrooms. Research in Autism Spectrum Disorders, 4(4), 619-625. • Kohler, F. W., Greteman, C., Raschke, D., & Highnam, C. (2007). Using A Buddy Skills Package To Increase The Social Interactions Between A Preschooler With Autism And Her Peers. Topics in Early Childhood Special Education, 27(3), 155-163. • Wang, S., Cui, Y., & Parrila, R. (2011). Examining The Effectiveness Of Peer-mediated And Video-modeling Social Skills Interventions For Children With Autism Spectrum Disorders: A Meta-analysis In Single-case Research Using HLM. Research in Autism Spectrum Disorders, 5(1), 562-569.

6. Trending Single case design inclusive preschools No generalisation phase Short sessions Acheivable and affordable No significant difference between video modelling and peer training

7. Clinical Bottom Line Banda (2010) A package consisting of training, teacher support and visual cue cards produced increases in frequency of social overtures that peers directed with their playmate with Autism . Lexie also directed more overtures to her peers, even though she did not receive direct teacher support. High levels of exchanges during maintenance period when teacher support was discontinued occurred. Kohler (2007) Both video-modeling and peer training are effective interventions to improve social skills in children with ASD. Video-modeling may be slightly more effective for younger children, although the results are not conclusive. No significant difference in treatment effect was found between the two interventions. Wang (2011) Adult direct instruction and prompts may increase the ability of school-aged children with ASD to initiate questions and respond to questions during small group peer interactions. It is unclear if this increase in initiation and response will be maintained when the adult prompts are no longer provided or when interacting in larger groups.

8. Relevance to practice • National disability insurance scheme & change of disability services to inclusive services in naturalistic environments • Realistic model of teaching social skills in inclusive environments

9. Ipad Topic

10. Ipad Continued….. Ipad research (new articles considered for CAPs): • Using Ipad for Videomodeling (play skills, imitation skills) • Using Ipad as Speech Generating Device to teach requesting (e.g. PECS vs Proloquo2go) • Using pictures on Ipad to teach requesting (e.g. My Choice Board) • Effectiveness of individual Apps (still mainly Proloquo2go)***

11. Articles we CAP’d • Kasari, C., Kaiser, A., Goods, K., Nietfeld, J., Mathy, P., Landa, R., Murphy, S., Almirall, D.(2012) Communication Interventions for Minimally Verbal Children with Autism: A Sequential Multiple Assignment Randomized Trial. Journal of the American Academy of Child & Adolescent Psychiatry, vol. 53, no. 6, 635-646 (Randomized Control – Level II evidence – 61 children (mean 6.31 years)) • Van Der Meer, L, Kagohara, D., Roche, L., Sutherland, D., Balandin, S., Green, V., O’Reilly, M., Lancioni, G., Marschik, P. Sigafoos, J. (2013). Teaching multi-step requesting and social communication to two children with autism spectrum disorders with three AAC options. Augmentative and Alternative Communication, 222-234. (Alternating Treatments – Level IV evidence – 2 children 10yr and 11 yr) • Dundon, M., McLaughlin, T. F., Neyman, J., Clark, A. (2013). The effects of a model, lead and test procedure to teach correct requesting using two Apps on an Ipad with a 5 year old student with Autism Spectrum Disorder. Educational Research International 1.3 (2013): 1-10. (Multiple baseline single subject – Level IV- 2 free apps (My Choice Board & Go Talk Now) Clinical Question: In minimally verbal children with ASD, does the use of an Ipad as a speech generated device improve communication outcome?

12. Bottom Line of CAPs PECS vs SGD – inconsistent results, but both better than manual signing – too small a sample size – needs further investigation Kasari – using an SGD (Ipad (app not specified) or Dynavox) in a blended intervention results in significantly more spontaneous communicative utterances than blended intervention with spoken language only (blended intervention including JAPSER (JA, Joint engagement, play) and Enhanced Milieu Teaching (systematic modeling and prompting for spoken language).

13. Dundon et al Two free Apps (with model, lead (hand over hand) and test, then withdrawn) – both led to increases in requesting but my choice board had best results Dependent Variable - # requests participant made using Ipad Not very robust study, but interesting as very clinically replicable research into a particular app

14. The Ipad is just a portable computer Meta-Analyses looking at efficacy of technology based/ computer based interventions (not Ipad specific) • There is some evidence that supports the use of technology based interventions for Autism Spectrum Disorders (Grynspan et al 2014) though there is a need for further research (i.e. RCT studies, and replication of previous results) • Use of computer based interventions to improve social and emotional skills of individuals with ASD is a “promising practice” though evidence limited and little information available about generalization to additional contexts and real life situations (Ramdoss et al 2012) These studies looked at software programs targeting specific skills such as social affect recognition and generating solutions for social conflict solutions.

15. Our bottom line so far… • The Ipad is a socially desirable device that may allow an affordable, portable and convenient means of practicing goals using an evidence based treatment model (e.g. using the Ipad video for videomodeling, but video camera equally as effective). • There continues to be little published research on the effectiveness of individual apps designed to target language and social skills that are currently available for the Ipad.

16. Issues..

17. Our Group Discussion for Clinical Practice • Many children already know the Ipad as a source of entertainment and may resist educational use • The Ipad may be used as a tool for respite for mum and dad or a coping mechanism (surviving the doctor’s waiting room) • Unmonitored Ipad access could increase social isolation (counterproductive) • <2 hr/ day screen time recommendations?

18. An Ipad may be a useful tool for a clinician for it’s portability and ease of use and can be used to deliver evidence based therapies, but it may not be the best tool for all children as a therapy tool and a therapist’s knowledge of the family and child will always be paramount in deciding whether it is a motivating reinforcer or a distraction.

19. Our (unresearched) Ipad App Spreadsheetin the absence of evidence

21. Thank you • To the group members who have stuck with us through three years of leadership changes and continue to attend meetings and submit CAPs • Kate Broome for supporting us to book rooms at a new location and who has very kindly agreed to take over group co-leadership in 2015 as I step down

22. Group Contacts for 2015 Anita Calabrese - Aspect acalabrese@autismspectrum.org.au Kate Broome – Sydney Children’s Hospital Kate.broome@sesiahs.health.nsw.gov.au