Evidenced-Based Socialization Interventions for Children with ASD

1. Evidenced-Based Socialization Interventions for Children with ASD Sunyoung Kim, M.Ed. & Gregory Lyons, M.A. University of Wisconsin – Madison

2. Why Improve Social Skills? • Difficulties in social functioning: • Are a defining aspect of ASD(Kanner, 1943; APA, 2000) • Put individuals with autism at risk for social isolation, loneliness, delinquent behavior, low academic achievement, increase job loss, and mental health problems(Williams & Asher, 1992; Bauminger & Kasari, 2000; Koegel & Koegel, 1995 ;& Strain, 1991) • Up to 38% risk of developing comorbid diagnosis in depression in comparison to only 6.7% of the general population (Stewart, et. al., 2006; NIMH.nih.gov/health/publications) • Appropriate social development in peer interactions is critical for later adjustment, acceptance by others, and one’s quality of life(Guralnick, 1990). • Children with successful social interactions have a higher positive self-concept and self-esteem(Janney & Snell, 2006)

3. Four Factors of evidence-based practice: Research Findings Professional judgment Values and Preferences Capacity (National Autism Center, 2009) Evidence-Based Practices Effective and Scientifically valid interventions and Treatments (for students with ASD)

4. IDEA in 2004: require that evidence-based practices be used to ensure individuals with disabilities receive the highest quality instruction. No Child Left Behind (NCLB): requires that teacher use evidence-based practices in their classrooms. Importance of Evidenced-Based Practices?

5. Established Treatments • Antecedent Package • Behavioral Package • Comprehensive Behavioral Treatment for Young Children • Joint Attention Intervention • Video Modeling • Naturalistic Teaching Strategies • Peer Training Package • Pivotal Response Treatment • Schedules • Self-Management • Story-based Intervention Package (The National Autism Center, 2009)

6. Two Evidenced-Based Interventions • Video Modeling • Naturalistic Behavior Interventions • Pivotal Response Treatment

7. Video-Modeling Intervention • The interventions rely on an adult or peer providing a demonstration of the target behavior that should result in an imitation of the target behavior by a target child with ASD. • VM involves a child watching videotapes of positive examples of adults, peers, or him- or her self engaging in a behavior that is being taught. (Haring, Kennedy, Adams & Pitts-Conway, 1987)

8. The observational learning is a basic learning mechanism. Visual perception abilities of individuals with autism are often seen as an area of strength. Motivation (Darden-Brunson et al., 2008; Bellini and Akullian, 2007) The Rationales for using video-based instruction

9. VM Procedures 1. Identify and select target social behaviors • Observable and measurable behaviors (e.g., saying hello to peers) 2. Interview parents and observe the child • Formal or informal preference assessment 3. Select and train models • Self-modeling and other-modeling • Training by role-play 4. Record target behaviors and Edit the video • Natural behaviors • The duration of the video

10. Procedure (Cont.) 5. Baseline • Collect baseline data • No video intervention 6. VM sessions: show the video clip of desired behavior to the target child • Refrain from adult direction • Several sessions • Identical setting to baseline • Collect intervention data and graph data 7. Promote maintenance and generalization • New settings, people or behaviors (Banda et al. 2007)

11. What if my child does not attend to the video? • Find a video the child likes, turn it on and play just a bit of it in order to get the child’s attention • Then before the child turns away, put on the video clip for the modeling intervention (Hine&Wolery, 2006)

12. Research/ the Effects of VM

13. Research D’Ateno, Mangiapanello, and Taylor (2003) • Adult modeled video intervention to teach complex interactive play sequences to a preschooler with autism. • A 3 years-old girl learned to use scripted and non-scripted play sequences, including verbal social commenting on the play (e.g., come on drink the tea) and actual play actions (e.g., placing plates on the table or pouring tea).

14. Example Evidence “Using video modeling to teach complex play sequences to a preschooler with autism” (D'Ateno, Mangiapanello & Taylor, 2003)

15. Example Evidence “Using video modeling to teach reciprocal pretend play to children with autism” (MacDonald et al. 2009)

16. Strengths • Convenience for parents and teachers because recorded video-taped can be reused. • Systemic and controlled, as the video scenario can be rehearsed and re-recorded until the behavior of the model is to an acceptable standard. • Time and cost effective. (Bourdeau& D’Entremont, 2010)

