University of Iowa Iowa Research Online Theses and Dissertations Spring 2014 Enhancing communicative interaction by training peers of children with autism Sarah Marie Labaz University of Iowa Copyright 2014 Sarah Marie Labaz This dissertation is available at Iowa Research Online: http://ir.uiowa.edu/etd/4673 Recommended Citation Labaz, Sarah Marie. "Enhancing communicative interaction by training peers of children with autism." MA (Master of Arts) thesis, University of Iowa, 2014. http://ir.uiowa.edu/etd/4673. Follow this and additional works at: http://ir.uiowa.edu/etd Part of the Speech Pathology and Audiology Commons ENHANCING COMMUNICATIVE INTERACTION BY TRAINING PEERS OF CHILDREN WITH AUTISM by Sarah Marie Labaz A thesis submitted in partial fulfillment of the requirements for the Master of Arts degree in Speech Pathology and Audiology in the Graduate College of The University of Iowa May 2014 Thesis Supervisor: Professor Richard R. Hurtig Copyright by SARAH MARIE LABAZ 2014 All Rights Reserved Graduate College The University of Iowa Iowa City, Iowa CERTIFICATE OF APPROVAL _______________________ MASTER'S THESIS _______________ This is to certify that the Master's thesis of Sarah Marie Labaz has been approved by the Examining Committee for the thesis requirement for the Master of Arts degree in Speech Pathology and Audiology at the May 2014 graduation. Thesis Committee: __________________________________ Richard R. Hurtig, Thesis Supervisor __________________________________ Karla McGregor __________________________________ Elizabeth Delsandro To my mentor Richard Hurtig, who has become much more than a thesis supervisor to me. Thank you for your patience, your wisdom, and for molding my passion of AAC. ii ACKNOWLEDGMENTS I wish to thank my committee members, Elizabeth Delsandro and Karla McGregor, for their expertise and time. It is truly an honor to be surrounded by such innovative and passionate individuals within the field of speech-language pathology. A special thanks is given to Lauren Zubow, for her ideas, guidance, and tremendous amount of time given to this thesis. I credit the basis and success of this project to her ingenuity. I would like to acknowledge and thank Lauren Lichty and Beth Weis, the lead teachers in the KidTalk preschools, for their flexibility and willingness in allowing me to come into their classrooms and interact with their students. iii ABSTRACT The aim of this study was to assess the effectiveness of training preschool-aged children to support the communication of their peers with autism spectrum disorder. Four typically developing peers participated in a 12-week training study that consisted of video models, social narratives, and practice opportunities. The peers were taught to implement the strategies “show, wait, and tell” with a classmate with autism during play. Peers were also provided with instruction to make them more aware of communication via augmentative modalities and to understand the Pragmatically Organized Dynamic Display (PODD) that the classmate with autism used to communicate. A second child with autism served as a control subject to measure generalization of the training to other children with autism. The study also included a group of four control peers who received no training in order to distinguish the effect of the training from normal communicative and social developmental that one might see over the time of the study. All play sessions were video recorded and coded utilizing a coding system that identified verbal and nonverbal behaviors of the peers and the children with autism. 3 of the 4 trained peers demonstrated the ability or willingness or implement the targeted strategies with the target child with autism. A single trained peer generalized the use of the trained strategies when interacting with to the control subject. Peers performed best when provided with clinician cues to implement strategies. Both children with autism increased their communication and interaction with trained peers during play when compared with their interactions with the control peers. Furthermore, the children with autism interacted maximally during sessions in which the trained peers utilized the communication strategies These results provide preliminary evidence of the effectiveness of preschool peer training to support the communication of children with autism. iv TABLE OF CONTENTS LIST OF TABLES ............................................................................................................. ix LIST OF FIGURES ............................................................................................................ x CHAPTER I. REVIEW OF THE LITERATURE ................................................................. 1 II. METHODS .................................................................................................... 11 Participants .................................................................................................... 11 Training Subject ..................................................................................... 11 Control Subject ....................................................................................... 11 Training Peers ......................................................................................... 12 Control Peers .......................................................................................... 12 Consent .......................................................................................................... 13 Training Content ............................................................................................ 13 Protocol .......................................................................................................... 15 Training Peers ......................................................................................... 19 Control Peers .......................................................................................... 21 Training Subject ..................................................................................... 22 Control Subject ....................................................................................... 23 Data Analysis ................................................................................................. 23 Reliability Coding .......................................................................................... 26 III. RESULTS ...................................................................................................... 28 Control Peers with Peers ................................................................................ 28 Control Peer 1 ......................................................................................... 28 C1 Behaviors to Peers Over Time ................................................... 28 C1 Total Strategy Use with Peers .................................................... 29 C1 Strategy Breakdown with Peers ................................................. 30 Control Peer 2 ......................................................................................... 30 C2 Behaviors to Peers Over Time ................................................... 30 C2 Total Strategy Use with Peers .................................................... 31 C2 Strategy Breakdown with Peers ................................................. 32 Control Peer 3 ......................................................................................... 32 C3 Behaviors to Peers Over Time ................................................... 32 C3 Total Strategy Use with Peers .................................................... 33 C3 Strategy Breakdown with Peers ................................................. 34 Control Peer 4 ......................................................................................... 35 C4 Behaviors to Peers Over Time ................................................... 35 C4 Total Strategy Use with Peers .................................................... 35 C4 Strategy Breakdown with Peers ................................................. 36 Control Peer Group 1 (Control Peer 1 & Control Peer 2) ...................... 37 CP1 Averaged Behaviors to Peers Over Time ................................ 37 CP1 Averaged Strategy Use with Peers .......................................... 37 CP1 Averaged Strategy Breakdown with Peers .............................. 38 Control Peer Group 2 (Control Peer 3 & Control Peer 4) ...................... 39 v CP2 Averaged Behaviors to Peers Over Time ................................ 39 CP2 Averaged Strategy Use with Peers .......................................... 39 CP2 Averaged Strategy Breakdown with Peers .............................. 40 All Control Peers .................................................................................... 41 Control Peer Averaged Behaviors ................................................... 41 Control Peer Averaged Strategy Use ............................................... 41 Control Peer Averaged Strategy Breakdown .................................. 42 Control Peers with Target & Control Subject................................................ 43 Control Peer 1 ......................................................................................... 43 C1 Behaviors to Subjects Over Time .............................................. 43 C1 Total Strategy Use with Subjects ............................................... 44 C1 Strategy Breakdown with Subjects ............................................ 45 Control Peer 2 ......................................................................................... 46 C2 Behaviors to Subjects Over Time .............................................. 46 C2 Total Strategy Use with Subjects ............................................... 46 C2 Strategy Breakdown with Subjects ............................................ 47 Control Peer 3 ......................................................................................... 48 C3 Behaviors to Subjects Over Time .............................................. 48 C3 Total Strategy Use with Subjects ............................................... 49 C3 Strategy Breakdown with Subjects ............................................ 50 Control Peer 4 ......................................................................................... 51 C4 Behaviors to Subjects Over Time .............................................. 51 C4 Total Strategy Use with Subjects ............................................... 51 C4 Strategy Breakdown with Subjects ............................................ 52 Control Peer Group 1 (Control Peer 1 & Control Peer 2) ...................... 53 CP1 Averaged Behaviors to Subjects Over Time ........................... 53 CP1 Averaged Strategy Use with Subjects ..................................... 53 CP1 Averaged Strategy Breakdown with Subjects ......................... 54 Control Peer Group 2 (Control Peer 3 & Control Peer 4) ...................... 55 CP2 Averaged Behaviors to Subjects Over Time ........................... 55 CP2 Averaged Strategy Use with Subjects ..................................... 55 CP2 Averaged Strategy Breakdown with Subjects ......................... 56 All Control Peers .................................................................................... 57 Control Peer Averaged Behaviors with Subjects ............................ 57 Control Peer Averaged Strategy Use with Subjects ........................ 57 Control Peer Averaged Strategy Breakdown with Subjects ............ 58 Trained Peers ................................................................................................. 59 Training.......................................................................................................... 59 Trained Peer 1 ......................................................................................... 59 Clinician Input to T1 ....................................................................... 59 Clinician Cues to T1 ........................................................................ 60 Trained Peer 2......................................................................................... 61 Clinician Input to T2 ....................................................................... 61 Clinician Cues to T2 ........................................................................ 62 Trained Peer 3......................................................................................... 63 Clinician Input to T3 ....................................................................... 63 Clinician Cues to T3 ........................................................................ 64 Trained Peer 4......................................................................................... 65 Clinician Input to T4 ....................................................................... 65 Clinician Cues to T4 ........................................................................ 65 All Trained Peers .................................................................................... 66 Clinician Input to all Trained Peers ................................................. 66 Clinician Cues to all Trained Peers ................................................. 67 Trained Peers with Peers ............................................................................... 68 vi Trained Peer 1 ......................................................................................... 69 T1 Behaviors to Peers Over Time ................................................... 69 T1 Total Strategy Use with Peers .................................................... 69 T1 Strategy Breakdown with Peers ................................................. 70 Trained Peer 2......................................................................................... 71 T2 Behaviors to Peers Over Time ................................................... 71 T2 Total Strategy Use with Peers .................................................... 71 T2 Strategy Breakdown with Peers ................................................. 72 Trained Peer 3......................................................................................... 73 T3 Behaviors to Peers Over Time ................................................... 73 T3 Total Strategy Use with Peers .................................................... 73 T3 Strategy Breakdown with Peers ................................................. 74 Trained Peer 4......................................................................................... 75 T4 Behaviors to Peers Over Time ................................................... 75 T4 Total Strategy Use with Peers .................................................... 75 T4 Strategy Breakdown with Peers ................................................. 76 Trained Peer Group 1 (Trained Peer 1 & Trained Peer 2)...................... 77 TP1 Averaged Behaviors to Peers Over Time ................................ 77 TP1 Averaged Strategy Use with Peers........................................... 77 TP1 Averaged Strategy Breakdown with Peers .............................. 78 Trained Peer Group 2 (Trained Peer 3 & Trained Peer 4)...................... 79 TP2 Averaged Behaviors to Peers Over Time ................................ 79 TP2 Averaged Strategy Use with Peers........................................... 79 TP2 Averaged Strategy Breakdown with Peers .............................. 80 All Trained Peers .................................................................................... 81 Trained Peer Averaged Behaviors ................................................... 81 Trained Peer Averaged Strategy Use .............................................. 81 Trained Peer Averaged Strategy Breakdown .................................. 82 Trained Peers with Subjects........................................................................... 83 Trained Peer 1 ......................................................................................... 84 T1 Behaviors to Subjects Over Time .............................................. 85 T1 Total Strategy Use with Subjects ............................................... 85 T1 Strategy Breakdown with Subjects ............................................ 85 Trained Peer 2......................................................................................... 86 T2 Behaviors to Subjects Over Time .............................................. 86 T2 Total Strategy Use with Subjects ............................................... 87 T2 Strategy Breakdown with Subjects ............................................ 88 Trained Peer 3......................................................................................... 89 T3 Behaviors to Subjects Over Time .............................................. 89 T3 Total Strategy Use with Subjects ............................................... 89 T3 Strategy Breakdown with Subjects ............................................ 90 Trained Peer 4......................................................................................... 91 T4 Behaviors to Subjects Over Time .............................................. 91 T4 Total Strategy Use with Subjects ............................................... 92 T4 Strategy Breakdown with Subjects ............................................ 93 Trained Peer Group 1 (Trained Peer 1 & Trained Peer 2)...................... 