Increasing joint attention, play and language through peer supported play

Peer mediation in play settings for minimally verbal students with autism Spectrum disorder

Background and aims

Peer-mediated interventions (PMIs) are effective strategies to foster socialization of children with autism spectrum disorder (ASD) in natural settings. However, research examining the efficacy of peer mediation for students with ASD who have the greatest cognitive and language impairments remains limited. Additionally, previous studies essentially targeted communicative abilities of participants. To address this gap, the present study evaluated the effects of a play-based PMI on three socio-communicative skills (play, social engagement and imitation) of minimally verbal students with ASD who also have a comorbidity of intellectual disability (ID).

Methods

Seven children with ASD attending ordinary school settings and 14 typically developing (TD) preschoolers participated. Seven single-sex groups were formed, and children played together during two 30 min weekly sessions. TD children were trained according to the principles of the integrated play group model. We used a multiple-baseline design across participants to measure the effects of the intervention on play skills, social engagement and motor imitation of students with ASD.

Results

Outcomes revealed an intervention effect for most of the participants, despite some variations across children. After the peer training, four children increased their duration of functional/symbolic play, six children improved their duration of interactive play and five children increased their rates of motor imitation. Concerning maintenance gains, inter-individual differences are also important.

Conclusions and implications

These findings suggest that a play-based PMI may be a feasible option for targeting inclusive education and improving socio-communicative skills of some minimally verbal students with ASD who also have an ID. However, variations across children invite further research to clarify how individual factors can moderate the effects of PMIs in children with ASD who are the most impaired.

Enhancing Joint Attention Skills in Children on the Autism Spectrum through an Augmented Reality Technology-Mediated Intervention

In the present study, the effects of an intervention based on an augmented reality technology called Pictogram Room were examined. The objective of the intervention was to improve the responding to joint attention (RJA) skills of gaze following and pointing in six children on the autism spectrum between 3 and 8 years old. A multiple baseline single-subject experimental design was conducted for 12 weeks in a school setting. Results indicated that all of the participant children improved performance in RJA following the intervention. Improvements were maintained over time and generalised to real-world situations. These findings demonstrate that autistic children can improve their RJA skills with a targeted and engaging intervention based on an accessible augmented reality technology tool.

Developing Pretend Play in Autistic Children Using the Playboxes Joint Play Approach as Part of Ongoing Practice

A repeated measures single subject design was used to examine the effectiveness of a joint play approach embedded in professional practice, in supporting pretend play for autistic children. Seven autistic children, aged 5–8 years, with a placement within a specialist educational provision, and who demonstrated restricted play, participated in weekly sessions using the Playboxes approach over a period of 3 months. Pre- and post-approach pretend play abilities were assessed using the Symbolic Play Test and the Test of Pretend Play. Every child gained increased age-equivalent scores on the Test of Pretend Play, ranging from + 8 to + 30 months. Pretend Play abilities can support developmental outcomes and incorporation of this approach into regular practice could be of value for autistic children.

Attentional Patterns to Emotional Faces Versus Scenes in Children with Autism Spectrum Disorders

Previous research has shown attentional biases in children with autism spectrum disorders (ASD) when processing distressing information. This study examined these attentional patterns as a function of the type of stimulus (scenes and faces) and the stimulus valence (happy, sad, threatening, neutral) using a within-subject design. A dot-probe was applied to ASD (n = 24) and typically developing (TD) children (n = 24). Results showed no differences between the groups for happy and sad stimuli. Critically, ASD children showed an attentional bias toward threatening scenes but away from threatening faces. Thus, the type of stimuli modulated the direction of attentional biases to distressing information in ASD children. These results are discussed in the framework of current theories on cognitive and emotional processing in ASD.

Communication deficits and avoidance of angry faces in children with autism spectrum disorder

BACKGROUND

Understanding how emotional faces are processed is important to help characterize the social deficits in Autism Spectrum Disorder (ASD).