17. Case Example: “Turn Taking”

18. Naturalistic Behavior Interventions Less “Natural” More “Natural” • Utilizes principles of Applied Behavior Analysis: • Natural environments and contexts (examples?) • Natural rewards • Natural activities • Peer-mediated • Promotes generalization/maintenance • Pivotal Response Treatment • Focus on motivation to use the target social skills/goals • Prioritizes certain ABA techniques • Developmentally Sensitive Not structured, little interference by a mediator or facilitator, purely contextualized (e.g., developmental-relationship based models) Highly structured and decontextualized (e.g., some programs in DTT) Naturalistic Behavior Interventions

19. Research Base • Pivotal Response Treatment (peer-mediated packages): • Pierce & Schreibman, (1995) • Pierce & Schreibman, (1997) • Pierce & Schreibman, (1997) • Harper, Symon, & Frea study (2008) • PRT w. Contextually Supported-Play Dates: • Koegel, Werner, Vismara, Koegel (2005) • Peer-mediated incidental teaching: • Mcgee et al. (1992) • Incorporating Special Child-Interests at Recess: • Baker, Koegel, & Koegel (1998) • Baker (2000) • Licciardello et al., 2008 • Boyd, Conroy, Mancil, Nakao, & Alter (2007) • Shafer et al. – adding preferred to recess • Priming Play • Zanolli et al. (1996)

20. Global Socialization Objectives • Increase length of time engaged with peers • Increase variety of activities engaged with peers • Increase responsivity toward peers • Increase initiations toward peers (e.g., play invitations, greetings) • Increase frequency and variety of communicative behaviors • behavior regulation (e.g., requesting) • question-asking • joint attention (e.g., commenting on the play/toy) • conversation • Pragmatics (nonverbal social skills) Goals should be individualized and developed collaboratively with and coordinated with caregivers.

21. Overview of Pivotal Response Treatment Principles: Based upon the principles of Applied Behavior Analysis (ABA) Implemented in the natural environment; within daily routine Improvements in untargeted areas (pivotal areas) Parent education model Pivotal Areas: Motivation Responsivity to Multiple Cues Self-management Self-initiations

22. Motivation: PRT Points When improving an individual’s motivation to acquire new socialization, conversation, and behavior skills: Point 1: Obtain individual’s attention first Point 2: Intersperse acquisition tasks among maintenance tasks Point 3: Provide choices; follow individual’s choice in activity/stimuli Point 4: Responsivity to multiple cues Point 5: Reinforcement contingentupon individual exhibiting target behavior Point 6: Reinforce attempts Point 7: Use direct and natural reinforcers

23. Child attention/Clear cues Maintenance tasks Child choice/ Shared control Antecedent Behavior Consequence B A C Opportunity presented Child responds Response reinforced • Contingent • Reinforce attempts • Direct and natural reinforcers • Depends on: • Target Goals • Context/activity • Maintenance/ • Acquisition balance

24. Peer: Child attention/Clear cues Maintenance tasks Child choice/ Shared control Antecedent Behavior Consequence B A C Opportunity presented Child responds Response reinforced Peer: • Contingent • Reinforce attempts • Direct and natural reinforcers

25. Peer Mediation • Explicit instruction • Modeling • Performance feedback (primarily positive) • Use child-friendly language.

26. Training peers: Be sure peers know ways to gain child’s attention (e.g., “Nicky, ask your brother which color he wants, but make sure he’s looking first by saying his name.”; “Wow Eli, I really like how you got Taj to look at your first!”) Make sure child with ASD is attending to the person speaking to him/her (may have to say the child’s name, tap shoulder, interrupt play) The opportunity to respond (model-prompt, instruction, question, choice, time delay) should be: • Clear • Appropriate to the task • Uninterrupted • Child must be attending

27. Training peers: Peers may need on-going coaching on what opportunities to provide. Step in when needed and remind peers to talk about different things OR provide models on how to give different types of opportunities OR a reminder to make sure they are asking their peers easy questions too. Make sure maintenance verbalizations are interspersed with acquisition verbalizations ***At first, the “acquisition” for children will be the socialization, and opportunities should be set up where child will be successful as often as possible*** Vary what types of verbalizations child with ASD is using to prevent overgeneralization or boredom Vary antecedents (e.g., types of opportunities) - Types of opportunities: Model-prompts, directives, choices, open-ended questions, leading statements, time delays

28. Child directed • Follow child’s lead • Shared control • Provide choices Training peers- Peers can be instructed to give children: - choices in activities to play - follow and see what the child wants to do (What does it look like Jay wants to play?) - give children choices as an opportunity during an activity (e.g., do you want 5 pieces or 2 pieces?). • gain shared control- “Remember to have the piece in your hand before you get his attention and ask him that.” “Wow, I like how you stopped the swing before you asked him if he wanted to go high or low!” • Create “Cooperative Arrangements” • Child directed • Follow child’s lead • Shared control • Provide choices