94 TP1 Averaged Behaviors to Subjects Over Time............................ 94 TP1 Averaged Strategy Use with Subjects ...................................... 94 TP1 Averaged Strategy Breakdown with Subjects ......................... 95 Trained Peer Group 2 (Trained Peer 3 & Trained Peer 4)...................... 96 TP2 Averaged Behaviors to Subjects Over Time............................ 96 TP2 Averaged Strategy Use with Subjects ...................................... 97 TP2 Averaged Strategy Breakdown with Subjects ......................... 98 All Trained Peers .................................................................................... 99 vii Trained Peer Averaged Behaviors with Subjects ............................ 99 Trained Peer Averaged Strategy Use with Subjects ........................ 99 Trained Peer Averaged Strategy Breakdown with Subjects.......... 100 Control Subject ............................................................................................ 101 Control Subject with Control Peers ...................................................... 102 CS Behaviors with C1 & C2 ......................................................... 102 CS Behaviors with C3 & C4 ......................................................... 102 Control Subject with Trained Peers ...................................................... 103 CS Behaviors with T1 & T2 .......................................................... 103 CS Behaviors with T3 & T4 .......................................................... 104 Target Subject .............................................................................................. 105 Target Subject with Control Peers ........................................................ 105 TS Behaviors with C1 & C2 .......................................................... 105 TS Behaviors with C3 & C4 .......................................................... 105 Target Subject with Trained Peers ....................................................... 106 TS Behaviors with T1 & T2 .......................................................... 106 TS Behaviors with T3 & T4 .......................................................... 106 IV. DISCUSSION .............................................................................................. 108 Qualitative Results ....................................................................................... 108 Control Peers with Subjects.................................................................. 108 Trained Peers with Subjects ................................................................. 109 Interaction ...................................................................................... 109 Strategies ....................................................................................... 109 Target Subject Behavior ....................................................................... 111 Control Subject Behavior ..................................................................... 113 Classroom Dynamics ................................................................................... 113 Personality Differences ................................................................................ 115 Training........................................................................................................ 117 Limitations ................................................................................................... 118 Future Directions ......................................................................................... 119 REFERENCES ............................................................................................................... 121 APPENDIX A. SOCIAL NARRATIVE “SOME KIDS USE PICTURE BOARDS TO TALK” ......................................................................................................... 124 B. SOCIAL NARRATIVE “IT CAN BE FUN WHEN EVERYONE PLAYS TOGETHER” ................................................................................. 135 C. RELIABILITY CODER INSTRUCTIONS ................................................ 146 D. RELIABILITY CODER CODE DESCRIPTIONS ..................................... 148 viii LIST OF TABLES Table 2.1 Participant Codes .............................................................................................. 16 Table 2.2 Participant Group Codes ................................................................................... 17 Table 2.3 Session Codes ................................................................................................... 17 Table 2.4 Outline of Protocol for Each Participant........................................................... 18 Table 2.5 Outline of Analyzed Behaviors......................................................................... 25 ix LIST OF FIGURES Figure 2.1 Screen shot from the video of researcher modeled PODD use ....................... 14 Figure 2.2 ELAN tiered template used for data analysis .................................................. 24 Figure 3.1 C1 Behaviors to Peers ..................................................................................... 29 Figure 3.2 C1 Total Strategy Use with Peers .................................................................... 29 Figure 3.3 C1 Strategy Breakdown with Peers ................................................................. 30 Figure 3.4 C2 Behaviors to Peers ..................................................................................... 31 Figure 3.5 C2 Total Strategy Use with Peers .................................................................... 31 Figure 3.6 C2 Strategy Breakdown with Peers ................................................................. 32 Figure 3.7 C3 Behaviors to Peers ..................................................................................... 33 Figure 3.8 C3 Total Strategy Use with Peers .................................................................... 34 Figure 3.9 C3 Strategy Breakdown with Peers ................................................................. 34 Figure 3.10 C4 Behaviors to Peers ................................................................................... 35 Figure 3.11 C4 Total Strategy Use with Peers .................................................................. 36 Figure 3.12 C4 Strategy Breakdown with Peers ............................................................... 36 Figure 3.13 CP1 Averaged Behaviors to Peers ................................................................. 37 Figure 3.14 CP1 Averaged Strategy Use with Peers ........................................................ 38 Figure 3.15 CP1 Averaged Strategy Breakdown with Peers ............................................ 38 Figure 3.16 CP2 Averaged Behaviors to Peers ................................................................. 39 Figure 3.17 CP2 Averaged Strategy Use with Peers ........................................................ 40 Figure 3.18 CP2 Averaged Strategy Breakdown with Peers ............................................ 40 Figure 3.19 CP Averaged Behaviors with Peers ............................................................... 41 Figure 3.20 CP Averaged Strategy Use with Peers .......................................................... 42 Figure 3.21 CP Averaged Strategy Breakdown with Peers .............................................. 43 Figure 3.22 Percentages of C1 Behaviors to Subjects ...................................................... 44 Figure 3.23 C1 Strategy Use with Subjects ...................................................................... 45 x Figure 3.24 C1 Strategy Breakdown with Subjects .......................................................... 45 Figure 3.25 Percentages of C2 Behaviors to Subjects ...................................................... 46 Figure 3.26 C2 Strategy Use with Subjects ...................................................................... 47 Figure 3.27 C2 Strategy Breakdown with Subjects .......................................................... 48 Figure 3.28 Percentages of C3 Behaviors to Subjects ...................................................... 49 Figure 3.29 C3 Strategy Use with Subjects ...................................................................... 50 Figure 3.30 C3 Strategy Breakdown with Subjects .......................................................... 50 Figure 3.31 Percentages of C4 Behaviors to Subjects ...................................................... 51 Figure 3.32 C4 Strategy Use with Subjects ...................................................................... 52 Figure 3.33 C4 Strategy Breakdown with Subjects .......................................................... 52 Figure 3.34 Averaged Percentages of CP1 Behaviors to Subjects ................................... 53 Figure 3.35 CP1 Averaged Strategy Use with Subjects ................................................... 54 Figure 3.36 CP1 Averaged Strategy Breakdown with Subjects ....................................... 54 Figure 3.37 Averaged Percentages of CP2 Behaviors to Subjects ................................... 55 Figure 3.38 CP2 Averaged Strategy Use with Subjects ................................................... 56 Figure 3.39 CP2 Averaged Strategy Breakdown with Subjects ....................................... 56 Figure 3.40 Averaged Percentages of All CP Behaviors with Subjects ........................... 57 Figure 3.41 Averaged CP Strategy Use with Subjects ..................................................... 58 Figure 3.42 Averaged CP Strategy Breakdown with Subjects ......................................... 58 Figure 3.43 Clinician Input to T1 ..................................................................................... 60 Figure 3.44 Clinician Cues to T1 ...................................................................................... 61 Figure 3.45 Clinician Input to T2 ..................................................................................... 62 Figure 3.46 Clinician Cues to T2 ...................................................................................... 63 Figure 3.47 Clinician Input to T3 ..................................................................................... 64 Figure 3.48 Clinician Cues to T3 ...................................................................................... 64 Figure 3.49 Clinician Input to T4 ..................................................................................... 65 Figure 3.50 Clinician Cues to T4 ...................................................................................... 66 xi Figure 3.51 Clinician Input to All Trained Peers .............................................................. 67 Figure 3.52 Clinician Cues to All Trained Peers .............................................................. 68 Figure 3.53 T1 Total Behaviors to Peers .......................................................................... 69 Figure 3.54 T1 Total Strategy Use with Peers .................................................................. 70 Figure 3.55 T1 Strategy Breakdown with Peers ............................................................... 70 Figure 3.56 T2 Total Behaviors to Peers .......................................................................... 71 Figure 3.57 T2 Total Strategy Use with Peers .................................................................. 72 Figure 3.58 T2 Strategy Breakdown with Peers ............................................................... 72 Figure 3.59 T3 Total Behaviors to Peers .......................................................................... 73 Figure 3.60 T3 Total Strategy Use with Peers .................................................................. 74 Figure 3.61 T3 Strategy Breakdown with Peers ............................................................... 74 Figure 3.62 T4 Total Behaviors to Peers .......................................................................... 75 Figure 3.63 T4 Total Strategy Use with Peers .................................................................. 76 Figure 3.64 T4 Strategy Breakdown with Peers ............................................................... 76 Figure 3.65 TP1 Averaged Behaviors to Peers Over Time .............................................. 77 Figure 3.66 TP1 Averaged Strategy Use with Peers......................................................... 78 Figure 3.67 TP1 Averaged Strategy Breakdown with Peers ............................................ 78 Figure 3.68 TP2 Averaged Behaviors to Peers Over Time .............................................. 79 Figure 3.69 TP2 Averaged Strategy Use with Peers......................................................... 80 Figure 3.70 TP2 Averaged Strategy Breakdown with Peers ............................................ 80 Figure 3.71 Trained Peers Averaged Behaviors ............................................................... 81 Figure 3.72 Trained Peer Averaged Strategy Use ............................................................ 82 Figure 3.73 Trained Peer Averaged Strategy Breakdown ................................................ 83 Figure 3.74 Percentages of T1 Behaviors to Subjects ...................................................... 84 Figure 3.75 T1 Strategy Use with Subjects ...................................................................... 85 Figure 3.76 T1 Strategy Breakdown with Subjects .......................................................... 86 Figure 3.77 Percentages of T2 Behaviors to Subjects ...................................................... 87 xii Figure 3.78 T2 Strategy Use with Subjects ...................................................................... 88 Figure 3.79 T2 Strategy Breakdown with Subjects .......................................................... 88 Figure 3.80 Percentages of T3 Behaviors to Subjects ...................................................... 89 Figure 3.81 T3 Strategy Use with Subjects ...................................................................... 90 Figure 3.82 T3 Strategy Breakdown with Subjects .......................................................... 91 Figure 3.83 Percentages of T4 Behaviors to Subjects ...................................................... 92 Figure 3.84 T4 Strategy Use with Subjects ...................................................................... 93 Figure 3.85 T4 Strategy Breakdown with Subjects .......................................................... 93 Figure 3.86 TP1 Averaged Percentage of Behaviors to Subjects ..................................... 94 Figure 3.87 TP1 Averaged Strategy Use with Subjects .................................................... 95 Figure 3.88 TP1 Averaged Strategy Breakdown with Subjects ....................................... 96 Figure 3.89 TP2 Averaged Percentage of Behaviors to Subjects ..................................... 97 Figure 3.90 TP2 Averaged Strategy Use with Subjects .................................................... 98 Figure 3.91 TP2 Averaged Strategy Breakdown with Subjects ....................................... 98 Figure 3.92 All TP Averaged Percentage of Behaviors to Subjects ................................. 99 Figure 3.93 TP Averaged Strategy Use with Subjects .................................................... 100 Figure 3.94 TP Averaged Strategy Breakdown with Subjects ....................................... 101 Figure 3.95 CS Behaviors with C1 & C2 ....................................................................... 102 Figure 3.96 CS Behaviors with C3 & C4 ....................................................................... 103 Figure 3.97 CS Behaviors with T1 & T2 ........................................................................ 104 Figure 3.98 CS Behaviors with T3 & T4 ........................................................................ 104 Figure 3.99 TS Behaviors with C1 & C2 ........................................................................ 105 Figure 3.100 TS Behaviors with T1 & T2 ...................................................................... 106 Figure 3.101 TS Behaviors with T3 & T4 ...................................................................... 107 Figure A1: “Some Kids Use Picture Boards to Talk,” page 1 ........................................ 124 Figure A2: “Some Kids Use Picture Boards to Talk,” page 2 ........................................ 125 Figure A3: “Some Kids Use Picture Boards to Talk,” page 3 ........................................ 126 xiii Figure A4: “Some Kids Use Picture Boards to Talk,” page 4 ........................................ 127 Figure A5: “Some Kids Use Picture Boards to Talk,” page 5 ........................................ 128 Figure A6: “Some Kids Use Picture Boards to Talk,” page 6 ........................................ 129 Figure A7: “Some Kids Use Picture Boards to Talk,” page 7 ........................................ 130 Figure A8: “Some Kids Use Picture Boards to Talk,” page 8 ........................................ 131 Figure A9: “Some Kids Use Picture Boards to Talk,” page 9 ........................................ 132 Figure A10: “Some Kids Use Picture Boards to Talk,” page 10 .................................... 133 Figure A11: “Some Kids Use Picture Boards to Talk,” page 11 .................................... 134 Figure B1: “It Can Be Fun When Everyone Plays Together,” page 1 ............................ 