AIMS

We examined: (i) whether attention is modulated by emotional facial expression; (ii) the time course of the attentional preferences (short vs. long stimulus presentation rates); and (iii) the association between attentional biases and autistic symptomatology.

METHOD AND PROCEDURES

We applied a dot-probe experiment with emotional faces (happy, sad, and angry). The sample was composed of ASD children without additional language and/or intellectual impairments (n=29) and age-matched Typically Developing (TD) children (n=29).

OUTCOMES AND RESULTS

When compared to the TD group, the ASD group showed an attentional bias away from angry faces at long presentation rates. No differences between groups were found for happy or sad faces. Furthermore, correlational analyses showed that the higher avoidance of angry faces, the greater are the social communication difficulties of ASD children. The attentional bias away from angry faces may be an underlying mechanism of social dysfunction in ASD. We discuss the implications of these findings for current theories of emotional processing in ASD.

Social Play and Autistic Spectrum Disorders

The article considers the nature of the presumed social play deficit in autistic spectrum disorders (ASDs). The nature of play and its typical development is outlined and discussed in relation to play development in ASDs. It is suggested that social play is a confluence of two strands of development that are affected in autism: social and emotional development, and the cognitive development of play. It is shown that social play develops in a transactional way and in ASDs initial social difficulties prevent the development of social interaction, with its role in eliciting and enriching spontaneous play. At the same time, cognitive and affective difficulties prevent the play of children with autism developing to the extent of attracting other children and being of a complexity from which social play might develop. This cycle of impoverished play opportunities for children with ASDs may be broken through direct teaching and there are encouraging models of teaching social play with some success.

Supporting Children on the Autism Spectrum in Peer Play at Home and School

The article focuses on integrated play groups (IPGs) as a model to support children with ASD in play with typically developing peers/siblings, and its recent adoption with children in a home and school setting in Taiwan. The first part provides a brief overview of the IPG model and its essential features. The second part reports on a pilot investigation that combined quantitative and qualitative methods to examine the effects of participation in IPGs on the symbolic and social play of two early elementary-aged children with autism. Preliminary findings suggest that each child made notable gains in reciprocal social interaction and symbolic/pretend play while participating in play groups. Implications are discussed in terms of play’s role in enhancing socialization, imagination and peer cultural inclusion.

Beyond Echoplaylia

The article was written to support the use of play as a medium to extend and enrich the communicative exchanges and, more specifically, the symbolic language of children on the autistic spectrum. The first argument in support of such use of play lies within the features of autistic communication, and particularly the extreme challenges encountered in imaginative play and narrative thought. The second argument on behalf of play lies within the selection of specific inter- vention strategies, which are discussed subsequently. Finally, the article presents a case illustration of how adult facilitated dramatic peer play led to a breakthrough in a range of symbolic behaviours in a 9-year- old girl with autism, who up to that point had not progressed beyond a semi-communicative use of echolalia, best described as ‘situation association’.

Effect of Occupational Therapy–Led Playgroups in Early Intervention on Child Playfulness and Caregiver Responsiveness: A Repeated-Measures Design

OBJECTIVE. This study's objective was to investigate the effects of a community playgroup on the playfulness of children with special needs ages 15 mo to 3 yr and the responsiveness of their caregivers.

METHOD. Using a pretest–posttest, repeated-measures design, we evaluated 8 child–caregiver dyads participating in an 8-wk occupational therapist–led community playgroup recruited from a purposive sample enrolled in early intervention. Video recordings from four time points over 4 mo were used to determine playfulness (Test of Playfulness) of the child and the responsiveness of the caregiver.

RESULTS. Blinded raters assessed playfulness and responsiveness outcomes. A repeated-measures analysis of variance demonstrated that participation in the playgroup significantly increased child playfulness (ηp2 = .89, p < .01). Analysis did not detect a change in caregiver responsiveness.

