Purpose and Objectives of Study Objective 1 Objective 2 Objective 3 Participants and Settings Intervention Description Social peer networks

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1 1 Title: Autism Peer Networks Project: Improving Social-Communication and Literacy for Young Children with ASD Funding: Institute of Education Sciences R324A Session Presenters: Debra Kamps and Rose Mason Background / Context Recent census data indicate an alarming increase in the number of young children identified with Autism Spectrum Disorders (ASD), with current estimates of 1 in 88, and 1 in 50 based on parent survey data ( autism). Social and communication deficits are considered core features for children with autism spectrum disorders-asd (American Psychiatric Association, 2012; Reichow & Volkmar, 2010; Smith, Scahill, Dawson, Guthrie, Lord, Odom, Rogers, & Wagner, 2007). Despite an impressive body of research in early intervention for children with ASD, limited intervention research has focused on programming and generalization of skills within the context of peer inclusive groups such as those found in school settings. Further, few programs have addressed building social competence with peers combined with content area instruction (e.g., literacy) required for academic success (Mirenda, 2003; Strain & Hoyson, 2000). We view this disparity as a wide divide in intervention research and educational programming for young children with ASD. Kamps and colleagues have investigated academic and social interventions for young children with ASD for over twenty years (Kamps et al., 1989, 199; 2002). Recently, 45 children with ASD in elementary school settings participated in a longitudinal 5-year study, demonstrating the power of peers as change agents for children with ASD (Kamps et al., 2002). Single subject design studies experimentally demonstrated the relationship of the increased social-communication and peer interactions, reduced inappropriate behavior, and improved peer and teacher ratings to treatment. Skill generalization was measured via videotaped probes across multiple years using computerized data collection. Analyses showed significantly different effects by peer group condition for durations of social interactions, and reciprocal interaction. Pairwise comparisons showed higher duration for the students with ASD and trained peers, than with the familiar peers, or with stranger peers. The interaction duration with Peer Network members was equal to typical peer levels. When analyzing data for the verbal students (n = 24), on topic language occurred during 36% of the intervals with trained peers, and was higher than with familiar or stranger peers (21%, 19%), but less than verbalizations by peers (mean, 51% of intervals). The Autism Peer Networks Program of research is based on prior research and the premise that social competence with peers, literacy, and adaptive behavior in group settings are fundamental and pivotal skills that can be taught in school settings. Intervention in early grades i.e., kindergarten and first grade provides the foundation for future school success, and the intervention also builds on key behaviors reported by kindergarten teachers as necessary for success in the classroom: group participation, following directions, competency in beginning literacy skills, social communication with peers, independence, and smooth transitions (Schwartz et al., 1996). The Autism Peer Networks Program intervention components consist of literacy groups using direct instruction curricula and social-communication groups with typically developing peers. Intervention groups are implemented in by school staff and occur three to four times per week for 30-minute periods.

2 2 Purpose and Objectives of Study The purpose of this IES GOAL 2 project was to (1) conduct an experimental study of a Peer Network Intervention on social-communication, literacy, and adaptive behaviors for young children with ASD in school settings; and (2) conduct development activities to assess and improve the feasibility of the intervention. It is a multi-site study with the University of Kansas and the University of Washington-Seattle. Objective 1 is to conduct a multi-site study of students with ASD for the Peer Networks Intervention (Social/Literacy/Adaptive) (n = 51 experimental, 39 comparison). Objective 2 is to investigate how child characteristics (e.g., learning status, autistic behaviors), and fidelity of intervention influence treatment outcomes. Objective 3 is to measure generalization of communication and social interactions, and decreases in challenging behaviors in non-treatment settings for children in the Peer Network Intervention. Participants and Settings Thirteen school districts in Kansas and Washington have participated. A total of 51 children were enrolled in the Peer Networks intervention with 39 enrolled in the comparison group. These children attended 51 elementary school settings in KS (MO) and WA. Over the four years of the project 118 children in all were assessed for eligibility; 105 were randomly assigned (66 in intervention, and 39 in comparison group). All participants had been previously diagnosed with ASD either through a clinical assessment or educationally based assessment. In order to be included in the study participants had to display functional communication, make requests, and utilize 2-3 word phrases. Additionally, the ability to understand and respond to requests and directions was required. In order to confirm the diagnosis of autism and current level of functioning the following assessments were administered: Vineland Adaptive Behavior Scales VABS (Sparrow, Balla, & Cicchetti, 1984), Childhood Autism Rating Scale (CARS: Lord et al., 1997; Lord et al., 2000; Schopler et al., 1988), and the Social Responsiveness Scale (SRS: Constantino & Gruber, 2005). See Table 1. Intervention Description The intervention has two components (1) Peer Network groups using social skills lessons from developed curriculum, and (2) and Peer Network groups using Reading Mastery curriculum taught in small groups with peers. The intervention was implemented over two years for each participant, in kindergarten and first grade. Social peer networks. The Peer Network groups were comprised of four steps including: (1) systematic and direct instruction on the targeted skill, (2) scripted practice of the skill, (3) peermediated free play, and (4) review of performance and reinforcement. Each session lasted for minutes. During the direct instruction portion of the group, the interventionist followed a script to provide the instruction and relevant examples (sharing and requesting, commenting, turn taking, niceties and play organizing skills). The visual cue card was present and the interventionist referred to this during the instruction. This portion of the intervention lasted for approximately 5-7 minutes. The scripted practice of the skill lasted for 3-5 minutes and involved both child-adult practice and child-peer practice. During child-adult practice, the interventionist practiced the skill with the focus child and assisted the focus child, prompting the focus child by modeling correct use of the visual cue card (i.e. gaining attention of the child and pointing at words and phrases he could use). Then, the focus child and peers practiced playing utilizing the