135 Figure B2: “It Can Be Fun When Everyone Plays Together,” page 2 ............................ 136 Figure B3: “It Can Be Fun When Everyone Plays Together,” page 3 ............................ 137 Figure B4: “It Can Be Fun When Everyone Plays Together,” page 4 ............................ 138 Figure B5: “It Can Be Fun When Everyone Plays Together,” page 5 ............................ 139 Figure B6: “It Can Be Fun When Everyone Plays Together,” page 6 ............................ 140 Figure B7: “It Can Be Fun When Everyone Plays Together,” page 7 ............................ 141 Figure B8: “It Can Be Fun When Everyone Plays Together,” page 8 ............................ 142 Figure B9: “It Can Be Fun When Everyone Plays Together,” page 9 ............................ 143 Figure B10: “It Can Be Fun When Everyone Plays Together,” page 10 ........................ 144 Figure B11: “It Can Be Fun When Everyone Plays Together,” page 11 ........................ 145 xiv 1 CHAPTER I REVIEW OF THE LITERATURE Preschool is a time of rapid growth and development of a multitude of skills and abilities. One crucial skill developed in preschool is the ability to form friendships and interact socially. Children with Autism Spectrum Disorder (ASD) who use Augmentative and Alternative Communication (AAC) have differences in a variety of areas that may result in difficulty communicating with peers. This difficulty often results in communication primarily with teachers during the school day (King & Fahsl, 2012). These factors contribute to limited peer communication, further hindering the development of friendship. Peer training interventions offer a way to break this cycle, and have been used successfully to increase social interactions between children with and without ASD using AAC (Banda, Hart, & Liu-Gitz, 2010). Peer relationships are important for healthy development from preschool through adulthood. Overtime, peer relationships contribute to a child’s identity and self-worth. Research has shown that peer interactions can enhance the language abilities of children with disabilities (McGregor, 2000). Many children with ASD have impairments in communication that may negatively impact the formation of friendships with peers. Often, children with ASD have difficulty establishing joint attention, initiating interactions, responding to peer attempts for interaction, and maintaining conversation (Rotheram-Fuller & Kasari, 2011). These communication impairments require partners to meet the child with ASD more than half way, a potential challenge for young playmates. In addition to communication, children with ASD have behavioral differences that can impact the development of friendships. Often children with ASD have focused interests or perseverative behaviors. These high interests make it difficult for children with ASD to change topic or activity per peer request. Furthermore, disruptive or undesirable behaviors may impact a peer’s desire to approach and engage a child with 2 ASD (Rotheram-Fuller & Kasari, 2011). Notably, Rotheram-Fuller (2005) showed that children with ASD in inclusive classrooms are more likely to be included by peers at younger ages than at older ages. It was hypothesized by the authors that younger children are more open to the differences amongst peers. A crucial piece that must develop to form friendships is Theory of Mind (ToM), or the ability to understand and interpret the thoughts and feelings of others. ToM helps children anticipate other’s interactions and modify their own behavior to maximize social interaction. ToM begins developing as young as 6 months, but starts to really emerge and become defined between 4-5 years of age (Eggum, Eisenberg, Kao, Spinrad, Bolnick, Hofer, Kupfer, & Fabricius, 2010). A stepping-stone in the development of ToM is joint attention and pretend play. Joint attention, a skill often lacking in children with ASD, emerges in typically developing children around 6 months of age. Pretend play, is typically first seen between 30-36 months, and is a critical step is developing ToM. Pretend play allows children to develop the skill of separating a representation from a reality (Miller, 2006). Wellman & Liu (2004) showed an extended series of conceptual insights in preschoolers as ToM develops. At this age, children are becoming aware that others have different beliefs, and may have wants and likes different than their own. A longitudinal study by Eggum et al. (2010) examined the development of emotional understanding, ToM, and prosocial orientation in children over time by taking measurements at 3.5, 4.5, and 6 years of age. Emotional understanding is the ability to identify others’ emotions, a skill that was shown to develop over time. Prosocial orientation is defined as voluntary behavior intended to benefit others. Examples include: helping, sharing or cooperating without a source of direct motivation. As emotional understanding and ToM develops across the preschool and school years, along with language and reasoning, prosocial behavior was also shown to increase. Eggum et al. found that at 4.5 years those with more developed ToM, as judged by false-belief tasks, had higher levels of mother-reported prosocial behavior. A child’s mental 3 understanding of others appears to allow for a deeper understanding of other’s challenges, fostering prosocial behavior. Lalonde & Chandler (1995) showed that preschool children who performed better on ToM tasks tended to play more cooperatively and engaged in longer play sessions than preschool children with less developed ToM. Theory of Mind is additionally correlated with language development. Children with increased mean length of utterance (MLU) and higher vocabulary scores tend to do better in tests of ToM. An intact language representation is necessary to understand and express abstract language and ideas, which underlie ToM (Miller, 2006). Another area that may impact the development of friendship is the pragmatic consequence of using AAC while communicating with peers. AAC can either supplement or replace spoken language, providing a way to communicate. However, this may disrupt the typicality of communication. Peer responsiveness to communication attempts is a critical component of language development. Many missed opportunities for communication development have been observed in interactions between AAC users and their communication partners. Eye contact and gaze, an important part of communication and pragmatic development is often lacking (Reichle, Hidecker, Brady, & Terry, 2003). AAC users tend to take on a more passive role in conversations. The partner often asks a much higher ratio of closed-ended questions to open-ended questions, resulting in the production of fewer items of information per conversational turn by the individual using AAC. Communication is often limited to exchanging basic wants and needs, and individuals using AAC are shown to rarely initiate interactions (McConanchie & Pennington, 1997). There are many forms of AAC ranging from no technology (e.g. white board, paper and pencil) to high technology systems (e.g. iPad). Gestures, sign systems, orthography, Picture Exchange Communication System (PECS), Pragmatic Organization Dynamic Display (PODD), and speech generating devices (SGD) are among the most 4 widely used strategies (Reichle & Buekelman & Light, 2002). Research suggests that the earlier an AAC system is put into place for a child, the greater the likelihood of preventing developmental delays in communication. AAC provides an immediate approach to communication, and it can also help children begin to develop prelinguistic skills and expand vocabulary. The acquisition of communication skills is a dynamic process influenced by both the speaker and listener (Reichle & Beukelman & Light, 2002). However, interventions are often solely aimed at the individual using an AAC system (Kent-Walsh & Rosa-Lugo, 2006). Communication breakdowns often seen in AAC are most commonly related to the skills of the communication partner. When teachers, parents or peers fail to understand the initial intent of the message, or ignore the attempt completely, maladaptive behaviors by the child often serve as the first attempt at a repair strategy. Typically, these maladaptive behaviors are more effective in gaining the partner’s attention, and as such are reinforced (Brady & Halle, 2002). This cycle of maladaptive behaviors has successfully been targeted in communication partner intervention by training skills such as implementing a pause time to allow for a response by the child with ASD, and looking rather than listening for a communication turn (Brady & Halle, 2002). A number of studies have explored the effects of training teachers to improve their roles as communication partners of children with ASD using AAC. The skills most often targeted in teacher interventions are: extended pause time, responding to communication attempts of the child, asking more open-ended questions, correctly positioning the AAC system for the child, and modeling correct AAC use (Kent-Walsh & McNaughton, 2005). Pennington et al. (1993) implemented the program “My Turn to Speak,” (MTS) with teachers of children communicating with AAC. The teachers were trained in the use of the strategies and at four months post-intervention the teachers showed significant gains over the control group in quality of interactions with students who use AAC. The teachers in the intervention group provided the children with more 5 opportunities for communication, increased their pause time, and increased their responses to the child’s attempts to communicate. Teacher training has been shown to be an effective way to improve the communicative interactions of children who use AAC (Pennington, 1993); however, teacher training does not encompass the crucial aspect of social development and formation of friendships. A less researched area that is currently receiving more attention, involves the development of programs focused on training peers. Peer-training programs have been looked at in relation to training peers to be effective communication partners for a variety of children with varying developmental disabilities, ASD, or who may use AAC. Using peers, rather than adults, is suggested as the most effective strategy for increasing the communicative interactions of children who use AAC, and has been shown to be effective for those as young as preschool (DiSalvo & Oswald, 2002). Three main types of peer interventions have been reported in the literature. Each type of intervention varies in the degree that the peer takes on an instructional role, as well as the role of the child with a disability in the training. The most common peer-training program is target-focused instruction. It involves teaching the child who uses AAC strategies for communication. The peer is included in the intervention merely to serve as a communication partner and receives no direct training. In peer-focused interventions, peers are taught to act as instructors and facilitators of communication. Lastly, in dyad-focused interventions, both the child using AAC and the peer communication partner are taught, together or separately, how to support each other in communication. All three interventions, although minimally researched, have shown positive gains in communication and peer relationships. However, the dyad-focused interventions target the area of pragmatics within communication, thus supporting the natural development of friendships and social language (Fisher & Shogren, 2012). The responsibility to initiate or maintain a conversation is shared by both communication partners, coinciding with a natural 6 communicative interaction. Peer-mediated interventions have been specifically targeted for use with children with ASD, as peers can provide great models of expected behaviors and patterns of communication development. Today an increasingly larger number of children with ASD are being integrated into general education classrooms. The number of children with ASD who use AAC is also increasing, and peer training in AAC competence is progressively more critical to the social and communicative development of the children who use AAC (King & Fahsl, 2012). Research has shown that the majority of interactions children using AAC have in the classroom are with their paraeducator or teacher (Chung, Carter & Sisco, 2012). Children who use AAC are more likely to communicate with these adults because they are better able to meet the children’s communication needs (King & Fahsl, 2012). If peers are trained and provided with the strategies to also successfully meet the complex communication needs of children with ASD who use AAC, it would follow that the social and language development of the children with ASD would also improve. King & Fahsl (2012) provide specific guidelines for what should be included in peer-mediated interventions that are geared towards younger children. They suggest that peers first increase their knowledge of different types of communication. Playing charades or watching cartoons that use non-verbal communication are sources of exposure for young peers to start understanding multimodal communication. Peers then should be taught explicit information regarding AAC systems, particularly those that their peers are using. This can be accomplished by targeting game playing activities, like “bingo” or “go fish”. Peers must also come to understand the barriers that communicating with AAC can present. Role-playing and having communication limited in some way can help in the peers’ developing insight into these communication barriers. Finally, the intervention strategies for communicating with children using AAC need to be taught. Strategies that King & Fahsl (2012) suggested include: giving the child using 7 AAC plenty of time to formulate their message, asking open-ended questions to encourage discussion, and modeling use of the AAC device. There have been a number of peer-training interventions reported in the literature that have focused on school-aged children communicating with peers that have ASD and who use AAC. Trottier, Kamp, & Mirenda (2011) conducted a peer-focused intervention for peers communicating with children that have ASD who use speech generating devices (SGD). The peers were trained in the basics of the SGD and how to navigate through the device content. They were instructed on prompts they can use to help their peers with ASD communicate while playing a game. Peers receiving the intervention were instructed to wait before prompting, model use of the SGD, and to prompt the use of the SGD if needed. A trainer was initially present during the play sessions in order to prompt the peers when they should be prompting the child with ASD. As the training continued the trainer no longer provided prompts to the peers, as they were expected to take on the instructional role independently. The children using AAC demonstrated an increase in communication acts made after peer prompting, suggesting that the peer-focused intervention was successful in training school-aged peers to take on an instructional role, and that children with ASD are responsive to prompting by peers. School-aged children appear to be able to take on the role of a peer-mediator independently; however, there is nothing that can be found in the literature to suggest a similar effect for children in preschool. As mentioned earlier, preschool children are in the process of developing Theory of Mind (ToM), or the ability to consider another’s perspective. In order to independently engage in the expected prosocial behaviors targeted in peer-training programs a child must have a developed ToM to consider another’s differences and perspective. Peer-training programs require processing of abstract language, engagement in pretend play, and cooperation without direct motivation. These skills develop 8 differently over time in all children, but typically begin to appear during the preschool years (Eggum et al., 2010). Trembath et al. (2009) is one of the few studies to report effects of peer-focused intervention of preschool children. Story scripts were used to inform the peer models what was expected of them. They were taught how to model use of the AAC system and how to implement peer-mediated teaching. The target principles taught to the peer models were to “show, wait, and tell,” the child with ASD what to do. Teacher prompts, not controlled for, were provided to peer models as needed. The children with ASD increased their use of communicative behaviors during the intervention context of play, and some children demonstrated a slight generalization to a non-intervention context of snack time. The results suggest that preschool children can act as successful peermediators and increase the communicative behaviors of children with ASD who use AAC. However, peer-mediators at this age appear to need consistent teacher prompts to correctly implement the strategies. McGregor (2000) reported that spontaneous peer modeling is only one component of an intervention program for preschool age children. If an opportunity to model is present, but not acted on by a peer, the clinician or teacher must prompt the trained peer to implement the strategy. As inclusive preschool classrooms become more widespread continued research into peer-training programs is necessary. Goldstein and English (1997) also reported results that are supportive of peer training in preschool aged children. In this study peers were trained to use a set of facilitative strategies, “stay, play, talk,” as well as to be more aware of communicative attempts from their classmates with disabilities. The peers were trained in these strategies and then paired with a classmate with a developmental disability. Goldstein & English’s results show an increase in the number of interactions between the peer-target child dyads in the classroom, and support the use of peer training for improving the communicative interaction and social integration in inclusive preschools. 