CONCLUSION. The results of this study have implications for the use of playgroups in comprehensive occupational therapy practice in early intervention.

Integrated play groups: promoting symbolic play and social engagement with typical peers in children with ASD across settings

Children with autism spectrum disorders (ASD) face pervasive challenges in symbolic and social play development. The Integrated Play Groups (IPG) model provides intensive guidance for children with ASD to participate with typical peers in mutually engaging experiences in natural settings. This study examined the effects of a 12-week IPG intervention on the symbolic and social play of 48 children with ASD using a repeated measures design. The findings revealed significant gains in symbolic and social play that generalized to unsupported play with unfamiliar peers. Consistent with prior studies, the outcomes provide robust and compelling evidence that further validate the efficacy of the IPG model. Theoretical and practical implications for maximizing children's developmental potential and social inclusion in play are discussed.

Similarity hypothesis: understanding of others with autism spectrum disorders by individuals with autism spectrum disorders

Individuals with an autism spectrum disorder (ASD) are generally thought to lack empathy. However, according to recent empirical and self-advocacy studies, individuals with ASD identify with others with ASD. Based on mutual understanding, individuals with ASD respond empathically to others with these disorders. Results have shown that typically developing (TD) adults identify with TD fictional characters, and that such identification plays a critical role in social cognition. TD individuals retrieve episodes involving TD individuals faster than they retrieve episodes involving ASD individuals. Individuals with ASD also show a “similarity effect” whereby they retrieve stories involving ASD individuals more effectively when the stories have consistent outcomes than when they have inconsistent outcomes. In this context, I hypothesized that similarities between a perceiver and a target facilitate cognitive processing. This hypothesis was named the “similarity hypothesis”. Perceivers empathize with targets similar to themselves, which facilitates subsequent cognitive processing. Behavioral and neuroimaging studies are reviewed based on the similarity hypothesis.

Teaching play skills to young children with autism

BACKGROUND

Play is critical for the development of young children and is an important part of their daily routine. However, children with autism often exhibit deficits in play skills and engage in stereotypic behaviour. We reviewed studies to identify effective instructional strategies for teaching play skills to young children with autism.

METHOD

Empirical studies on teaching play skills to young children with autism published from 1990 to 2011 were located. These studies included single subject and group designs.

RESULTS

Twenty-six studies were reviewed. The majority of studies on teaching play skills used combined interventions. Children with autism improved their play skills, with direct intervention embedding their interests during play. Improvements in play skills increased positive social interactions and decreased inappropriate behaviour as collateral effects.

CONCLUSIONS

Further research is needed to develop more effective play skill interventions that assess the functional use of play and are implemented in the natural environment.

Comparing cognitive outcomes among children with autism spectrum disorders receiving community-based early intervention in one of three placements

Little comparative research examines which community-based preschool intervention placements produce the best outcomes for which children with autism spectrum disorders. Autism-specific placements can provide intensive evidence-based care; however, inclusion settings provide interaction with typically developing peers, the importance of which is increasingly recognized. This study examined the association between early intervention placement in three settings (autism-only, mixed disability, or inclusive) and cognitive outcomes upon entry into elementary school in an urban school district for 98 preschool-aged children with autism spectrum disorders. Initial child and demographic characteristics were similar among the three placements. Controlling for initial cognitive scores and other covariates, cognitive outcomes for children in inclusive placements were better than those of children in mixed disability settings. A consistent pattern emerged that suggested the particular importance of inclusive placements for children with initially greater social impairments, greater adaptive behavior impairments, and at least a baseline level of language skills. Opportunities to interact with typically developing peers may be particularly beneficial for certain subgroups of young children with autism spectrum disorders. The results provide preliminary insight into important child characteristics to consider when parents and providers make preschool early intervention placement decisions.

