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Autism: Family Life - Tactics for Getting Normal Again
Autism continuing education social worker CEUs

Section 16
Interventions that Increase School-age Children's Social Interactions at Home and in School

CEU Question 16 | CEU Answer Booklet | Table of Contents | Autism
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

Interventions that Increase School-Aged Children’s Social Interactions with Adults
Several different successful approaches for increasing interactions of school-age children with adults have been reported. These have included self-management strategies, teaching sociodramatic role-play usingautism Family Life counselor CEU pivotal teaching responses, and video-modeling techniques, as well as more straightforward adult instruction.

Self-Management Techniques
Koegel, Koegel, Hurley, and Frea (1992) reported a multiple baseline across settings and four subjects focused on increasing appropriate verbal responses to others’ social initiations. Training was conducted across several settings. Children used a wrist counter to tally frequencies, which were converted to points and exchanged at intervals for small (mainly edible) rewards.

The reinforcement schedule was thinned drastically (1:30) within the first few training sessions. Each of the children demonstrated rapid improvement in appropriate responding that remained at high levels across the rest of the study, as well as in collateral decreases in inappropriate language and disruptive behavior. Withdrawal of the procedure for two subjects resulted in decreases in responding.

 Pivotal Response Training (PRT)
Thorp, Stahmer, and Schreibman (1995) used PRT to teach sociodramatic role play to three verbal boys with autism in a multiple baseline across participants probe design, with children selecting preferred materials, adult modeling and shaping procedures used, approximations reinforced with task-related reinforcers, and high levels of success assured. While the training focused on play acts with objects, measures of social engagement and initiations were also collected. The procedure resulted in increased amounts and complexity of sociodramatic play that generalized across settings, increased appropriate language, decreased inappropriate language, increased appropriate social engagement, and decreased inappropriate social behavior. Social initiation was affected less by the training. This also essentially replicates the Stahmer (1995) study.

Video-Modeling Techniques
Charlop and Milstein (1989) reported the successful use of video modeling to teach conversational skills. Three high-functioning boys with autism repeatedly watched an experimental videotape containing simple appropriate conversations and then reproduced the conversations with an adult. All children rapidly acquired reciprocal conversational speech from these scripts, with improvements generalized to other people and topics and maintained over a 15-month follow-up period.

Direct Instruction
Coe, Matson, Fee, Manikam, and Linarello (1990) reported a direct instruction procedure using multiple baselines across three 6-year-old children, two with autism, to play ball with an adult. Four steps in the chain were taught using primary reinforcers. Three (pick up, throw, initiate) were taught at the same time. The last (praise) was taught after acquisition of the others. All three children increased both verbal and nonverbal behaviors associated with ball play, with initiation being
the hardest to acquire. However, no data involving maintenance or generalization were reported.
- Rogers, SJ, Interventions that facilitate socialization in children with autism, Journal of Autism and Development Disorders, Oct 2000, Vol. 30
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #9
The preceding section contained information about interventions that increase school-age children's social interactions.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 16
What four approaches are used to increase interactions of school-age children with adults? Record the letter of the correct answer the CEU Answer Booklet.