9 An important factor that may influence the success of peer training is a function of the expectations that the peers have of the children using AAC. Beck et al. (2002) reported factors intrinsic to children that play an influential role in reported attitudes towards children using AAC. Gender was a large contributor, with girls being more accepting of children using AAC than boys. However, the most important predictor of reported attitudes was prior familiarity with people with disabilities. This supports not only inclusive preschool classrooms, but also early peer-intervention training. If the level of familiarity of communication differences can be increased early on in the school years, interactions throughout the school years and beyond may be positively influenced. Although limited, a review of the literature supports the use of communication partner training for increasing communication acts from children with ASD using AAC (Trottier, 2011; Trembath, 2009; Goldstein & English, 1997). With teacher prompting, the effectiveness of peer training has been demonstrated in children as young as preschool age (Trembath, 2009). Despite the demonstrated effectiveness, the use of peer training in preschools continues to be rare. One concern has been that implementation of peer training may interfere in the academic learning of peers. However, research has shown that inclusive classrooms and involvement in peer training programs do not decrease the academic gains made by normally developing preschool children (Choi, 2007). Few interventions focus on teaching the peer communication partner and the child with ASD who uses AAC together, supporting the development of a natural social relationship (Fisher & Shogren, 2012). Additionally, the peer-mediated intervention programs that are typically chosen teach peers how to take on an instructional role. This role may not support the development of natural peer relationships, that are often the primary goal of peer training. The present study aimed to provide preschool peers with instruction on ways to engage with and support the complex communication needs of children with ASD who 10 use AAC. It aimed to teach peers about alternative forms of communication and provide them with a set of strategies to better support their interactions with children with ASD. It aimed to support the natural development of friendship, and thus peers were trained to support, not instruct, the children with ASD. The study tested two hypotheses. Can training increase preschool peers’ awareness of children with ASD during play, as demonstrated by an overall increase in interactions, use of trained strategies, and awareness of AAC use by the child with ASD? Do children with ASD increase appropriate communicative behaviors when interacting with trained peers? 11 CHAPTER II METHODS Participants Ten preschool children, 4 and 5 years old, participated in this study. Children were enrolled in either the KidTalk I or KidTalk II afternoon preschool at the Wendell Johnson Speech and Hearing Center. Both KidTalk I and KidTalk II are inclusive classrooms. Each classroom has five typically developing children to serve as peer models. In KidTalk I there are additional children that have been identified as having speech and language impairments and have an Individualized Education Plan (IEP). In KidTalk II there are additional children with speech and language impairments or Autism Spectrum Disorders (ASD) that have an IEP. The current study involved four participant groups. Training Subject The training subject (TS) was a boy with ASD in the KidTalk II classroom whose age at the start of training was 4:2. During the training program, training peers were taught strategies with TS as the target recipient. TS’s picture and name appeared in the social narratives used in the training. TS communicated primarily with gestures, oneword verbal approximations, and through the Pragmatic Organization Dynamic Display (PODD) system. PODD is a system that organizes aided symbol vocabulary to support communication for functional purposes during daily activities. Each page of the PODD is organized to provide vocabulary for a particular topic or situation. It should be noted that the entire PODD book was not present during sessions, but single laminated pages corresponding to each specific activity were appropriately positioned around the room. Control Subject The control subject (CS) was a boy with ASD in the KidTalk II classroom whose age at the start of training was 5:4. CS served as a generalization subject for this training study. He was not present during any of the peer training sessions, and strategies were 12 not taught to the training peers with him as the direct target. CS’s participation allowed the researchers to observe the generalization of the trained strategies across children with ASD. CS communicated primarily by verbal expression, although his verbal expressions were characterized as echolalic or comments not always appropriate to the conversational topic. Training Peers Four normally developing children that did not have any identified speech and language impairment or ASD served as training peers. Two children were randomly selected from both the KidTalk I and KidTalk II classrooms. These children participated in the entire training study. The two participants from KidTalk I were not classmates of the target or control subject, and had limited interaction with the subjects outside of the study. Training peer 1 (TP1) was a male who at the start of the study was 5:3. Training peer 2 (TP2) was a female who at the start of the study was 4:11. The two participants from KidTalk II were classmates of the subjects, and had daily classroom instruction and interaction alongside of them. Training peer 3 (TP3) was a male who at the start of the study was 4:11. Training peer 4 (TP4) was a female who at the start of the study was 5:1. KidTalk I and KidTalk II are located across the hall from each other. There is some interaction between classrooms for certain activities and when on the playground, but for the majority of the day the children are in their assigned classroom. Control peers Four normally developing children that did not have any identified speech and language impairment or ASD served as control peers. Two children were randomly selected from both the KidTalk I and KidTalk II classrooms. Control peer 1 (CP1) was a male from KidTalk I who at the start of the study was 4:9, and control peer 2 (CP2) was a female from KidTalk I who at the start of the study was 4:6. Control peer 3 (CP3) was a male from KidTalk II who at the start of the study was 4:11, and control peer 4 (CP4) was a female from KidTalk II who at the start of the study was 4:11. These children 13 received no training. The participation of these children allowed the researchers to observe general developmental gains in the target behaviors over the 3-month intervention period. Consent The study protocol was reviewed and approved by the University of Iowa Institutional Review Board. To obtain consent of the participants’ parents, a letter of interest was sent home by the classroom teacher for eligible children. Once families expressed an interest in the study their contact information was shared with the researchers to follow-up with the consent process. All consents were obtained in either the KidTalk I or KidTalk II classrooms after parents had the opportunity to ask questions about the study. Parents were informed that their child’s participation would not impact academic instruction or services provided by the school. Training Content The training protocol was presented to the training peers via video modeling, social narratives, and direct instruction with practice opportunities. At the first training session trained peers listened to a researcher created social narrative entitled, “Some Kids Use Picture Boards to Talk” (See Appendix A). The narrative used pictures of TS and of the PODD. The social narrative explained that different people talk in different ways and that TS sometimes uses a picture board to tell people want he wants or what he likes. It also explained that when TS uses a picture board the peers should try to look at the board so they can see what TS is saying. Additionally, the social narrative explained that it might help TS if they held the picture board up to him while playing to let him make choices. The training peers then viewed a 1-minute video of two researchers modeling use of the PODD during play (See Figure 2.1). After listening to the social narrative and watching the video, the training peers were given an opportunity, in groups of two, to practice using the picture boards with the researcher. Toys and associated PODD boards were 14 available. Each trained peer took a turn pretending not to talk and trying out communication via the picture board. Figure 2.1 Screen shot from the video of researcher modeled PODD use During the second training session, peers were trained on three behavioral strategies to use when interacting with TS. First, training peers listened to a researchermade social narrative entitled, “It Can Be Fun When Everyone Plays Together” (See Appendix B). The narrative included pictures of TS and other classmates playing independently and then together. It explained that TS might be playing alone because he needs help joining the group. The narrative encouraged the training peers to invite TS to join the group. The training peers then watched three 30-second researcher-made videos demonstrating each of the target strategies (e.g. show, wait, and tell.) The first target strategy was to “show” TS what they are doing or something to play with. For example, “I’m going to play with blocks, want to play?” while showing TS a block. The video modeling the strategy included two researchers playing with a 15 farm set. Researcher 2 was playing alone when researcher 1 approached her and showed her a toy animal while inviting her to play with the farm set. The training peers were given the opportunity to practice this strategy immediately following the video. Each training peer (TP) took a turn playing alone and the other TP approached him or her with a toy and invited him or her to play. Each TP practiced and demonstrated the strategy a minimum of 3 times. The second strategy was to “wait” for TS to play or take a turn talking. In the video modeling of this strategy, researcher 1 asked researcher 2 what she wanted to play with. Researcher 1 then imposed a delay to allow researcher 2 to respond using the PODD. Immediately after watching the video the training peers practiced using the “wait” strategy. Each TP took a turn using the PODD, and the other TP asked him or her questions while watching the PODD and waiting for an answer. Each TP practiced and demonstrated the strategy a minimum of 3 times. The third strategy was to “tell” TS what to do or how to do something. For example, “TS, put the block on the top.” In the third video, researcher 1 tells researcher 2 to stack the block on the tower. After watching the video, each TP practiced and demonstrated the tell strategy a minimum of 3 times. At the end of the training session all three strategies were reviewed and the pair of two training peers worked together to explain their understanding of each strategy to the researcher. The researcher supplemented the peers’ understanding as needed. Protocol The training program lasted 12 weeks. Each session occurred during the normal school day and ranged from 15-30 minutes in length. Sessions were conducted during free play to ensure children did not miss any academic instruction or snack time. Sessions took place in a large therapy room in the Wendell Johnson Speech and Hearing Center. Children were taken out of class by the researcher and brought down the hall to the therapy room. The room was set up to mimic the classroom environment with four 16 centers, each with a set of different toys. Each session was recorded using two video cameras within the room. The two cameras ensured the entire room was being captured on video. A series of codes were used to classify the session types. Table 2.1 below presents the codes given to each participant. Table 2.2 presents the codes given to the participant groups, and Table 2.3 presents the codes given to each session type. Each session received the following code of “date-who was involved-session type.” For example “3-8-CP-baseline,” is the code given to the session that occurred on 3/8 that was a baseline session involving all control peers. Each of the four participant groups had a unique protocol. Table 2.4 outlines the sessions each peer attended throughout the study. Table 2.1 Participant Codes C1 C2 C3 C4 T1 T2 T3 T4 TS CS Control Peer # 1 Control Peer # 2 Control Peer # 3 Control Peer #4 Trained Peer #1 Trained Peer #2 Trained Peer #3 Trained Peer #4 Target Subject Control Subject 17 Table 2.2 Participant Group Codes CP CP1 CP2 TP TP1 TP2 All Control Peers Control Peers Group 1 Control Peer #1 and Control Peer #2 (Students in KidTalk I) Control Peers Group 2 Control Peer #3 and Control Peer #4 (Students in KidTalk II) All Trained Peers Trained Peer #1 and Trained Peer #2 (Students in KidTalk I) Trained Peer #3 and Trained Peer #4 (Students in KidTalk II) Table 2.3 Session Codes Session Code Training 1 Training 2 CP1 Session Type Training 1 Training 2 Controlled Practice 1 CP2 Controlled Practice 2 AP Advanced Practice Final Training Final Training Final Test Final Test Baseline/Final Baseline/Final Session Description PODD training Strategy training Clinician provided prompting to TP during interactions with TS Clinician provided prompting to TP during interactions with TS TP interacted with TS with no clinician input A sticker chart was introduced to TP. TPs were given a final opportunity to practice strategies. TP interacted with TS. A sticker chart was present, and stickers were awarded to peers for strategy usage. The clinician prompted strategy usage every 3 minutes. Initial and final sessions between each participant group. 18 Table 2.4 Outline of Protocol for Each Participant Session Code 3-­‐8-­‐CP-­‐ baseline 3-­‐8-­‐TP-­‐ baseline 3-­‐12-­‐TP1TS Session Date 3/8/13 Ses. # 3/8/13 2 3/12/13 3 3-­‐12-­‐TP2TS 3/12/13 4 3-­‐13-­‐CP2TS 3/13/13 3-­‐15-­‐CP1TS 3/15/13 3-­‐26-­‐TP1CS 3/26/13 3-­‐26-­‐TP2CS 3/26/13 3-­‐27-­‐TP2-­‐ training1 3-­‐29-­‐CP1CS 3/27/13 4-­‐2-­‐CP2CS 4/2/13 4-­‐2-­‐TP1-­‐ training1 4-­‐3-­‐TP2-­‐ training2 4-­‐5-­‐TP1-­‐ training2 4-­‐9-­‐TP1TS-­‐ CP1 4-­‐9-­‐TP2TS-­‐ CP1 4-­‐16-­‐TP1TS-­‐ CP2 4-­‐16-­‐TP2TS-­‐ CP2 4-­‐26-­‐TP2TS-­‐ AP 4-­‐30-­‐TP1TS-­‐ AP 5-­‐1-­‐TP2-­‐ training 4/16/13 5-­‐3-­‐TP1-­‐ training 5-­‐7-­‐TP2TS-­‐ finaltest 5-­‐8-­‐CP1TS-­‐ finaltest 5-­‐10-­‐TP1TS-­‐ finaltest TS CS T1 T2 T3 T4 C1 C2 C3 C4 x x x x x x x x x x x x x x 5 TS and CP2 Baseline 6 TS and CP1 Baseline 7 CS and TP1 Baseline 8 CS and TP2 Baseline 9 TP2 Training #1 x x x x x x x x x x x x x x x x x x x x 4/2/13 10 CS and CP1 Baseline 11 CS and CP2 Baseline 12 TP1 Training #1 x x 4/3/13 13 TP2 Training #2 x x 4/5/13 14 TP1 Training #2 x x 4/9/13 15 TS and TP1 Controlled Prac. #1 16 TS and TP2 Controlled Prac. #1 x x x x x x x x x x x x x x x x x x 5/1/13 17 TS and TP1 Controlled Prac. #2 18 TS and TP2 Controlled Prac. #2 19 TS and TP2 Advanced Practice 20 TS and KidTalk I TP Advanced Practice 21 TP2 Final Training x x 5/3/13 22 TP1 Final Training x x 5/7/13 23 TS and TP2 Final Test 24 TS and CP1 Final Test 25 TS and TP1 Final Test x x x x x x x x x 3/29/13 4/9/13 4/16/13 4/26/13 4/30/13 5/8/13 5/10/13 1 Session Description Control Peer Baseline Session Training Peer Baseline Session TS and TP1 Baseline TS and TP2 Baseline 19 Table 2.4. Continued 5-­‐14-­‐CP2TS-­‐ finaltest 5-­‐17-­‐CP-­‐ finalbaseline 5-­‐17-­‐TP-­‐ finalbaseline 5-­‐21-­‐TP1CS-­‐ final 5-­‐28-­‐CP1CS-­‐ final 5-­‐28-­‐CP2CS-­‐ final 5-­‐28-­‐TP2CS-­‐ final 5/14/13 26 5/17/13 27 5/17/13 28 5/21/13 29 5/28/13 30 5/28/13 31 5/28/13 32 TS and CP2 Final Test Control Peer Final Session Training Peer Final Session CS and TP1 Final Session CS and CP1 Final Session CS and CP2 Final Session CS and TP2 Final Session x x x x x x x x x x x x x x x x x x x x x x x Training Peers The training peers participated in a total of 12 sessions. One session occurred each week with the exception of sessions #2 and #3 which both occurred during the second week of the study. No sessions were conducted over the preschool’s Spring Break. In session #1, baseline data for all 4 training peers interacting were collected over a period of 20 minutes. A researcher was present during the session, but sat to the side to minimize any impact on the interaction. In the remainder of the sessions, with the exception of session #10, KidTalk I and KidTalk II training peers attended sessions separately. In session #2, baseline data were recorded of the training peers interacting