3 3 game provided. During this time each peer took turns playing with the focus child while the other peer provided prompts as needed to the focus child. The interventionist provided instruction to the peers on how to prompt the focus child. Prompts included pointing to the cue card, full prompts (i.e. telling the focus child what to say), and physical prompts such as guiding the focus child s hands to give an object to the other peer. Peer-mediated free play followed instruction. Data collection occurred during this segment of the intervention. During free play the interventionist prompted the peers to prompt the focus child. If the focus child did not respond to the peers, the interventionist provided the prompt. Free play lasted for 10 minutes, during which the observer collected data. Following free play, the interventionist provided specific feedback on the participants performance, and if the children met criteria for use of the skills, the peers and focus child were allowed to choose an item from the treasure box. Reading peer networks. Supplemental reading intervention was provided for the majority of the participants during kindergarten, and for some in their first grade year. The Reading Mastery and Read Well curricula served as the instruction and the groups consisted of the child with ASD and 1-3 peers. Groups occurred 3-4 times per week and followed the curriculum guidelines. Fidelity was collected to monitor implementation, and averaged 85% or higher across implementers. Research Design, Data Collection and Analysis Experimental methods consisted of an experimental group receiving peer networks intervention and a comparison group. When possible, randomization occurred when recruiting children across three cohorts (n=51 experimental, 39 comparison group). While the small number of participants doesn t provide enough power for statistically significant findings, trends in the data and differences between the groups will provide information to support continued and larger group study. A series of single case designs have also been conducted to demonstrate experimental control for small groups of participants within the study. Social Measures. Noldus Observer Software was the primary observation/data collection method used for monitoring social behavior of children during the baseline video probes, treatment sessions, follow up video probes, and generalization settings. Teacher ratings included (1) the Teacher Impression Scale, a researcher developed checklist related to targeted skills and impressions of skill use in classroom settings, and (2) the Social Responsiveness Scale. Reading Measures. Improvements in literacy were measured using: (1) curriculum based vocabulary and passages from the Reading Mastery curriculum, (2) the Woodcock Reading Mastery Test, and (3) the DIBELS nonsense and oral reading fluency measures. Findings / Results Findings to date are summarized for the first two cohorts of children for direct observations during treatment sessions. Communications and initiations between children with ASD and their peers increased during Social Peer Network treatment sessions improved over time with significant improvements from baseline probes to the end of treatment. See Figures 1 and 2 and Tables 2-6. Single case designs confirmed improvements for a small group of first graders (see Figure 3) with Tau showing moderate to large effect sizes for total communications, initiations