29. Training peers: “Remember, if your friend Sally needs help opening her snack, wait for her to ask for your help first.” “I like how you asked Taj a question! Next time remember to wait to hand him a card until he answers your question.” “Wow, you’re fast! I’m impressed how you chased Jay when he asked you chase him down the hill!” • Reinforcement contingent upon desired child behavior • Immediate • Appropriate • Dependent

30. Training peers: “Remember, Sally is still learning to talk with friends, so if she tries to ask you to play on the swing, let’s go play on the swing with her.” • Increase motivation to respond • Reasonable attempt • Attention to the task • Related to the task • Intent to respond

31. Training peers: This will naturally fall into place. “Wow, you’re fast! I’m impressed how you chased Jay when he asked you chase him down the hill!” “Wow! When Taj tried to ask you for a turn, you gave her a turn!” “I like how you offered Sally a seat next to you to share a snack, when she asked you what you are eating!” Natural consequence Directly related to the behavior Functionally related to the behavior Generalization to the natural environment

32. PRT for Socialization Follow the child’s lead(i.e., target child chooses which game/toy to play with peer) Interspersemaintenance behavior regulation initiations (previously mastered requests/directives/protests) among acquisition (new requests/directives/protests) behavior regulation initiations Vary the taskto maintain the child’s interest Provide direct and natural reinforcersdirectly related to the child’s behavior (e.g., opportunity to obtain a game piece following initiation toward peer)

33. Example Procedure • Child w/ autism chooses game/activity • Game/toy pieces divided between children or placed in see-through containers for shared control • Child w/ autism prompted to make a behavior regulation initiation toward peer (e.g., “Tell your friend which color you want.”) or peer prompted to get attention & clearly ask the child the child a question. • After making behavior regulation initiation, target child contingently reinforced with natural reinforcers (e.g., requested color) by peer • If necessary, peer prompted by clinician to provide target child with natural reinforcer (e.g., requested color) • Sequence repeated as much as necessary • ***Prompting faded as quickly as possible***

34. Creating a Social Context • Contextually supported interactions- provides a context for • Cooperative Arrangements • Mutually reinforcing activities Where? - Playdates, recess on playground, recess in a class, neighborhood park, ice cream shop…

35. Cooperative Arrangements(cooperative contingencies) • Structure the activity/game so participation of each individual is critical to developing a positive outcome • This strategy is necessary for shared control, gaining child attention,and using natural reinforcers • Find activities that create interdependency- how do I structure an activity so that one kid will need the other kid in order for reinforcement to occur? • How it’s done: • Use toys/games/activities with multiple pieces • Divide pieces in container and take turns • Take turns and share the items

36. Mutually Reinforcing Activities • Activities that both child with ASD and typical peer/siblings both find motivating • How it’s done: • Observe what typical peers play and do • Assess what games and activities child with ASD enjoys • Provide choices during play episode (2 – 3 choices) • Child with ASD has final say • Be discrete • Take turns

37. Cooperative Arrangements: Examples

38. Now it’s Your Turn…Brainstorm how to make these a Cooperative Arrangement

39. General Guidelines:Cooperative Arrangments & MRA’s Child with ASD should be familiar with game/activity Limit to 2 – 3 peers Create cooperative arrangements Explain rules to ALL kids (e.g., “We’re going to practice paying nicely and take turns asking each other for pieces”) Be sure child with ASD has opportunities to respond as well as initiate Give feedback to ALL the kids Have typically developing peers also practice responding and initiating to each other

40. General Guidelines: Continued • Initially focus on opportunities for behavior regulation (requesting); intersperse some opportunities for social interaction and joint attention statements if appropriate • Be sure to have kids respond to each other immediately as well as immediately deliver natural reinforcers (prompt if necessary) • Practice both “telling” and “asking” • Use colloquial speech • Systematically fade prompting • Initially may need to prompt both child with ASD and peers • Initially start with model-prompt for entire utterance • Quickly fade to partial verbal prompts, gestural prompts, time delays • Make it short at first

41. Summary • How you can choose evidence-based practices. • Two ways to teach and motivate your child to learn and use social skills. • We saw this through.. • Showing your child video models of social skills • Setting up PRT opportunities within contextually supported interaction with peers.

42. Thank you! • We would like to thank Dr. Wendy Machalicek for her guidance. • For ongoing presentations on recent advances in autism research (RADAR), please visit: • uwradar.wordpress.com • Also, for more information on Pivotal Response Treatment: • www.education.ucsb.edu/autism