with TS. In session #3, baseline data were recorded of training peers interacting with CS. Each session lasted approximately 15 minutes. A researcher was present during the session, but sat to the side to minimize any impact on interaction. In session #4, training peers received strategy training. During the session the peers were introduced to the PODD system that TS uses in the classroom to communicate. Children watched a social narrative, “Some Kids Use Picture Boards to 20 Talk,” and viewed a video of two researchers modeling PODD use within the classroom. After watching the social narrative and the video, each child was given approximately 10 minutes to practice using the PODD to communicate. In session #5, training peers received additional strategy training. During the session the children were introduced to the three target strategies, “show, wait, and tell,” to use with TS. The children viewed the social narrative, “It Can Be Fun When Everyone Plays Together,” and viewed three short clips of the researchers modeling each of the three strategies. After each video the children were given time to practice each new strategy. In session #6 and #7, training peers took part in controlled practice of the strategies with TS. A researcher was present in this session to model strategy use and prompt use of the strategies by the training peers. If an opportunity to use strategies was presented, but not identified and acted on by the training peers, the researcher cued strategy use by the training peers. The session lasted for approximately 20 minutes. In session #8, training peers participated in advanced practice of the strategies with TS. A researcher was present during the session, but sat to the side to minimize any impact on interaction. No prompting to use the trained strategies was provided. The session lasted for approximately 15 minutes. In session #9, feedback was provided to the training peers regarding their performance in session #8. All strategies were reviewed by re-watching the videos. Peers were given additional opportunities to practice each strategy. Additionally, during session #9 a new reinforcement system was introduced to the training peers in the form of a sticker chart. Each training peer was given a picture with nine empty boxes drawn on it. Each time a strategy was demonstrated by a training peer, a sticker was immediately placed into the box. The session lasted for approximately 20 minutes. The session served as a final reminder of the strategies before the final sessions in which they interacted with TS and CS. 21 Session #10 involved the final observation of the training peers interacting with TS. The sticker chart reinforcement system was used during this session. Additionally, the researcher provided the following prompt every 3 minutes, “Remember to use your strategies to try to earn stickers,” to remind the training peers of the session’s goal. The session lasted approximately 15 minutes. In session #11, a final observation of all 4 training peers interacting was obtained over a period of 20 minutes. A researcher was present during this session, but sat to the side to minimize any impact on interaction. Session #12 involved the final observation of the training peers interacting with the control subject, CS. This session provided data to determine whether the use of the trained target strategies generalized to interactions with other children with ASD. The sticker chart reinforcement system was also used during this session. Additionally, the researcher provided the following prompt every 3 minutes, “Remember to use your strategies to try to earn stickers,” to remind the training peers of the session’s goal. The session lasted approximately 15 minutes. Control Peers The control peers received no training and participated in a total of 6 sessions. Each session lasted approximately 15-20 minutes. In all sessions a researcher was present, but sat to the side to minimize any impact on interaction. Sessions #1-3 data were collected during the initial 3 weeks of the 12-week study, and session #4-6 were collected during the final 3 weeks of the study. In session #1, initial baseline data were taken of all 4 control peers playing together. In the remainder of the sessions, with the exception of session #4, KidTalk I and KidTalk II control peers attended sessions separately. In session #2, baseline data were taken of control peers interacting with the training subject, TS. In session #3, baseline data were taken of control peers interacting with control subject, CS. 22 In session #4, final outcome data were taken of all 4 control peers playing together. In session #5, final outcome data were taken of control peers interacting with TS. In session #6, final outcome data were taken of control peers interacting with CS. Training Subject The training subject (TS) participated in 14 sessions. Each session lasted approximately 15-20 minutes and occurred in a therapy room in Wendell Johnson Speech and Hearing Center. TS interacted with 2 sets of 2 training peers, and 2 sets of 2 control peers. At each activity center a PODD was provided with the vocabulary related to that specific activity. Session #1, 2, 3, and 4 occurred during week 2 of the training program. Baseline observations were collected of TS interacting with the four different sets of classroom peers. The researcher was present for each session, but sat to the side to minimize any impact on interaction. Session #5, 6, 7, and 8 were controlled practice sessions for the training peers. TS participated in each of the two controlled practice sessions for both sets of training peers. The researcher was present during these sessions to provide prompting to the training peers on strategy use. Prompting of TS was provided to encourage response to peer attempts to interact. Session #9 and 10 were advanced practice sessions for the training peers. TS participated in one advanced practice session for each group of training peers. No researcher prompting was provided to the training peers or TS during these sessions. The researcher was present for each session, but sat to the side to minimize any impact on interaction. Sessions #11 and 12 were final testing sessions for the training peers. TS participated in one testing session for each group of training peers. A sticker chart was used and researcher prompting was provided to the training peers during these sessions. TS was provided with a sticker chart and earned stickers when he responded to a peer’s 23 communication attempt or initiated an interaction. However, no researcher prompting to engage with peers was provided to TS. The session lasted approximately 15 minutes. Sessions #13 and 14 were final observations of TS interacting with the control peers. TS participated in one session with each group of control peers. The researcher was present for each session, but sat to the side to minimize any impact on interaction. Control Subject The control subject (CS) participated in 8 sessions. Each session lasted approximately 15-20 minutes and occurred in a therapy room in Wendell Johnson Speech and Hearing Center. CS interacted with 2 sets of 2 training peers, and 2 sets of 2 control peers. A researcher was present for each session, but sat to the side to minimize any impact on interaction. Session #1, 2, 3, and 4 occurred during week 2 of the training program. Initial baseline observations were collected of CS interacting with the four different sets of classroom peers. Session #5, 6, 7, and 8 occurred during week 12 of the training program. Final observations were collected of CS interacting with the four different sets of classroom peers. Data Analysis The sessions were analyzed using the ELAN software system developed by the Max Plank Geselschaft. ELAN allows transcription and multiple forms of analysis to be completed on audio or video files. ELAN provides platform that allows a detailed analysis of any coded annotated transcript of the recorded sessions. ELAN allowed the two videos from the two cameras to be streamed simultaneously. ELAN allows the investigator to construct a tiered template that can be used to code each video. (See Figure 2.2) Each composite video was transcribed and coded for the presence of the various target behaviors. For each tier a controlled vocabulary was developed and made available that allowed for specifics of each observed 24 behavior to be identified/coded. See Table 2.5 for an outline of the behaviors coded in each tier and their descriptions. Figure 2.2 ELAN tiered template used for data analysis 25 Table 2.5 Outline of Analyzed Behaviors Tier Actor Actor Behavior Controlled Vocabulary Selections Trained Peers (T1-T4), Control Peers (C1-C4), Training Subject (TS), and Control Subject (CS) Verbal Gesture AAC Hitting Grabbing Toy Walking Away No Response Actor Strategy Show Wait Tell Recipient Peer, Subject, Peer & Subject Recipient Gender Recipient Classroom PODD Response Male, Female, Male & Female KidTalk I, KidTalk II, KidTalk I & II TS, CS, T1-T4, C1-C4 Clinician Cue Cue Given Description of Vocabulary The participant who initiated the interaction Using words or vocalizations Sign language or natural gesture Use of the PODD Aggressive physical touching of another participant Taking a toy away from another participant Walking away from an attempt to interact from another participant Not responding to an attempt to interact from another participant Shows another participant an item to play with. Shows another participant how to do something. Hands another participant a toy. Wait for a participant to take a turn Wait for a participant to respond Repeat a question if the participant does not respond Tell another participant how to do something or what to do Who the actor initiated an interaction with The gender of the recipient. The classroom of the recipient. Who responded to the use of the PODD The provision of a hint to the peers to use strategies with subjects 26 Reliability Coding A graduate student in speech-language pathology, not involved with the study, was trained in both ELAN and the study’s code to complete the reliability coding. The primary investigator trained the coder in the basics of ELAN necessary to complete coding. This included how to load videos, how to make annotations, and how to save the coded samples. The coder was provided with written instructions to supplement the verbal instruction (See Appendix C). Next, the coder was trained on the specific behavior codes used in this study. She was trained to identify each participant, the specific type of behaviors, and the specific strategies. The coder was also provided with written instructions that enumerated each of the possible codes for the specific tiers (See Appendix D). After the initial instruction on the code, the coder and primary investigator coded two five-minute video segments together to allow the coder to become familiar with the program and the children. The coder then coded additional practice five-minute video samples independently. Once, the coder achieved over 80% reliability, she began the coding of the remaining 16 selected video segments. These 16 five-minute segments constituted 20% of the total recorded video samples. Training sessions in which trained peers were receiving direct clinician instruction were not coded, and therefore are not factored into the base from which the 20% reliability sample was derived. The coder was instructed to code the actor of each behavior and identify the type of strategy used if present. During training, the reliability coder demonstrated 100% accuracy in identification of the recipient of an action, and therefore that tier was not coded during reliability. As some of the audio and video samples were poor, the reliability coder was also provided with the transcription of the video session as she was coding each session. She was also given a list of the time windows for which the presence and type of each strategy should be coded. For identification of the actor of each behavior, reliability was 90% (890/992 total behaviors). Overall reliability for strategy identification was 83% (111/133 total strategies). Reliability was highest for identification of the strategy “tell” with 91% (94/103 occurrences). “Show” was 58% (14/24 occurrences), and “wait” was 50% (3/6 occurrences) for reliability measures. Both “show” and “wait” were lower frequency events that may have resulted in lower reliability associated with these strategies. 27 28 CHAPTER III RESULTS The results are divided into sections based on participant group. Control peers performance with peers and with subjects is presented first. A figure is provided detailing each participant’s total behaviors, total strategy use, and a breakdown of strategy type. In addition to each peer’s performance, figures are provided detailing collective control peer performance and control peer performance based on classroom. Following the control peer data, the trained peer’s performance is presented in the same format as the control peers. Additionally, figures are presented detailing each trained peer’s participation in the training. Lastly, figures are provided that present both the control and target subject’s overall interaction with both control and trained peers, based on which classroom they were from. Control Peers with Peers Each control peer participated in 6 total sessions, totaling 15 minutes. In session number 1 and 4, all four control peers were present. In the remainder of the sessions, the two control peers from the same classroom were present with the addition of either the target or control subject. Figures 3.1 - 3.12 detail each control peer’s total behaviors, total strategy use, and a breakdown of strategy type with other control peers. In addition to each peer’s individual performance, figures 3.13 – 3.21 provide aggregate control peer performance and control peer performance based on classroom. Control Peer 1 C1 Behaviors to Peers Over Time Figure 3.1 depicts the total number of behaviors over time to a peer by Control Peer 1 (C1). C1 showed relatively stable interaction amounts with peers over time. 29 Figure 3.1 C1 Behaviors to Peers # of Behaviors C1 Behaviors to Peers 100 90 80 70 60 50 40 30 20 10 0 3-­‐8-­‐CP-­‐baseline 3-­‐15-­‐CP1TS 3-­‐29-­‐CP1CS 5-­‐8-­‐CP1TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP1CS Session Title C1 Total Strategy Use with Peers Figure 3.2 depicts the total number of strategies used over time by C1 with a peer. C1 showed a slight increase in the amount of overall strategies used with peers over time. Figure 3.2 C1 Total Strategy Use with Peers # of Strategies Used C1 Strategy Use with Peers 36 32 28 24 20 16 12 8 4 0 3-­‐8-­‐CP-­‐baseline 3-­‐15-­‐CP1TS 3-­‐29-­‐CP1CS 5-­‐8-­‐CP1TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP1CS Session Title 30 C1 Strategy Breakdown with Peers Figure 3.3 details the types of strategies used by C1 with peers over time. C1 primarily demonstrated the strategy of “tell” throughout the course of the study. Figure 3.3 C1 Strategy Breakdown with Peers # of Strategies Used C1 Strategy Breakdown with Peers 36 32 28 24 20 16 12 8 4 0 Show Wait Tell 3-­‐8-­‐CP-­‐baseline 3-­‐15-­‐CP1TS 3-­‐29-­‐CP1CS 5-­‐8-­‐CP1TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP1CS Session Title Control Peer 2 C2 Behaviors to Peers Over Time Figure 3.4 depicts Control Peer 2 (C2) behaviors to peers over the course of the study. C2 interacted more with peers during sessions in which the target or control subject were present and the only additional peer was C1. C2 demonstrated relatively little interaction with peers when all other peers were present in the session (CP-baseline and CP-final sessions). 31 Figure 3.4 C2 Behaviors to Peers # of Behaviors C2 Behaviors To Peers 100 90 80 70 60 50 40 30 20 10 0 3-­‐8-­‐CP-­‐baseline 3-­‐15-­‐CP1TS 3-­‐29-­‐CP1CS 5-­‐8-­‐CP1TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP1CS Session Title C2 Total Strategy Use with Peers Figure 3.5 depicts the total strategies used over time with peers by Control Peer 2 (C2). C2 showed minimal use of strategies throughout the study. Figure 3.5 C2 Total Strategy Use with Peers % of Strategies Used C2 Total Strategy Use with Peers 36 32 28 24 20 16 12 8 4 0 3-­‐8-­‐CP-­‐baseline 3-­‐15-­‐CP1TS 3-­‐29-­‐CP1CS 5-­‐8-­‐CP1TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP1CS Session Title 32 C2 Strategy Breakdown with Peers Figure 3.6 shows a breakdown of the type of strategies used by C2 with peers over time. C2 used few strategies; however, showed a preference for the strategy “show.” Figure 3.6 C2 Strategy Breakdown with Peers C2 Strategy Breakdown with Peers 36 # of Strategies Used 32 28 24 20 Show 16 Wait 12 Tell 8 4 0 3-­‐8-­‐CP-­‐baseline 3-­‐15-­‐CP1TS 3-­‐29-­‐CP1CS 5-­‐8-­‐CP1TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP1CS Session Title Control Peer 3 C3 Behaviors to Peers Over Time Figure 3.7 depicts Control Peer 3’s (C3) total number of behaviors over time to a peer. C3 showed variable interaction amounts with peers over time. It should be noted that in the sessions with almost no interactions with a peer, C3 was engaged exclusively with either the control or target subject. These interactions will be discussed in detail later. 