 
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Anxiety in 3- to 7-year-old children with autism spectrum disorder seeking treatment for disruptive behavior
Autism, Ahead of Print.
Anxiety is a common and impairing problem in children with autism spectrum disorder, but little is known about it in preschool children with autism spectrum disorder. This article reports on the characteristics of anxiety symptoms in young children with autism spectrum disorder using a parent-completed rating scale. One hundred and eighty children (age 3–7 years) participated in a clinical trial of parent training for disruptive behaviors. Anxiety was measured as part of pre-treatment subject characterization with 16 items from the Early Childhood Inventory, a parent-completed scale on child psychiatric symptoms. Parents also completed other measures of behavioral problems. Sixty-seven percent of children were rated by their parents as having two or more clinically significant symptoms of anxiety. There were no differences in the Early Childhood Inventory anxiety severity scores of children with IQ < 70 and those with ⩾70. Higher levels of anxiety were associated with severity of oppositional defiant behavior and social disability. Anxiety symptoms are common in preschoolers with autism spectrum disorder. These findings are consistent with earlier work in school-age children with autism spectrum disorder. There were no differences in anxiety between children with IQ below 70 and those with IQ of 70 and above. Social withdrawal and oppositional behavior were associated with anxiety in young children with autism spectrum disorder.
Obesity, physical activity, and sedentary behaviors in adolescents with autism spectrum disorder compared with typically developing peers
Autism, Ahead of Print.
Decreased engagement in beneficial physical activity and increased levels of sedentary behavior and unhealthy weight are a continued public health concern in adolescents. Adolescents with autism spectrum disorder may be at an increased risk compared with their typically developing peers. Weekly physical activity, sedentary behavior, and body mass index classification were compared among adolescents with and without autism spectrum disorder. Analyses included 33,865 adolescents (autism spectrum disorder, n = 1036) from the 2016–2017 National Survey of Children’s Health (United States). After adjustment for covariates, adolescents with autism spectrum disorder were found to engage in less physical activity and were more likely to be overweight and obese compared with their typically developing peers (p’s < 0.05). As parent-reported autism spectrum disorder severity increased, the adjusted odds of being overweight and obese significantly increased and physical activity participation decreased (p-for-trends < 0.001). The findings suggest there is a need for targeted programs to decrease unhealthy weight status and support physical activity opportunities for adolescents with autism spectrum disorder across the severity spectrum.
Scanpath similarity measure reveals not only a decreased social preference, but also an increased nonsocial preference in individuals with autism
Autism, Ahead of Print.
We compared scanpath similarity in response to repeated presentations of social and nonsocial images representing natural scenes in a sample of 30 participants with autism spectrum disorder and 32 matched typically developing individuals. We used scanpath similarity (calculated using ScanMatch) as a novel measure of attentional bias or preference, which constrains eye-movement patterns by directing attention to specific visual or semantic features of the image. We found that, compared with the control group, scanpath similarity of participants with autism was significantly higher in response to nonsocial images, and significantly lower in response to social images. Moreover, scanpaths of participants with autism were more similar to scanpaths of other participants with autism in response to nonsocial images, and less similar in response to social images. Finally, we also found that in response to nonsocial images, scanpath similarity of participants with autism did not decline with stimulus repetition to the same extent as in the control group, which suggests more perseverative attention in the autism spectrum disorder group. These results show a preferential fixation on certain elements of social stimuli in typically developing individuals compared with individuals with autism, and on certain elements of nonsocial stimuli in the autism spectrum disorder group, compared with the typically developing group.
Psychosocial deficits across autism and schizotypal spectra are interactively modulated by excitatory and inhibitory neurotransmission
Autism, Ahead of Print.
Continued human and animal research has strengthened evidence for aberrant excitatory–inhibitory neural processes underlying autism and schizophrenia spectrum disorder psychopathology, particularly psychosocial functioning, in clinical and nonclinical populations. We investigated the extent to which autistic traits and schizotypal dimensions were modulated by the interactive relationship between excitatory glutamate and inhibitory GABA neurotransmitter concentrations in the social processing area of the superior temporal cortex using proton magnetic resonance spectroscopy. In total, 38 non-clinical participants (20 females; age range = 18–35 years, mean (standard deviation) = 23.22 (5.52)) completed the autism spectrum quotient and schizotypal personality questionnaire, and underwent proton magnetic resonance spectroscopy to quantify glutamate and GABA concentrations in the right and left superior temporal cortex. Regression analyses revealed that glutamate and GABA interactively modulated autistic social skills and schizotypal interpersonal features (pcorr < 0.05), such that those with high right superior temporal cortex glutamate but low GABA concentrations exhibited poorer social and interpersonal skills. These findings evidence an excitation–inhibition imbalance that is specific to psychosocial features across the autism and schizophrenia spectra.
Gender differences in self-reported camouflaging in autistic and non-autistic adults
Autism, Ahead of Print.
Social camouflaging describes the use of strategies to compensate for and mask autistic characteristics during social interactions. A newly developed self-reported measure of camouflaging (Camouflaging Autistic Traits Questionnaire) was used in an online survey to measure gender differences in autistic (n = 306) and non-autistic adults (n = 472) without intellectual disability for the first time. Controlling for age and autistic-like traits, an interaction between gender and diagnostic status was found: autistic females demonstrated higher total camouflaging scores than autistic males (partial η2 = 0.08), but there was no camouflaging gender difference for non-autistic people. Autistic females scored higher than males on two of three Camouflaging Autistic Traits Questionnaire subscales: Masking (partial η2 = 0.05) and Assimilation (partial η2 = 0.06), but not on the Compensation subscale. No differences were found between non-autistic males and females on any subscale. No differences were found between non-binary individuals and other genders in either autistic or non-autistic groups, although samples were underpowered. These findings support previous observations of greater camouflaging in autistic females than males and demonstrate for the first time no self-reported gender difference in non-autistic adults.

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