4 4 and responses for the participants (see Tables 7-9). Use of peer networks in recess settings showed further improved social and communication skills (see Figures 4 and 5). Teacher ratings were completed 3 times a year during kindergarten and first grade for Cohorts 1-3. Questions rated use of social skills, cooperative behaviors, and responsiveness to peers. We used SAS PROC MIXED to run a Multi-Level Model analysis. For kindergarten and first grade there is a significant effect for time, and a significant effect for the interaction of group*time. In general scores improved over time for both grades, and both groups. Those in the Peer Network Intervention group had scores that improved over time much more than children in the Comparison group (see Table 10). Findings are summarized for reading improvements as follows: DIBELS Nonsense Word Fluency and DIBELS Oral Reading Fluency: a significant interaction for time*intervention from kindergarten to first for beginning readers (see Figures 6 and Table 11, however the experimental group was lower at start on oral reading assessments); CBM-Reading Mastery Words: a significant interaction for time*intervention from kindergarten to first for beginning readers (see Figure 7); Woodcock Word ID subtest: a significant interaction for time*intervention from kindergarten to first grade for beginning readers (however the experimental group was lower at start) (see Table 12); Woodcock Word Attack and Passage Comprehension subtests: a significant interaction for time*intervention from kindergarten to first grade for children who were already readers. Conclusions, Limitations, and Recommendations Results confirmed prior research indicating that peer mediated social skills interventions for young children with ASD generally improve children s behaviors (Kamps et al., 2002). Improvements in early literacy skills were also noted for participants. In this study and prior research the effective use of peer models as change agents for improving social behaviors was demonstrated. This is important for several reasons. First classmates are the natural community for children with ASD. Improving the ability of children to learn from other children and to successfully communicate with them is socially valid for all children. In addition, school resources are limited and increasing the number of persons to assist in promoting improved social communication skills (facilitating, prompting, reinforcing) takes advantage of peers as a valuable resource. In addition, peers as persons who come in contact with children with ASD in school environments will naturally influence their behaviors. Several important features of the intervention are noteworthy. School staff implemented the social groups, rather than researchers. This is a desirable feature of the study in that the intervention is may be more likely to be replicated by practitioners. Several procedures may have contributed to this successful implementation by school staff. We found the use of teaching scripts to be very helpful in guiding teachers to facilitate the groups. The scripts gave precise narrative for each section of the group: introducing the skills for the session, role play between the children, free play with prompting through the peers during games and activities, and feedback from the teacher during and at the end of the sessions. Text cues in the form of pictures and words also seemed to facilitate children s acquisition of social behaviors and served as prompts during the free play portion of the social groups to use the skills. Teachers referred to

5 5 the text cues repeatedly during the teaching portion of the group and pointed to them during free play to prompt peers to prompt the children with autism to use the skills. Teachers reported and we anecdotally observed that children began to use the skills and phrases without referring to the text cues fairly quickly. The teachers also reported that children began to use the phrases in new contexts and expanded the phrases to include new and relevant words. Implementation of peer networks and other social-communication interventions with larger groups of children and using randomized designs is warranted. The current study did not include sufficient numbers for such analysis. Future research must address the issue of adapting peer networks to be less resource intensive for school personnel, and yet still effective, and investigate the use of peer mediation with older students. Additional study of effective intervention to improve the quality of communication for highly verbal children with autism is necessary. The inclusion of cognitive behavioral treatments for addressing higher order skills (e.g., executive functioning, working memory) are an area of research that may also improve the communication and relationships of children with ASD and their peers, teachers, and family members.

6 6 Table 1. Participant Characteristics Group Gender CARS PPVT SRS Vineland Intervention N = 51 Comparison N = males 7 females 31 males 8 females 32.6 (21-41) 32.0 ( ) 87.6 (50-135) 84.5 (44-123) 63.1 (43-81) 66.4 (48-86) 86.2 (51-116) 81.5 (42-120) Table 2. Mean Number of Communicative Acts Including Standard Error and Relevant Confidence Intervals Treatment Mean Std. Error 95% Confidence Interval Lower Bound Upper Bound Baseline Middle Kindergarten End Kindergarten Middle 1 st Grade End 1 st Grade Table 3. Pairwise Contrasts with Relevant Effect Size for Total Communicative Acts Contrast F Sig. (p =.012) Partial Eta Squared Baseline vs. Middle K Baseline vs. End K Baseline vs. Middle 1st Baseline vs. End 1st Middle K vs. End K ns*.167 Middle K vs. Middle 1st Middle K vs. End 1st End K vs. Middle 1st Middle 1 st vs. End 1st ns*.114 Note. * = not a statistically significant difference where p=.012