33 Figure 3.7 C3 Behaviors to Peers # of Behaviors C3 Behaviors with Peers 100 90 80 70 60 50 40 30 20 10 0 3-­‐8-­‐CP-­‐baseline 3-­‐13-­‐CP2TS 4-­‐2-­‐CP2CS 5-­‐14-­‐CP2TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP2CS Session Title C3 Total Strategy Use with Peers Figure 3.8 depicts the total number of strategies used by C3 with a peer. C3 showed a decrease in the amount of strategies used with peers over time. This decrease is consistent with the overall drop in interaction between C3 and the other peers over the course of the study. 34 Figure 3.8 C3 Total Strategy Use with Peers # of Strategies Used C3 Strategy Use with Peers 36 32 28 24 20 16 12 8 4 0 3-­‐8-­‐CP-­‐baseline 3-­‐13-­‐CP2TS 4-­‐2-­‐CP2CS 5-­‐14-­‐CP2TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP2CS Session Title C3 Strategy Breakdown with Peers Figure 3.9 details the type of strategy used by C3 with peers. C3 primarily used the strategy “tell.” Figure 3.9 C3 Strategy Breakdown with Peers C3 Strategy Breakdown with Peers 36 # of Strategies Used 32 28 24 20 Show 16 Wait 12 Tell 8 4 0 3-­‐8-­‐CP-­‐baseline 3-­‐13-­‐CP2TS 4-­‐2-­‐CP2CS 5-­‐14-­‐CP2TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP2CS Session Title 35 Control Peer 4 C4 Behaviors to Peers Over Time Figure 3.10 depicts the total behaviors to peers by Control Peer 4 (C4). C4 showed variable interaction with some peers over time. C4’s interactions with all control peers remained consistent from baseline to final testing. However, interactions with C4’s classroom partner, Control Peer 3 (C3), showed a large drop from baseline to final sessions in which only C3 was present. Figure 3.10 C4 Behaviors to Peers # of Behaviors C4 Behaviors to Peers 100 90 80 70 60 50 40 30 20 10 0 3-­‐8-­‐CP-­‐baseline 3-­‐13-­‐CP2TS 4-­‐2-­‐CP2CS 5-­‐14-­‐CP2TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP2CS Session Title C4 Total Strategy Use with Peers Figure 3.11 presents C4’s strategy use with peers over time. C4 decreased in the amount of strategies used with a peer over time. 36 Figure 3.11 C4 Total Strategy Use with Peers # of Strategies Used C4 Total Strategy use with Peers 36 32 28 24 20 16 12 8 4 0 3-­‐8-­‐CP-­‐baseline 3-­‐13-­‐CP2TS 4-­‐2-­‐CP2CS 5-­‐14-­‐CP2TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP2CS Session Title C4 Strategy Breakdown with Peers Figure 3.12 breaks down the types of strategies used by C4 with peers over time. C4 primarily used the strategy “tell.” Figure 3.12 C4 Strategy Breakdown with Peers # of Strategies Used C4 Strategy Breakdown with Peers 36 32 28 24 20 16 12 8 4 0 Show Wait Tell 3-­‐8-­‐CP-­‐baseline 3-­‐13-­‐CP2TS 4-­‐2-­‐CP2CS 5-­‐14-­‐CP2TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP2CS Session Title 37 Control Peer Group 1 (Control Peer 1 & Control Peer 2) CP1 Averaged Behaviors to Peers Over Time Figure 3.13 depicts Control Peer Group 1’s (CP1) averaged behaviors to peers over time. CP1 includes C1 and C2, students in the KidTalk I classroom. CP1’s interactions with other peers remained stable over time. Figure 3.13 CP1 Averaged Behaviors to Peers # of Behaviors CP1 Averaged Behaviors To Peers 100 90 80 70 60 50 40 30 20 10 0 3-­‐8-­‐CP-­‐baseline 3-­‐15-­‐CP1TS 3-­‐29-­‐CP1CS 5-­‐8-­‐CP1TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP1CS Session Title CP1 Averaged Strategy Use with Peers Figure 3.14 depicts CP1’s averaged strategy use over time with peers. CP1’s strategy usage with peers remained relatively stable throughout the study. 38 Figure 3.14 CP1 Averaged Strategy Use with Peers # of Strategies Used CP1 Averaged Strategy Use with Peers 36 32 28 24 20 16 12 8 4 0 3-­‐8-­‐CP-­‐baseline 3-­‐15-­‐CP1TS 3-­‐29-­‐CP1CS 5-­‐8-­‐CP1TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP1CS Session Title CP1 Averaged Strategy Breakdown with Peers Figure 3.15 shows an averaged breakdown of the type of strategies used by CP1 with peers over time. CP1 primarily used the strategy “tell.” Figure 3.15 CP1 Averaged Strategy Breakdown with Peers # of Strategies Used CP1 Averaged Strategy Breakdown with Peers 36 32 28 24 20 16 12 8 4 0 Show Wait Tell 3-­‐8-­‐CP-­‐baseline 3-­‐15-­‐CP1TS 3-­‐29-­‐CP1CS 5-­‐8-­‐CP1TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP1CS Session Title 39 Control Peer Group 2 (Control Peer 3 & Control Peer 4) CP2 Averaged Behaviors to Peers Over Time Figure 3.16 depicts Control Peer Group 2’s (CP2) averaged behaviors to peers over time. CP2 includes C3 and C4, students in the KidTalk II classroom. CP2’s interactions with other peers decreased over the course of the study. Figure 3.16 CP2 Averaged Behaviors to Peers CP2 Averaged Behaviors to Peers # of Behaviors 100 80 60 40 20 0 3-­‐8-­‐CP-­‐baseline 3-­‐13-­‐CP2TS 4-­‐2-­‐CP2CS 5-­‐14-­‐CP2TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP2CS Session Title CP2 Averaged Strategy Use with Peers Figure 3.17 depicts CP2’s averaged strategy use over time with peers. CP2’s strategy usage with peers decreased over the course of the study. This is consistent with the overall decrease in peer interaction exhibited by CP2. 40 Figure 3.17 CP2 Averaged Strategy Use with Peers # of Strategies Used CP2 Averaged Strategy Use with Peers 36 32 28 24 20 16 12 8 4 0 3-­‐8-­‐CP-­‐baseline 3-­‐13-­‐CP2TS 4-­‐2-­‐CP2CS 5-­‐14-­‐CP2TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP2CS Session Title CP2 Averaged Strategy Breakdown with Peers Figure 3.18 shows an averaged breakdown of the type of strategies used by CP2 with peers over time. CP2, like CP1, primarily used “tell” throughout the study. Figure 3.18 CP2 Averaged Strategy Breakdown with Peers # of Strategies Used CP2 Averaged Strategy Breakdown with Peers 36 32 28 24 20 16 12 8 4 0 Show Wait Tell 3-­‐8-­‐CP-­‐baseline 3-­‐13-­‐CP2TS 4-­‐2-­‐CP2CS 5-­‐14-­‐CP2TS 5-­‐17-­‐CP-­‐=inal 5-­‐28-­‐CP2CS Session Title 41 All Control Peers Control Peer Averaged Behaviors Figure 3.19 depicts the average number of behaviors with other peers in the control peer baseline and final control peer session involving C1-C4. All control peers showed a relatively stable amount of interactions with other control peers from the initial to final 15-minute baseline session. Figure 3.19 CP Averaged Behaviors with Peers # of Behaviors CP Averaged Behavior with Peers 100 90 80 70 60 50 40 30 20 10 0 3-­‐8-­‐CP-­‐Baseline 5-­‐17-­‐CP-­‐=inal Session Title Control Peer Averaged Strategy Use Figure 3.20 depicts the averaged number of strategies used by peers in the control peer baseline and final control peer session involving C1-C4. In general, the amount of strategies used by control peers with other peers decreased over time. 42 Figure 3.20 CP Averaged Strategy Use with Peers # of Strategies Used CP Averaged Strategy Use with Peers 36 32 28 24 20 16 12 8 4 0 3-­‐8-­‐CP-­‐Baseline 5-­‐17-­‐CP-­‐=inal Session Title Control Peer Averaged Strategy Breakdown Figure 3.21 depicts the averaged type of strategies used by peers in the control peer baseline and final control peer session involving C1-C4. In general, if a control peer were to use a strategy, it tended to be the strategy “tell.” 43 Figure 3.21 CP Averaged Strategy Breakdown with Peers # of Strategies Used CP Averaged Strategy Breakdown with Peers 36 32 28 24 20 16 12 8 4 0 3-­‐8-­‐CP-­‐Baseline 5-­‐17-­‐CP-­‐=inal Show Wait Tell Strategy Type Control Peers with Target & Control Subject Each control peer participated in four total sessions with either the Target Subject (TS) or the Control Subject (CS). They spent 15 minutes in a baseline and final session with the TS and one other peer, and 15 minutes in a baseline and final session with the CS and one other peer. Each peer’s performance with either the TS or CS is depicted in Figures 3.22 – 3.33 below. The TS is represented in the following figures by blue bars. The CS is represented in the following figures by yellow bars. In addition to each peer’s individual performance, figures 3.34 – 3.42 provide collective control peer performance and control peer performance based on classroom. Control Peer 1 C1 Behaviors to Subjects Over Time Figure 3.22 depicts the percentage of behaviors towards a subject out of total behaviors over time by Control Peer 1 (C1). C1 showed a decrease in percentage of behaviors towards the TS over time. C1 showed a stable percentage of behaviors towards 44 the CS over time. Overall, total percentage of behaviors directed towards a subject was low throughout the study. Figure 3.22 Percentages of C1 Behaviors to Subjects % of Behaviors to Subject % of C1 Behaviors to Subjects 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% 3-­‐15-­‐CP1TS-­‐baseline 3-­‐29-­‐CP1CS-­‐baseline 5-­‐8-­‐CP1TS-­‐=inal 5-­‐28-­‐CP1CS-­‐=inal Session Title C1 Total Strategy Use with Subjects Figure 3.23 depicts the total number of strategies used over time with a subject by C1. C1 showed a decrease in strategy use with subjects over time. 45 Figure 3.23 C1 Strategy Use with Subjects # of Strategies Used C1 Strategies Use with Subjects 36 32 28 24 20 16 12 8 4 0 3-­‐15-­‐CP1TS-­‐ baseline 3-­‐29-­‐CP1CS-­‐ baseline 5-­‐8-­‐CP1TS-­‐=inal 5-­‐28-­‐CP1CS-­‐=inal Session Title C1 Strategy Breakdown with Subjects Figure 3.24 shows a breakdown of the type of strategies used by C1 with subjects over time. C1 used few strategies with subjects; however, showed a preference for “tell.” Figure 3.24 C1 Strategy Breakdown with Subjects # of Strategies Used C1 Strategy Breakdown with Subjects 36 32 28 24 20 16 12 8 4 0 Show Wait Tell 3-­‐15-­‐CP1TS-­‐baseline 3-­‐29-­‐CP1CS-­‐baseline 5-­‐8-­‐CP1TS-­‐=inal 5-­‐28-­‐CP1CS-­‐=inal Session Title 46 Control Peer 2 C2 Behaviors to Subjects Over Time Figure 3.25 depicts the percentage of behaviors towards a subject out of total behaviors over time by C2. C2 showed a decrease in percentage of behaviors towards the target subject over time. C2 did not interact with the CS at all throughout the course of the study. Figure 3.25 Percentages of C2 Behaviors to Subjects % of Behaviors to Subject 100.00% % C2 Behaviors to Subjects 80.00% 60.00% 40.00% 20.00% 0.00% 3-­‐15-­‐CP1TS-­‐baseline 3-­‐29-­‐CP1CS-­‐baseline 5-­‐8-­‐CP1TS-­‐=inal 5-­‐28-­‐CP1CS-­‐=inal Session Title C2 Total Strategy Use with Subjects Figure 3.26 depicts the total number of strategies used over time with a subject by C2. C2 showed a decrease in strategy use with subjects over time. 47 Figure 3.26 C2 Strategy Use with Subjects # of Strategies Used C2 Strategy Use with Subjects 36 32 28 24 20 16 12 8 4 0 3-­‐15-­‐CP1TS-­‐ baseline 3-­‐29-­‐CP1CS-­‐ baseline 5-­‐8-­‐CP1TS-­‐=inal 5-­‐28-­‐CP1CS-­‐=inal Session Title C2 Strategy Breakdown with Subjects Figure 3.27 shows a breakdown of the type of strategies used by C2 with subjects over time. C2 used few strategies with subjects; however, showed a preference for the strategy “tell.” 48 Figure 3.27 C2 Strategy Breakdown with Subjects # of Strategies Used C2 Strategy Breakdown with Subjects 36 32 28 24 20 16 12 8 4 0 Show Wait Tell 3-­‐15-­‐CP1TS-­‐baseline 3-­‐29-­‐CP1CS-­‐baseline 5-­‐8-­‐CP1TS-­‐=inal 5-­‐28-­‐CP1CS-­‐=inal Session Title Control Peer 3 C3 Total Behaviors to Subjects Over Time Figure 3.28 depicts the percentage of behaviors towards a subject out of total behaviors over time by Control Peer 3 (C3). It should be noted that in the 4-2-CP2CSbaseline, 47% of C3’s behaviors towards the CS were aggressive. This session was terminated at 7 ½ minutes due to aggression between both C3 and CS. In session 5-14CP2TS-final, 90% of C3’s behaviors towards the TS were nonverbal while taking turns during a game. This interaction lasted for the entirety of the session. 49 Figure 3.28 Percentages of C3 Behaviors to Subjects % Behaviors to Subject % C3 Behaviors to Subjects 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% 3-­‐13-­‐CP2TS-­‐baseline 4-­‐2-­‐CP2CS-­‐baseline 5-­‐14-­‐CP2TS-­‐=inal 5-­‐28-­‐CP2CS-­‐=inal Session Title C3 Total Strategy Use with Subjects Figure 2.29 depicts the total number of strategies used over time with a subject from Control Peer 3 (C3). C3 showed a slight increase in strategy use with the TS, but a slight decrease in strategy use with the CS. 50 Figure 3.29 C3 Strategy Use with Subjects # of Strategies Used C3 Strategy Use with Subjects 36 32 28 24 20 16 12 8 4 0 3-­‐13-­‐CP2TS-­‐ baseline 4-­‐2-­‐CP2CS-­‐baseline 5-­‐14-­‐CP2TS-­‐=inal 5-­‐28-­‐CP2CS-­‐=inal Session Title C3 Strategy Breakdown with Subjects Figure 3.30 shows a breakdown of the types of strategies used by C3 with the subjects. C3 used few strategies with subjects, but showed a propensity for “tell.” Figure 3.30 C3 Strategy Breakdown with Subjects # of Strategies Used C3 Strategy Breakdown with Subjects 36 32 28 24 20 16 12 8 4 0 Show Wait Tell 3-­‐13-­‐CP2TS-­‐baseline 4-­‐2-­‐CP2CS-­‐baseline 5-­‐14-­‐CP2TS-­‐=inal 5-­‐28-­‐CP2CS-­‐=inal Session Title 51 Control Peer 4 C4 Behaviors to Subjects Over Time Figure 3.31 depicts the percentage of behaviors towards a subject out of total behaviors over time by Control Peer 4 (C4). C4 showed a decrease in behaviors towards the CS over the course of the study. It appears that C4 showed an increase in percentage of behaviors to the TS from initial to final baseline; however, it should be noted that C4 only demonstrated 2 behaviors during the course of the 5-14-CP2TS-final session, 1 of which was to the TS, giving her a percentage of 50%. Figure 3.31 Percentages of C4 Behaviors to Subjects % of Behaviors to Subject % C4 Behaviors to Subjects 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% 3-­‐13-­‐CP2TS-­‐baseline 4-­‐2-­‐CP2CS-­‐baseline 5-­‐14-­‐CP2TS-­‐=inal* 5-­‐28-­‐CP2CS-­‐=inal Session Title C4 Total Strategy Use with Subjects Figure 3.32 depicts the total number of strategies used over time with a subject from Control Peer 4 (C4). C4 showed little to no strategy use with subjects over the course of the study. 52 Figure 3.32 C4 Strategy Use with Subjects # of Strategies Used C4 Strategy Use with Subjects 36 32 28 24 20 16 12 8 4 0 3-­‐13-­‐CP2TS-­‐ baseline 4-­‐2-­‐CP2CS-­‐baseline 5-­‐14-­‐CP2TS-­‐=inal 5-­‐28-­‐CP2CS-­‐=inal Session Title C4 Strategy Breakdown with Subjects Figure 3.33 shows a breakdown of the type of strategies used by C4 with subjects over time. C4 only exhibited use of the strategy “tell.” Figure 3.33 C4 Strategy Breakdown with Subjects # of Strategies Used C4 Strategy Breakdown with Subjects 36 32 28 24 20 16 12 8 4 0 Show Wait Tell 3-­‐13-­‐CP2TS-­‐baseline 4-­‐2-­‐CP2CS-­‐baseline 5-­‐14-­‐CP2TS-­‐=inal 5-­‐28-­‐CP2CS-­‐=inal Session Title 53 Control Peer Group 1 (Control Peer 1 & Control Peer 2) CP1 Averaged Behaviors to Subjects Over Time Figure 3.34 depicts the average percentage of behaviors over time to a subject by Control Peer Group 1 (CP1), including Control Peer 1 (C1) and Control Peer 2 (C2). CP1’s percentage of interactions with the TS decreased over time. CP1’s percentage of interactions with the CS remained stable, at a low percentage, over the course of the study. Figure 3.34 Averaged Percentages of CP1 Behaviors to Subjects Average % of Behaviors to Subjects Average % C1 & C2 Behaviors to Subjects 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% 3-­‐15-­‐CP1TS-­‐baseline 3-­‐29-­‐CP1CS-­‐baseline 5-­‐8-­‐CP1TS-­‐=inal 5-­‐28-­‐CP1CS-­‐=inal Session Title CP1 Averaged Strategy Use with Subjects Figure 3.35 depicts the average number of strategies used over time with a subject from Control Peer Group 1 (CP1). CP1’s strategy usage with subjects decreased over time. 54 Figure 3.35 CP1 Averaged Strategy Use with Subjects Average # of Strategies Used C1 & C2 Averaged Strategy Use with Subjects 36 32 28 24 20 16 12 8 4 0 3-­‐15-­‐CP1TS-­‐baseline 3-­‐29-­‐CP1CS-­‐baseline 5-­‐8-­‐CP1TS-­‐=inal 5-­‐28-­‐CP1CS-­‐=inal Session Title CP1 Averaged Strategy Breakdown with Subjects Figure 3.36 shows a breakdown of the type of strategies used by CP1 with subjects over time. CP1 primarily used the strategy “tell.” Figure 3.36 CP1 Averaged Strategy Breakdown with Subjects Average # of Strategies Used C1 & C2 Averaged Strategy Breakdown with Subjects 36 32 28 24 20 16 12 8 4 0 Show Wait Tell 3-­‐15-­‐CP1TS-­‐baseline 3-­‐29-­‐CP1CS-­‐baseline 5-­‐8-­‐CP1TS-­‐=inal 5-­‐28-­‐CP1CS-­‐=inal Session Title 55 Control Peer Group 2 (Control Peer 3 & Control Peer 4) CP2 Averaged Behaviors to Subjects Over Time Figure 3.37 depicts the average percentage of behaviors over time to a subject by Control Peer Group 2 (CP2), including Control Peer 3 (C3) and Control Peer 4 (C4). CP2’s interactions with subjects were variable, and can be attributed to the factors described earlier related to the 4-2-CP2CS-baseline and 5-14-CP2TS-final sessions. Figure 3.37 Averaged Percentages of CP2 Behaviors to Subjects Average % of Behaviors to Subject Averaged % of C3 & C4 Behaviors to Subjects 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% 3-­‐13-­‐CP2TS-­‐baseline 4-­‐2-­‐CP2CS-­‐baseline 5-­‐14-­‐CP2TS-­‐=inal 5-­‐28-­‐CP2CS-­‐=inal CP2 Averaged Strategy Use with Subjects Figure 3.38 depicts the average number of strategies used over time with a subject from Control Peer Group 2 (CP2). CP2’s strategy usage with subjects remained low across time. 56 Figure 3.38 CP2 Averaged Strategy Use with Subjects Average # of Strategies Used C3 & C4 Averaged Strategies Use with Subjects 36 32 28 24 20 16 12 8 4 0 3-­‐13-­‐CP2TS-­‐baseline 4-­‐2-­‐CP2CS-­‐baseline 5-­‐14-­‐CP2TS-­‐=inal 5-­‐28-­‐CP2CS-­‐=inal Session Title CP2 Averaged Strategy Breakdown with Subjects Figure 3.39 shows a breakdown of the type of strategies used by CP2 with subjects over time. CP2 used few strategies, but showed a propensity for “tell.” Figure 3.39 CP2 Averaged Strategy Breakdown with Subjects Average # of Strategies Used C3 & C4 Averaged Strategy Breakdown with Subjects 36 32 28 24 20 16 12 8 4 0 Show Wait Tell 3-­‐13-­‐CP2TS-­‐baseline 4-­‐2-­‐CP2CS-­‐baseline 5-­‐14-­‐CP2TS-­‐=inal 5-­‐28-­‐CP2CS-­‐=inal Session Title 57 All Control Peers Control Peer Averaged Behaviors with Subjects Figure 3.40 depicts the average percentage of behaviors over time to a subject by all control peers. Overall percentage of interactions the subjects remained low throughout the study, less than 40%. Peaks in interactions can be attributed to interactions with the TS and the CS by C3. Figure 3.40 Averaged Percentages of All CP Behaviors with Subjects Average % of Behaviors to Subject Averaged % CP Behaviors with Subjects 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% 3-­‐15-­‐CP1TS-­‐baseline 3-­‐29-­‐CP1CS-­‐baseline 5-­‐8-­‐CP1TS-­‐=inal 5-­‐28-­‐CP1CS-­‐=inal Session Title Control Peer Averaged Strategy Use with Subjects Figure 3.41 depicts the average number of strategies used over time with a subject from all control peers. Overall strategy usage showed a decline over the course of the study. 