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Interventions for Facilitating Social Interactions in Preschoolers
Interventions That Enhance Preschoolers’ Interactions with Other Adults
Stahmer (1995) compared two interventions—symbolic play training and language training—using pivotal response techniques, including child choice and reinforcing attempts, among others, with seven preschoolaged children with autism who had some verbal skills. In addition to demonstrating increases in the targeted symbolic play skills, the children demonstrated increased positive responses to adult initiations and smaller increases in initiations to adults in the play training, but not the language training, intervention. These results were maintained for 3 months after the end of treatment and generalized over settings and other adults, but not peers.
Krantz and McClannahan (1998) used a visual cuing system involving a script-fading procedure to increase social initiations to a teacher. The technique, previously found to be effective with older children, involved using a one-word stimulus embedded in a child’s independent play schedule. The stimulus prompted the child to approach an adult and initiate a joint attention request (look, watch me, etc.), to which the adult responded with various comments about the child’s behavior, but without any other reinforcing consequence.
Over time the script was faded. Three preschoolers with some language learned the procedure, maintained and increased initiations even after the stimuli were faded, and demonstrated generalization by using unscripted and elaborated initiations and by generalizing across new adults and new activities. One important aspect of this technique for eliciting social initiations deserves highlighting. By using a visual cue, potential difficulties seen in adult prompting paradigms (disruptions in ongoing social interactions, constant presence of cuing adult, difficulties with fading adult prompts; Oke & Schreibman, 1990) were avoided.
Interventions That Increase Preschoolers’ Peer Interactions
Progress in this area has been profoundly influenced by the work of Strain, Odom, Goldstein, and their associates, who have worked to develop successful peer-mediated strategies for the past 20years, some of which are discussed below. Their work represents the strongest empirical support for a single type of social intervention for autism. In their peer-mediated approach, typical peers are taught to initiate "play organizers" with perseverance: sharing, helping, giving affection, and praise. Peers role-play with adults until they have learned the strategies successfully and then are cued by adults to begin to interact with the target children around typical play materials and activities. The peers are reinforced by adults for their efforts, and the reinforcements are systematically and carefully reduced.
These strategies are powerful in increasing the social interactions of young children with autism, and both generalization and maintenance have been demonstrated in inclusive preschool classes, as reported in many published multiple baseline studies (Goldstein, Kaczmarek, Pennington, & Shafer, 1992; Hoyson, Jamieson, & Strain, 1984; Odom et al., 1999; Odom & Strain, 1986; Strain, Kerr, & Ragland, 1979; Strain, Shores, & Timm, 1977). Over the years, these researchers have carefully explored variables involved in achieving maximum effects, including generalization and maintenance. Such variables have included characteristics of the peers, methods of prompting and reinforcing peers, fading reinforcers, ages of children, and characteristics of the setting. Various replications of these techniques have demonstrated the importance of using multiple peer trainers in achieving generalization across untrained peers (Brady, Shores, McEvoy, Ellis, & Fox, 1987) and in maintaining skills in the peer-trainers (Sainato, Goldstein, & Strain, 1992). Self-monitoring systems have been successfully used to maintain the interactions without adult reinforcement (Strain, Kohler, Storey, & Danko, 1994). Delivering these interventions in inclusive preschools rather than in lab settings results in the more stable, generalized, and well-maintained increases in social interactions. Finally, Strain and Danko (1995) and Strain et al. (1994) demonstrated that parents could be taught to teach peer-mediated approaches to siblings at home, with resulting improvements in child–sibling interactions.
The use of play organizers was replicated and extended by Oke and Schreibman (1990) in a case study. After using the peer-mediated approach with one high functioning 5-year-old with autism, they added two procedures. First, they trained the typical peer to discriminate between parallel play and interactive play, which increased and stabilized responding of the target child. Second, they trained the target child in the peer-initiating procedures. This third intervention had four important effects: maintenance of high rates of social engagement during the reversal phase, decrease in inappropriate behaviors, normalization of child affect, and maintenance and generalization across peers but not across settings.
The peer-mediated procedures appear to gain their effectiveness by using typical peers as the interventionists, thus eliminating the need to develop procedures to transfer learning from adult partners to peer partners. This is an important feature because studies have demonstrated that use of adult partners to increase interactions of children with autism does not easily generalize to peer partners. These highly effective peer-mediation approaches are complex to deliver, requiring socially skilled typical peers and precise adult control at training peers, managing and fading reinforcement, and monitoring ongoing child interaction data. However, the approach is manualized (Danko, Lawry, & Strain, 1998) and well described in many publications.
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