Competência social, inclusão escolar e autismo: um estudo de caso comparativo

A presente pesquisa analisou o perfil de competência social (CS) de uma criança pré-escolar com autismo, na escola comum comparado a uma criança com desenvolvimento típico e investigou a influência do ambiente escolar (sala de aula ou pátio) no perfil de CS de ambas. As interações sociais com seus pares foram filmadas, na escola, e a codificação dos vídeos foi realizada por um avaliador independente. Utilizou-se como instrumento a versão adaptada da Escala Q-sort de CS. Os resultados demonstraram que enquanto o perfil de competência social da criança com desenvolvimento típico pouco variou entre os contextos, a criança com autismo demonstrou maior frequência de comportamentos de cooperação e asserção social e menor frequência de agressão e desorganização do self, no pátio.

Co-learning facilitates memory in mice: a new avenue in social neuroscience

Social context affects brain function but our understanding of its neurobiology is at an early stage. The mere presence of one individual can alter the cognitive capacities of another and social learning has been demonstrated in many species, including the mouse. We asked several questions: 1. How can active engagement of two familiar mice in the same learning activity (co-learning) alter their memory? 2. Under which environmental conditions (aversive vs non-aversive) can we expect the memory to be enhanced, impaired, or not affected? 3. Can a genetic factor modify the co-learning effect on memory? More specifically, can co-learning correct memory deficits in autistic-like BTBR inbred mice with deficient sociability? We demonstrated that pairs of familiar inbred mice of the same or different genotypes (C57BL/6J and BTBR) that were habituated to new objects and their spatial location, had enhanced episodic memory in the spatial object recognition test, whereas individually-trained animals failed to solve this task. Notably, the co-learning effect was genotype-dependent. BTBR mice paired with BTBR cage-mates in the habituation session modestly ameliorated their performance in the object recognition test but co-learning with a familiar C57BL/6J mouse completely normalized episodic memory deficit. Next, we explored the co-learning effect on fear memory in these inbred strains. Interestingly, mice of both genotypes displayed significantly enhanced contextual fear memory once they had been conditioned together with BTBR animals. The same influence of BTBR presence was observed on cued fear memory in C57BL/6J mice, whereas a modest co-learning effect was found on cued fear conditioning in the BTBR strain. Taken together, we demonstrated for the first time the co-learning effect on cognitive capacities in mice, which can be modified by genetic background and environmental conditions. The possible implications of this methodological approach in social neuroscience are discussed. This article is part of a Special Issue entitled 'Cognitive Enhancers'.

Initiating and responding to joint attention bids in children with autism: a review of the literature

Joint attention is a skill that involves coordinating the attention of at least two individuals towards an object or event. Although it is seen as a critical skill in early child development, it is frequently absent in children with autism and has been linked to poorer language outcomes for those children. As a result, multiple interventions have been developed to teach children with autism to respond to, and initiate, bids for joint attention. These interventions, however, differ widely both in terms of procedures used and in whether they focus on teaching children to respond to, or initiate, bids for joint attention. This literature review was conducted to document research gaps and intervention similarities between joint attention intervention studies for children with autism. The specific intent of this review was to determine whether researchers teach responding and initiating separately or sequentially, describe the extent to which procedures differ among studies, and identify whether social or non-social consequences are used during joint attention training. Implications for the treatment of joint attention deficits are discussed and recommendations to both researchers and practitioners are provided.

Interventions targeting attention in young children with autism

PURPOSE

The ability to focus and sustain one's attention is critical for learning. Children with autism demonstrate unusual characteristics of attention from infancy. It is reasonable to assume that early anomalies in attention influence a child's developmental trajectories. Therapeutic interventions for autism often focus on core features of autism such as communication and socialization, while very few interventions specifically address attention. The purpose of this article is to provide clinicians a description of attention characteristics in children with autism and discuss interventions thought to improve attention.

METHOD

Characteristics of attention in children with autism are presented. Intervention studies featuring measures of attention as an outcome variable for young children with autism are reviewed to present interventions that have empirical evidence for improvements in attention. Results are synthesized by strategy, specific feature of attention targeted, and results for both habilitative goals and accommodations for attention.