58 Figure 3.41 Averaged CP Strategy Use with Subjects Average # of Strategies Used Averaged CP Strategy Use with Subjects 36 32 28 24 20 16 12 8 4 0 3-­‐15-­‐CP1TS-­‐baseline 3-­‐29-­‐CP1CS-­‐baseline 5-­‐8-­‐CP1TS-­‐=inal 5-­‐28-­‐CP1CS-­‐=inal Session Title Control Peer Averaged Strategy Breakdown with Subjects Figure 3.42 shows a breakdown of the type of strategies used by all control peers with subjects over time. Control peers primarily used the strategy “tell.” Figure 3.42 Averaged CP Strategy Breakdown with Subjects Average # of Strategies Used Averaged CP Strategy Breakdown with Subjects 36 32 28 24 20 16 12 8 4 0 Show Wait Tell 3-­‐15-­‐CP1TS-­‐baseline 3-­‐29-­‐CP1CS-­‐baseline 5-­‐8-­‐CP1TS-­‐=inal 5-­‐28-­‐CP1CS-­‐=inal Session Title 59 In summary, control peers decreased their usage of behaviors and strategies to other control peers over the course of the study. If they were to use a strategy, it was almost exclusively “tell.” With respect to control peer performance with subjects, overall behaviors remained low at less than 40% of total behaviors seen towards subjects. Any peaks in interactions were attributed to C3’s aggressive or nonverbal interactions with the subjects. Amongst control peers, a decrease in strategies was observed with the primary strategy used being “tell.” This lack of growth seen by the control peers, suggests that any growth demonstrated by the training peers is a result of the training and not overall maturation. Trained Peers Each of the trained peers participated in 5 training sessions throughout the course of the study. In training 1 and 2, trained peers were present in groups of 2 with their trained peer group partner (T1 and T2 were grouped and T3 and T4 were grouped). Each peer received the same foundational instruction; however, the number of practice opportunities and amount of interaction with the clinician was partially dependent on each participant’s level of engagement. Trained peers showed various levels of participation and interest in the material, and this discrepancy is depicted and explained in the graphs below. Furthermore, clinician cues to use strategies were dependent on each participant’s ability to independently implement strategies. The clinician faded cues as participants gained independence in implementing trained strategies. Training Trained Peer 1 Clinician Input to T1 Figure 3.43 shows the total number of times the clinician spoke to, or engaged with, Trained Peer 1 (T1) over the course of the study. The clinician showed a decline in total input to T1 over time. 60 Figure 3.43 Clinician Input to T1 Clinician Input to TP Clinician Input to T1 180 160 140 120 100 80 60 40 20 0 Training 1 Training 2 CP1 CP2 Final Training Session Title Clinician Cues to T1 Figure 3.44 shows the total number of clinician cues to Trained Peer 1 (T1) over the course of the study. Clinician Cues are defined as specific prompts to use a strategy. The clinician showed a decline in total cues to T1 over time. 61 Figure 3.44 Clinician Cues to T1 Clinician Cues to T1 Clinician Cues to TP 25 20 15 10 5 0 CP1 CP2 Final Training Final Test Session Title Trained Peer 2 Clinician Input to T2 Figure 3.45 shows the total number of times the clinician spoke to, or engaged with, Trained Peer 2 (T2) over the course of the study. The clinician showed a decline in total input after the initial training, but remained at a stable level for the remainder of the study. 62 Figure 3.45 Clinician Input to T2 Clinician Input to T2 Clinician Input to T2 180 160 140 120 100 80 60 40 20 0 Training 1 Training 2 CP1 CP2 Final Training Session Title Clinician Cues to T2 Figure 3.46 shows the total number of clinician cues to Trained Peer 2 (T2) over the course of the study. The clinician showed a decrease in cues over time; however, used more cues with T2 compared to T1. 63 Figure 3.46 Clinician Cues to T2 Clinician Cues to T2 Clinician Cues to T2 25 20 15 10 5 0 CP1 CP2 Final Training Final Test Session Title Trained Peer 3 Clinician Input to T3 Figure 3.47 shows the total number of times the clinician spoke to, or engaged with, Trained Peer 3 (T3) over the course of the study. In contrast with T1 and T2, the clinician engaged at relatively stable levels with T3 over the course of the study. 64 Figure 3.47 Clinician Input to T3 Clinician Input to T3 Clinician Input to T3 180 160 140 120 100 80 60 40 20 0 Training 1 Training 2 CP1 CP2 Final Training Session Title Clinician Cues to T3 Figure 3.48 shows the total number of clinician cues to T3 throughout the study. Maximum cues were given during the CP2 session and then were faded. Figure 3.48 Clinician Cues to T3 Clinician Cues to T3 Clinician Cues to T3 25 20 15 10 5 0 CP1 CP2 Final Training Final Test Session Title 65 Trained Peer 4 Clinician Input to T4 Figure 3.49 shows the total number of times the clinician spoke to, or engaged with, Trained Peer 4 (T4) over the course of the study. The clinician engaged at relatively stable levels with T4 over the course of the study. Figure 3.49 Clinician Input to T4 Clinician Input to T4 Clinician Input to T4 180 160 140 120 100 80 60 40 20 0 Training 1 Training 2 CP1 CP2 Final Training Session Title Clinician Cues to T4 Figure 3.50 shows the total number of clinician cues to Trained Peer 4 (T4) over the course of the study. The clinician provided the most cues during the CP2 sessions; however faded cues following that session. 66 Figure 3.50 Clinician Cues to T4 Clinician Cues to T4 Clinician Cues to T4 25 20 15 10 5 0 CP1 CP2 Final Training Final Test Session Title All Trained Peers Clinician Input to all Trained Peers Figure 3.51 compares the total number of times the clinician spoke to, or engaged with, trained peers over the course of the study. The clinician demonstrated increased interactions with T1 and T2 during the initial training; however interaction levels were comparable across trained peers for the remainder of the sessions. It should be noted, that any interactions after the basic training components, were dependent on participant engagement with the clinician. 67 Figure 3.51 Clinician Input to All Trained Peers Clinician Input to Trained Peers Cliician Input to Peers 200 150 T1 100 T2 T3 50 T4 0 Training 1 Training 2 CP1 CP2 Final Training Session Title Clinician Cues to all Trained Peers Figure 3.52 compares clinician cues provided to all trained peers over the course of the study. Overall, T1 received the least amount of direct clinician cues. It should be noted that clinician cues were partially dependent on participant independence with strategy usage. In the final test, each peer received a total of 6 cues, 1 cue every 3 minute for 15 minutes. 68 Figure 3.52 Clinician Cues to All Trained Peers Clinician Cues to Trained Peers Clincian Cues to Trained Peers 35 30 25 20 T1 15 T2 10 T3 5 T4 0 CP1 CP2 Final Training Final Test Session Title Trained Peers with Peers Each trained peer participated in seven total sessions with other peers present. They spent 15 minutes in a baseline and final session with other trained peers, a baseline and final session with the TS, an advanced practice session with the TS, and a baseline and final session with the CS. Baseline and final sessions with other trained peers involved Trained Peers 1-4. Baseline and final sessions with both the TS and the CS, as well as the Advanced Practice session, involved Trained Peers in groups of two. Trained Peer 1 (T1) and Trained Peer 2 (T2) were always paired together (TP1), and Trained Peer 3 (T3) and Trained Peer 4 (T4) were always paired together (TP2). Each peer’s individual performance with other peers is depicted in Figures 3.53 – 3.64 below. In addition to each peer’s individual performance, figures 3.65 – 3.73 provide collective trained peer performance and trained peer performance based on classroom. 69 Trained Peer 1 T1 Behaviors to Peers Over Time Figure 3.53 depicts the total number of behaviors over time to a peer by Trained Peer 1 (T1). T1 showed a stable number of behaviors towards a peer in the initial and baseline trained peer only sessions. However, in sessions in which a subject was present, T1 showed a decline in behaviors to the peers over time. Figure 3.53 T1 Total Behaviors to Peers # of Behaviors 100 90 80 70 60 50 40 30 20 10 0 T1 Total Behaviors to Peers Session Title T1 Total Strategy Use with Peers Figure 3.54 depicts the total number of strategies used over time with a peer from Trained Peer 1 (T1). In the sessions in which T1 interacted with peers, strategy usage remained relatively stable over time. 70 Figure 3.54 T1 Total Strategy Use with Peers # of Strategies T1 Strategy Use with Peers 36 32 28 24 20 16 12 8 4 0 Session Title T1 Strategy Breakdown with Peers Figure 3.55 shows a breakdown of the type of strategies used by T1 with peers over time. T1 primarily used “tell” with peers throughout the course of the study. Figure 3.55 T1 Strategy Breakdown with Peers # of Strategies T1 Strategy Breakdown with Peers 36 32 28 24 20 16 12 8 4 0 Show Wait Tell Session Title 71 Trained Peer 2 T2 Behaviors to Peers Over Time Figure 3.56 depicts the total number of behaviors over time to a peer by Trained Peer 2 (T2). T2 showed an increase in the amount of behaviors to peers in trained peer only initial and final baseline sessions. However, T2 showed a decrease in behaviors to peers in sessions in which a subject was present. This is consistent with T1’s lack of engagement with T2 during these same sessions. # of Behaviors Figure 3.56 T2 Total Behaviors to Peers 100 90 80 70 60 50 40 30 20 10 0 T2 Total Behaviors to Peers Session Title T2 Total Strategy Use with Peers Figure 3.57 depicts the total number of strategies used over time with a peer from Trained Peer 2 (T2). In the sessions in which T2 interacted with peers, strategy usage increased over time. 72 Figure 3.57 T2 Total Strategy Use with Peers # of Strategies T2 Strategy Use with Peers 36 32 28 24 20 16 12 8 4 0 Session Title T2 Strategy Breakdown with Peers Figure 3.58 shows a breakdown of the type of strategies used by T2 with peers over time. T2 primarily used the strategy “tell,” with peers throughout the study. Figure 3.58 T2 Strategy Breakdown with Peers # of Strategies T2 Strategy Breakdown with Peers 36 32 28 24 20 16 12 8 4 0 Show Wait Tell Session Title 73 Trained Peer 3 T3 Behaviors to Peers Over Time Figure 3.59 depicts the total number of behaviors over time to a peer by Trained Peer 3 (T3). Overall, quantity of behaviors to peers did not change from initial to final performance. T3 did demonstrate a drop in interactions with a peer during the middle sessions of the study. # of Behaviors Figure 3.59 T3 Total Behaviors to Peers 100 90 80 70 60 50 40 30 20 10 0 T3 Total Behaviors to Peers Session Title T3 Total Strategy Use with Peers Figure 3.60 depicts the total number of strategies used over time with a peer from Trained Peer 3 (T3). T3 showed an overall decrease in strategy usage with peers over time. 74 Figure 3.60 T3 Total Strategy Use with Peers # of Strategies T3 Total Strategy Use with Peers 36 32 28 24 20 16 12 8 4 0 Session Title T3 Strategy Breakdown with Peers Figure 3.61 shows a breakdown of the type of strategies used by T3 with peers over time. T3 primarily used “tell;” however, did demonstrate use of “show.” # of Strategies Figure 3.61 T3 Strategy Breakdown with Peers 36 32 28 24 20 16 12 8 4 0 T3 Strategy Breakdown Peers Show Wait Tell Session Title 75 Trained Peer 4 T4 Behaviors to Peers Over Time Figure 3.62 depicts the total number of behaviors over time to a peer by Trained Peer 4 (T4). Behaviors towards peers increased in the peer only sessions and control subject session. Behaviors to a peer decreased in the trained subject sessions, including the advanced practice session. Figure 3.62 T4 Total Behaviors to Peers # of Behaviors T4 Total Behaviors to Peers 100 90 80 70 60 50 40 30 20 10 0 Session Title T4 Total Strategy Use with Peers Figure 3.63 depicts the total number of strategies used over time with a peer by Trained Peer 4 (T4). T4 showed a relatively stable amount of strategy usage with peers over time. The amount of strategies used per session, are consistent with the overall amount of interactions T4 had with peers depicted in the above graph. 76 # of Strategies Figure 3.63 T4 Total Strategy Use with Peers 36 32 28 24 20 16 12 8 4 0 T4 Total Strategy Use with Peers Session Title T4 Strategy Breakdown with Peers Figure 3.64 shows of the types of strategies used by T4 with peers. T4 primarily used “tell” throughout the study, but did demonstrate “wait” and “show.” Figure 3.64 T4 Strategy Breakdown with Peers # of Strategies T4 Stategy Breakdown with Peers 36 32 28 24 20 16 12 8 4 0 Show Wait Tell Session Title 77 Trained Peer Group 1 (Trained Peer 1 & Trained Peer 2) TP1 Averaged Behaviors to Peers Over Time Figure 3.65 depicts the average number of behaviors over time to a peer by Trained Peer Group 1 (TP1), including Trained Peer 1 (T1) and Trained Peer 2 (T2). TP1’s interactions with peers remained stable over time for sessions in which no subjects were present. However, in sessions with which either the target or control subject was present, TP1’s overall interactions with each other decreased over time. Figure 3.65 TP1 Averaged Behaviors to Peers Over Time Average # of Behaviors T1 & T2 Averaged Behaviors to Peers 100 90 80 70 60 50 40 30 20 10 0 Session Title TP1 Averaged Strategy Use with Peers Figure 3.66 depicts the total number of strategies used over time with a peer from Trained Peer Group 1 (TP1). TP1’s strategy usage with peers was consistent with the overall amount of interaction exhibited by T1 and T2. Strategy usage with peers increased slightly from the initial to final baseline sessions with peers only. 78 Figure 3.66 TP1 Averaged Strategy Use with Peers Average # of Strategies 36 32 28 24 20 16 12 8 4 0 T1 & T2 Averaged Strategy Use with Peers Session Title TP1 Averaged Strategy Breakdown with Peers Figure 3.67 shows a breakdown of the type of strategies used by TP1 with peers over time. TP1 primarily used the strategy “tell” with peers across the study. Figure 3.67 TP1 Averaged Strategy Breakdown with Peers Average # of Strategies T1 & T2 Averaged Strategy Breakdown with Peers 36 32 28 24 20 16 12 8 4 0 Show Wait Tell Session Title 79 Trained Peer Group 2 (Trained Peer 3 & Trained Peer 4) TP2 Averaged Behaviors to Peers Over Time Figure 3.68 depicts the average number of behaviors over time to a peer by Trained Peer Group 2 (TP2), including Trained Peer 3 (T3) and Trained Peer 4 (T4). TP2’s interactions with peers remained relatively stable over time, with a drop during sessions in the middle of the study. Figure 3.68 TP2 Averaged Behaviors to Peers Over Time Average # of Behaviors T3 & T4 Averaged Behaviors to Peers 100 90 80 70 60 50 40 30 20 10 0 Session Title TP2 Averaged Strategy Use with Peers Figure 3.69 depicts the total number of strategies used over time with a peer from Trained Peer Group 2 (TP2). TP2’s strategy usage with peers decreased over the course of the study. 80 Figure 3.69 TP2 Averaged Strategy Use with Peers Average # of Strategies T3 & T4 Averaged Strategy Use withPeers 36 32 28 24 20 16 12 8 4 0 Session Title TP2 Averaged Strategy Breakdown with Peers Figure 3.70 shows a breakdown of the type of strategies used by TP2 with peers over time. TP2 primarily used the strategy “tell” with peers across the study. Figure 3.70 TP2 Averaged Strategy Breakdown with Peers Average # of Strategies T3 & T4 Averaged Strategy Breakdown with Peers 36 32 28 24 20 16 12 8 4 0 Show Wait Tell Session Title 81 All Trained Peers Trained Peer Averaged Behaviors Figure 3.71 depicts the average number of behaviors with other peers in the trained peer baseline and final trained peer session involving T1-T4. The average amount of trained peer behaviors to other peers increased slightly from the beginning to end of this study. Figure 3.71 Trained Peers Averaged Behaviors Average Total # of Behaviors TP Averaged Total Behaviors to Peers 100 90 80 70 60 50 40 30 20 10 0 3-­‐8-­‐TP-­‐baseline 5-­‐17-­‐TP-­‐=inalbaseline Session Title Trained Peer Averaged Strategy Use Figure 3.72 depicts the average number of strategies used by peers in the trained peer baseline and final trained peer session involving T1-T4. The average strategies used by peers with other peers remained relatively stable from initial to final sessions in this study. 