7 7 Table 4. Mean Number of Initiations Including Standard Error and Relevant Confidence Intervals. Treatment Mean Std. 95% Confidence Interval Error Lower Bound Upper Bound Baseline Middle of Kindergarten End of Kindergarten Middle 1 st Grade End of 1 st Grade Table 5. Pairwise Contrasts with Relevant Effect Size for Initiations Only Contrast F Sig. (p =.012) Partial Eta Squared Baseline vs. Middle K Baseline vs. End K Baseline vs. Middle 1st Baseline vs. End 1 st Middle K vs End K *.211 Middle K vs. Middle 1st Middle K vs. End 1st End K vs Middle 1 st *.198 Middle 1 st vs End 1st *.000 Note. * = not a statistically significant difference where p=.012 Table 6. Results of Repeated Measures from Baseline Video Probe Compared with End of First Video Probe Mean Difference (I-J) Sig. F Partial Eta Squared 95% Confidence Interval for Difference Lower Upper Bound Bound * Table 7. Participants Tau Effect Size and Relevant Confidence Intervals for Total Communications*

8 8 Participant Tau Effect Size P-value 90% CI Lower Limit Upper Limit 1.92 < < < < Weighted Average.90 < Table 8. Participants Tau Effect Size and Relevant Confidence Intervals for Initiations* Participant Tau Effect Size P-value 90% CI Lower Limit Upper Limit < < Weighted Average.66 < Table 9. Participants Tau Effect Size and Relevant Confidence Intervals for Responses* Participant Tau Effect Size P-value 90% CI Lower Limit Upper Limit < < Weighted Average.74 < *Four First Graders Enrolled in Peer Networks, Single Case Study

9 9 Table 10. Teacher Impression Rating Scale Estimates for Experimental and Comparison Groups Least Squares Means Effect Time Kindergarten Estimate Peer Intervention Fall Peer Intervention Winter Peer Intervention Spring Comparison Fall Comparison Winter Comparison Spring First Grade Estimate Table 11. DIBELS Oral Reading Estimates for Experimental and Comparison Groups Least Squares Means Effect Intervention Time Already Reading Intervention*time Comparison Fall Intervention*time Comparison Winter Intervention*time Comparison Spring Intervention*time Reading Mastery Fall Intervention*time Reading Mastery Winter Intervention*time Reading Mastery Spring Beginning Reader

10 10 Table 12. Least Squares Means for Woodcock Word ID scores Beginning Readers Least Squares Means Effect Intervention Time in months Estimate Intervention*time Comparison Fall of kinder or at study entry Intervention*time Comparison Fall of 1st grade Intervention*time Comparison Spring of 1st grade Intervention*time Reading Mastery Fall of kinder or at study entry Intervention*time Reading Mastery Fall of 1st grade Intervention*time Reading Mastery Spring of 1st grade Already Reading Least Squares Means Effect Intervention Time in months Estimate Intervention*time Other reading Fall of kinder or at study entry Intervention*time Other reading Fall of 1st grade Intervention*time Other reading Spring of 1st grade Intervention*time Reading Mastery Fall of kinder or at study entry Intervention*time Reading Mastery Fall of 1st grade Intervention*time Reading Mastery Spring of 1st grade

11 Frequency Frequency Figure 1. Average Communicative Acts Pre - Kindergarten mid/end to First Grade mid/end - Post Figure 2. Average Initiations to Peers Pre - Kindergarten mid/end to First Grade mid/end - Post

12 Figure 3. Total Communicative Acts during Social Peer Networks for Four First Graders 12

13 13 Figure 4. Social-Communicative Behaviors for Children with ASD at Recess 100% 80% 60% Peer behavior Participant behavior 40% 20% 0% % 80% 60% 40% 20% 0% % 80% 60% 40% 20% 0% % 80% 60% 40% 20% 0%

14 Number of Communicative Acts 14 Figure 5. Total Communications for Three Students Enrolled in Recess Peer Networks Sam Ed Brian Sessions

15 number of words sounds per minute 15 Figure 6. DIBELS Nonsense Word Fluency Scores for All Readers Kindergarten Pre and Post Exp n=46 comp n= Beginning readers experimental = 9 to 23.6 sounds (n=33); comp 16.9 to 30.2 (n=28) Figure 7. Reading Mastery Words CBM Pre and Post for All Readers exp n=48 comp n= Beginning readers: experimental= 1.5 to 50.6 words; comp 6.2 to 42.6