CONCLUSION

Although research is not extensive, several strategies to support attention in young children with autism have been investigated. The empirical findings regarding these strategies can inform evidence-based practice.

Social peers rescue autism-relevant sociability deficits in adolescent mice

Behavioral therapies are currently the most effective interventions for treating the diagnostic symptoms of autism. We employed a mouse model of autism to evaluate components of behavioral interventions that improve sociability in mice. BTBR T+tf/J (BTBR) is an inbred mouse strain that exhibits prominent behavioral phenotypes with face validity to all three diagnostic symptom categories of autism, including robust and well-replicated deficits in social approach and reciprocal social interactions. To investigate the role of peer interactions in the development of sociability, BTBR juvenile mice were reared in the same home cage with juvenile mice of a highly social inbred strain, C57BL/6J (B6). Subject mice were tested as young adults for sociability and repetitive behaviors. B6 controls reared with B6 showed their strain-typical high sociability. BTBR controls reared with BTBR showed their strain-typical lack of sociability. In contrast, BTBR reared with B6 as juveniles showed significant sociability as young adults. A 20-day intervention was as effective as a 40-day intervention for improving social approach behavior. High levels of repetitive self-grooming in BTBR were not rescued by peer-rearing with B6, indicating specificity of the intervention to the social domain. These results from a robust mouse model of autism support the interpretation that social enrichment with juvenile peers is a beneficial intervention for improving adult outcome in the social domain. This novel paradigm may prove useful for discovering factors that are essential for effective behavioral treatments, and biological mechanisms underlying effective behavioral interventions.

Empirisch überprüfte Frühfördermethoden bei autistischen Störungen

Autistische Störungen (AS) zeichnen sich durch Einschränkungen in den drei Bereichen soziale Interaktion, Kommunikation und Sprache sowie durch stereotypes Verhalten und Sonderinteressen aus. Im Rahmen der Frühförderung bei AS geht es um eine umfassende Förderung der gemeinsamen Aufmerksamkeit, des Spielverhaltens, der Sprachentwicklung sowie insbesondere der sozialen Interaktion und Kommunikation. Es existieren unterschiedliche, empirisch relativ gut überprüfte, verhaltenstherapeutische Ansätze und Therapieprogramme, die in diesem Artikel zusammengefasst sind. Dabei wird besonderer Wert auf die wissenschaftliche Evidenz der jeweiligen Ansätze gelegt.

Social skills interventions for individuals with autism: evaluation for evidence-based practices within a best evidence synthesis framework

This paper presents a best evidence synthesis of interventions to increase social behavior for individuals with autism. Sixty-six studies published in peer-reviewed journals between 2001 and July 2008 with 513 participants were included. The results are presented by the age of the individual receiving intervention and by delivery agent of intervention. The findings suggest there is much empirical evidence supporting many different treatments for the social deficits of individuals with autism. Using the criteria of evidence-based practice proposed by Reichow et al. (Journal of Autism and Developmental Disorders, 38:1311-1318, 2008), social skills groups and video modeling have accumulated the evidence necessary for the classifications of established EBP and promising EBP, respectively. Recommendations for practice and areas of future research are provided.

Competência social, inclusão escolar e autismo: revisão crítica da literatura

O autismo se caracteriza pela presença de um desenvolvimento acentuadamente atípico na interação social e comunicação, assim como pelo repertório marcadamente restrito de atividades e interesses. Estas características podem levar a um isolamento contínuo da criança e sua família. Entretanto, acredita-se que a inclusão escolar pode proporcionar a essas crianças oportunidades de convivência com outras da mesma faixa etária, constituindo-se num espaço de aprendizagem e de desenvolvimento da competência social. O objetivo deste estudo foi revisar criticamente a literatura a respeito do conceito de competência social e dos estudos atualmente existentes na área de autismo e inclusão escolar. Identificaram-se poucos estudos sobre este tema, os quais apresentam limitações metodológicas. Este panorama aponta para a necessidade de investigações que demonstrem as potencialidades interativas de crianças com autismo e a possibilidade de sua inclusão no ensino comum, desde a educação infantil.

Spontaneous imitation by children with autism during a repetitive musical play routine

Joint-attention-type intervention strategies have been identified as effective scaffolds for increasing social engagement in children with autism. Imitating children with autism within child-led social routines has increased children's attention and active participation in social interaction. The current study expands on this research by establishing a musical social milieu using repetitive imitation routines for four children with autism. Results were evaluated using an MPD across three behaviors and four children with an ABAB reversal for one child. Children increased spontaneous imitation of the researcher's models after being imitated with only social reinforcement for increased imitation. However, experimental control was weakened with carry-over effects for two children and failure to fully replicate results across participants and behaviors. The accumulation of evidence from varied studies, despite some mixed results, encourages further study into the effects of imitating children with autism to increase spontaneous social engagement.

Effects of the use of visual strategies in play groups for children with autism spectrum disorders and their peers

The purpose of this study was to investigate the impact of visual strategies with preschool children with autism spectrum disorders (ASD) and their peers during play group sessions. A changing-criterion design was implemented with three preschool-aged children with ASD while they participated in play groups with four typically-developing peers. Results indicated improvements in the use of script phrases, context-related comments, and intervals in which speech occurred for all three participants. Results regarding unscripted phrases, responses, and use of prompts were variable and are discussed.

Why Does Joint Attention Look Atypical in Autism?

This essay answers the question of why autistic children are less likely to initiate joint attention (e.g., use their index finger to point to indicate interest in something) and why they are less likely to respond to bids for their joint attention (e.g., turn their heads to look at something to which another person points). It reviews empirical evidence that autistic toddlers, children, adolescents, and adults can attend covertly, even to social stimuli, such as the direction in which another person's eyes are gazing. It also reviews empirical evidence that autistics of various ages understand the intentionality of other persons' actions. The essay suggests that autistics' atypical resistance to distraction, atypical skill at parallel perception, and atypical execution of volitional actions underlie their atypical manifestations of joint attention.

Comparison of behavioural and natural play interventions for young children with autism

The article reports the results of a pilot study comparing traditional behavioural approaches and natural play interventions for young children with autism over a 10 week period. Two matched groups of eight young children with autism participated. Using a crossover design, children in both groups showed positive gains in compliance, attending, play and communication with their therapists and parents. Improvements in attending and compliance were higher following the behavioural condition compared with the natural play condition. Seven participants had reduced autism scores after the intervention. The findings suggest that behavioural and play approaches affect behaviour in different ways and that autistic symptomatology of young children may be amenable to treatment. The discussion focuses on the active ingredients of treatments and the need to base efficacy research on well-planned treatment comparisons.

Peer interaction and loneliness in high-functioning children with autism

Social interaction with peers and the understanding and feelings of loneliness were examined in 18 high-functioning children with autism and 17 typically developing children matched for IQ, chronological age, gender, and maternal education. Observations were conducted on children's spontaneous social initiations and responses to their peers in natural settings such as recess and snack time, and children reported on their understanding and feelings of loneliness and social interaction. Overall, children with autism revealed a good understanding of both social interaction and loneliness, and they demonstrated a high level of social initiation. However, they spent only half the time in social interactions with peers compared with their matched counterparts, and they interacted more often with a typically developing child than with another special education child. Despite the intergroup differences in frequency of interaction, a similar distribution of interactions emerged for both groups, who presented mostly positive social behaviors, fewer low-level behaviors, and very infrequent negative behaviors. Children with autism reported higher degrees of loneliness than their typical age-mates, as well as a lower association between social interaction and loneliness, suggesting their poorer understanding of the relations between loneliness and social interaction. Research and practice implications of these findings are discussed.