82 Average # of Strategies to Peers Figure 3.72 Trained Peer Averaged Strategy Use 36 32 28 24 20 16 12 8 4 0 TP Averaged Strategy Use with Peers 3-­‐8-­‐TP-­‐baseline 5-­‐17-­‐TP-­‐=inalbaseline Session Title Trained Peer Averaged Strategy Breakdown Figure 3.73 depicts the average strategies per type used by peers in the trained peer baseline and final trained peer session involving T1-T4. In general, if a trained peer were to use a strategy with another peer, it tended to be the strategy “tell.” 83 Figure 3.73 Trained Peer Averaged Strategy Breakdown Average # of Strategies TP Averaged Strategy Breakdown with Peers 36 32 28 24 20 16 12 8 4 0 3-­‐8-­‐TP-­‐baseline 5-­‐17-­‐TP-­‐=inalbaseline Show Wait Tell Session Title In Summary, trained peers performance was partially dependent on the presence of the subject in the session. In sessions in which the subject was present, a decrease in peer-to-peer interaction was noted. However, in peer only sessions, the amount of interaction between peers remained relatively stable throughout the study. The use of strategies with peers was consistent with the amount peers were interacting with each other, and remained stable from the start to finish of the study. The primary strategy demonstrated by trained peers with other peers was “tell.” Trained Peers with Subjects Each trained peer participated in a total of seven sessions with either the target subject (TS) or the control subject (CS). They spent 15 minutes in a baseline and final session with the TS and one other peer and 15 minutes in a baseline and final session with the CS and one other peer. Additionally, each trained peer participated in two controlled practice sessions and one advanced practice session with the TS and one other peer. It should be noted that the clinician was present and providing consistent 84 prompting during both controlled practice sessions. Each peer’s performance with either the TS or CS is depicted in figures 3.74 – 3.85 below. The TS is represented in the following graphs by blue bars. The CS is represented in the following graphs by yellow bars. In addition to each peer’s individual performance, figures 3.86 – 3.94 provide collective trained peer performance and trained peer performance based on classroom. Trained Peer 1 T1 Behaviors to Subjects Over Time Figure 3.74 depicts the percentage of behaviors towards a subject out of total behaviors over time by Trained Peer 1 (T1). T1 showed a large increase in total percentage of behaviors to both the TS and the CS over the course of the study. T1 showed a decline in percentage of behaviors to the TS in the advanced practice session; however, returned to a high percentage for the remaining sessions. At the end of the study, T1 was interacting almost exclusively with the trained and control subjects. Figure 3.74 Percentages of T1 Behaviors to Subjects % Behaviors to Subject % T1 Behaviors to Subjects 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% Session Title 85 T1 Total Strategy Use with Subjects Figure 3.75 depicts the total number of strategies used over time with a subject from Trained Peer 1 (T1). T1 showed an increased in strategy usage with subjects over time. The largest increase in strategy usage was observed from the initial to final baseline sessions with the trained subject. T1 used the most strategies, 36, in this session that of all sessions collected during the course of this study. Furthermore, T1 demonstrated generalization of strategy use to the control subject, with an increase in strategy usage with the CS from initial and final control subject baselines. Figure 3.75 T1 Strategy Use with Subjects # of Strategies Used T1 Strategy Use with Subjects 36 32 28 24 20 16 12 8 4 0 Session Title T1 Strategy Breakdown with Subjects Figure 3.76 shows a breakdown of the type of strategies used by T1 with subjects over time. T1 primarily used the strategy “tell;” however, did demonstrate some usage of both “show” and “wait.” T1 did not use “show” or “wait” with peers. 86 Figure 3.76 T1 Strategy Breakdown with Subjects # of Strategies Used T1 Strategy Breakdown with Subjects 36 32 28 24 20 16 12 8 4 0 Show Wait Tell Session Title Trained Peer 2 T2 Behaviors to Subjects Over Time Figure 3.77 depicts the percentage of behaviors towards a subject out of total behaviors over time by Trained Peer 2 (T2). T2 showed a large increase in total percentage of behaviors to both the TS and the CS over the course of the study. T2 showed a decline in percentage of behaviors to the TS in the advanced practice session; however, returned to a high percentage for the remaining sessions. 87 Figure 3.77 Percentages of T2 Behaviors to Subjects % of Behaviors to Subject % T2 Behaviors to Subjects 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% Session Title T2 Total Strategy Use with Subjects Figure 3.78 depicts the total number of strategies used over time with a subject from Trained Peer 2 (T2). T2 peaked in strategy usage during the control practice sessions, in which clinician cues were provided. T2 showed a small increase in strategy usage towards the TS, but did not demonstrate any generalization of strategy usage to the CS. 88 Figure 3.78 T2 Strategy Use with Subjects # of Strategies Used T2 Strategy Use with Subjects 36 32 28 24 20 16 12 8 4 0 Session Title T2 Strategy Breakdown with Subjects Figure 3.79 shows a breakdown of the types of strategies used by T2 with subjects. T2 largely used “tell,” but did demonstrate use of both “show” and “wait.” Figure 3.79 T2 Strategy Breakdown with Subjects # of Strategies Used T2 Strategy Breakdown with Subjects 36 32 28 24 20 16 12 8 4 0 Show Wait Tell Session Title 89 Trained Peer 3 T3 Behaviors to Subjects Over Time Figure 3.80 depicts the percentage of behaviors towards a subject out of total behaviors over time by Trained Peer 3 (T3). T3 demonstrated independent interaction with the target subject in the advanced practice session; however, this was not maintained into the final session. Furthermore, T3 did not show any generalization of behaviors. Figure 3.80 Percentages of T3 Behaviors to Subjects % Behaviors to Subject % T3 Behaviors to Subjects 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% Session Title T3 Total Strategy Use with Subjects Figure 3.81 depicts the total number of strategies used over time with a subject from Trained Peer 3 (T3). T3 peaked in strategy usage during the control practice sessions, in which clinician cues were provided. T3 showed a small maintenance in strategy usage with TS during the final TS baseline session; however, did not demonstrate the ability to generalize strategy usage to the control subject. 90 Figure 3.81 T3 Strategy Use with Subjects # of Strategies Used T3 Strategy Use with Subjects 36 32 28 24 20 16 12 8 4 0 Session Title T3 Strategy Breakdown with Subjects Figure 3.82 shows a breakdown of the type of strategies used by T3 with subjects over time. T3 used all three strategies with the TS over the course of the study. With a peer, T3 used primarily the strategy “tell;” however demonstrated more of a variety in interactions with the TS. 91 Figure 3.82 T3 Strategy Breakdown with Subjects # of Strategies Used T3 Strategy Breakdown with Subjects 36 32 28 24 20 16 12 8 4 0 Show Wait Tell Session Title Trained Peer 4 T4 Behaviors to Subjects Over Time Figure 3.83 depicts the percentage of behaviors towards a subject out of total behaviors over time by Trained Peer 4 (T4). T4 showed a large increase in behaviors to the trained subject in both the controlled and advanced practice sessions; however, this did not maintain throughout the study. T4 showed little interaction with the control subject during the course of the study. 92 Figure 3.83 Percentages of T4 Behaviors to Subjects % Behaviors to Subject 100.00% % T4 Behaviors to Subjects 80.00% 60.00% 40.00% 20.00% 0.00% Session Title T4 Total Strategy Use with Subjects Figure 3.84 depicts the total number of strategies used over time with a subject from Trained Peer 4 (T4). T4 demonstrated very little strategy use with the TS over time; however, did show the ability to demonstrate usage of the strategies during sessions, in particular, with clinician support. 93 Figure 3.84 T4 Strategy Use with Subjects # of Strategies Used T4 Strategy Use with Subjects 36 32 28 24 20 16 12 8 4 0 Session Title T4 Strategy Breakdown with Subjects Figure 3.85 shows a breakdown of the type of strategies used by T4 with subjects over time. T4 used all three strategies with TS over the course of the study. Figure 3.85 T4 Strategy Breakdown with Subjects # of Strategies Used T4 Strategy Breakdown with Subjects 36 32 28 24 20 16 12 8 4 0 Show Wait Tell Session Title 94 Trained Peer Group 1 (Trained Peer 1 & Trained Peer 2) TP1 Averaged Behaviors to Subjects Over time Figure 3.86 depicts the average percentage of behaviors over time to a subject by Trained Peer Group 1 (TP1), including Trained Peer 1 (T1) and Trained Peer 2 (T2). TP1’s percentage of interactions with the TS and the CS showed a large increase over time. Figure 3.86 TP1 Averaged Percentage of Behaviors to Subjects Average % Behaviors to Subject Averaged % T1 & T2 Behaviors to Subjects 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% Session Title TP1 Averaged Strategy Use with Subjects Figure 3.87 depicts the average number of strategies used over time with a subject from Trained Peer Group 1 (TP1). TP1’s strategy usage with subjects increased over time. T1 and T2 demonstrated the ability to use strategies during controlled practice with clinician support. Performance showed a decline during the advanced practice session 95 with no cueing provided. After the introduction of the sticker chart, performance increased again during the final baseline sessions. Figure 3.87 TP1 Averaged Strategy Use with Subjects Average # of Strategies Used T1 & T2 Averaged Strategy Use with Subjects 36 32 28 24 20 16 12 8 4 0 Session Title TP1 Averaged Strategy Breakdown with Subjects Figure 3.88 shows a breakdown of the type of strategies used by TP1 with subjects over time. TP1 primarily used the strategy “tell” with subjects across the study; however, did demonstrate the usage of both “show” and “wait.” 96 Figure 3.88 TP1 Averaged Strategy Breakdown with Subjects Average # of Strategies Used T1 & T2 Averaged Strategy Breakdown with Subjects 36 32 28 24 20 16 12 8 4 0 Show Wait Tell Session Title Trained Peer Group 2 (Trained Peer 3 & Trained Peer 4) TP2 Averaged Behaviors to Subjects Over Time Figure 3.89 depicts the average percentage of behaviors over time to a subject by Trained Peer Group 2 (TP2), including Trained Peer 3 (T3) and Trained Peer 4 (T4). TP2’s percentage of interactions with the TS and the CS showed a large increase during controlled practice sessions in which a clinician was present and providing cueing. Furthermore, TP2 demonstrated the ability to independently interact with the target subject, evidenced in the advanced practice session. However, this increase in interaction did not maintain into the final baseline sessions. 97 Figure 3.89 TP2 Averaged Percentage of Behaviors to Subjects Average % Behaviors to Subject Average % T3 & T4 Behaviors to Subjects 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% Session Title TP2 Averaged Strategy Use with Subjects Figure 3.90 depicts the average number of strategies used over time with a subject from Trained Peer Group 2 (TP2). T3 and T4 demonstrated the ability to implement strategies with clinician cueing. They maintained some usage of strategies with TS without clinician support; however, they showed no generalization to the control subject. 98 Figure 3.90 TP2 Averaged Strategy Use with Subjects Average # of Strategies Used T3 & T4 Averaged Strategy Use with Subjects 36 32 28 24 20 16 12 8 4 0 Session Title TP2 Averaged Strategy Breakdown with Subjects Figure 3.91 shows a breakdown of the type of strategies used by TP2 with subjects over time. TP2 used a relatively equal amount of all three strategies. Figure 3.91 TP2 Averaged Strategy Breakdown with Subjects Average # of Strategies Used T3 & T4 Averaged Strategy Breakdown with Subjects 36 32 28 24 20 16 12 8 4 0 Show Wait Tell Session Title 99 All Trained Peers Trained Peer Averaged Behaviors with Subjects Figure 3.92 depicts the average percentage of behaviors to subjects over time by all trained peers. Overall behaviors increased with both the TS and the CS over time. Figure 3.92 All TP Averaged Percentage of Behaviors to Subjects Average % Behaviors to Subjects Averaged % TP Behaviors to Subjects 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% Session Title Trained Peer Averaged Strategy Use with Subjects Figure 3.93 depicts the average number of strategies used over time with a subject from all trained peers. Overall strategy usage showed an increase over the course of the study. 100 Figure 3.93 TP Averaged Strategy Use with Subjects Average # of Strategies used TP Averaged Strategy Use with Subjects 36 32 28 24 20 16 12 8 4 0 Session Title Trained Peer Averaged Strategy Breakdown with Subjects Figure 3.94 shows a breakdown of the type of strategies used by all trained peers with subjects over time. Trained peers used all three strategies over the course of the study. This performance is contrasted with all other conditions, in which “tell” was the primary strategy used by peers. 101 Figure 3.94 TP Averaged Strategy Breakdown with Subjects Average # of Strategies Used TP Averaged Strategy Breakdown with Subjects 36 32 28 24 20 16 12 8 4 0 Show Wait Tell Session Title In summary, trained peers showed positive, yet variable, performance. T1 and T2 showed a large increase in overall behaviors to the target subject, and generalized this increase to the control subject. T3 and T4 also showed an increase in overall behaviors to the target subject; however, both showed a large drop in performance towards the end the training. This phenomenon of what appeared to be “too much exposure” will be discussed later. With respect to strategy usage, T1, T2 and T3 showed the ability to independently use strategies with the target subject, with T1 generalizing this skill to the control subject. Notably, the peers who showed strategy usage with subjects, used not only “tell,” but implemented “show” and “wait” as well. This use of “show” and “wait” is unique to trained peers’ performance with subjects, and can be attributed to the training. Control Subject The control subject (CS) participated in two sessions, an initial and final baseline, with each of the four groups of peers. Figures 3.95 – 3.98 below depict CS’s performance over time. 102 Control Subject with Control Peers CS Behaviors with C1 & C2 Figure 3.95 depicts the total behaviors of the CS with Control Peer Group 1, C1 and C2. C1 and C2 are in a different class than the CS. The CS showed a slight increase in behaviors to CP1 over time. Figure 3.95 CS Behaviors with C1 & C2 CS Behaviors with C1 & C2 40 # of Behaviors 35 30 25 20 15 10 5 0 3-­‐29-­‐CP1CS 5-­‐28-­‐CP1CS-­‐=inal Session Title CS Behaviors with C3 & C4 Figure 3.96 depicts the total behaviors of the CS with Control Peer Group 2, C3 and C4. C3 and C4 are in a same class as the CS. The CS showed a large decrease in behaviors to the CP2 over time. It should be noted that in the 4-2-CP2CS session, the majority of the behaviors demonstrated by CS were in the form of aggression to C3. This session was terminated at 7 ½ minutes due to the aggression and fighting between C3 and the CS. 103 Figure 3.96 CS Behaviors with C3 & C4 CS behaviors with C3 & C4 40 # of Behaviors 35 30 25 20 15 10 5 0 4-­‐2-­‐CP2CS** 5-­‐28-­‐CP2CS-­‐=inal Session Title Control Subject with Trained Peers CS Behaviors with T1 & T2 Figure 3.97 depicts the total behaviors of the CS with Trained Peer Group 1, T1 and T2. T1 and T2 are in a different class than the CS. The CS showed a slight large increase in behaviors to TP1 over time. 104 Figure 3.97 CS Behaviors with T1 & T2 CS Behaviors with T1 & T2 40 # of Behaviors 35 30 25 20 15 10 5 0 3-­‐26-­‐TP1CS 5-­‐21-­‐TP1CS Session Title CS Behaviors with T3 & T4 Figure 3.98 depicts the total behaviors of CS with T3 and T4, classmates of CS. The CS showed little interaction with the TP2 over the course of the study. Figure 3.98 CS Behaviors with T3 & T4 CS Behaviors with T3 & T4 40 # of Behaviors 35 30 25 20 15 10 5 0 3-­‐26-­‐TP2CS 5-­‐28-­‐TP2CS-­‐=inal Session Title 105 Target Subject Target Subject with Control Peers The target subject (TS) participated in two sessions, an initial and final baseline, with each of the two groups of control peers. TS Behaviors with C1 & C2 Figure 3.99 depicts the total behaviors of the TS with Control Peer Group 1, C1 and C2. C1 and C2 are in a different class than the TS. The TS showed relatively stable amounts of behaviors towards CP1 over time. Figure 3.99 TS Behaviors with C1 & C2 TS Behaviors with C1 & C2 40 # of Behaviors 35 30 25 20 15 10 5 0 3-­‐15-­‐CP1TS 5-­‐8-­‐CP1TS Session Title TS Behaviors with C3 & C4 The total behaviors of TS towards CP2 increased from 0 to 72 total behaviors between the initial and baseline sessions. This data is no depicted in a graph, due to the nature of the interaction between the TS and C3. The entirety of the 72 behaviors was characterized by nonverbal turn taking in what appeared to be a self-stimulatory game. 106 Target Subject with Trained Peers The target subject participated in five sessions with two groups of two trained peers. They participated in an initial and final baseline session, as well as two controlled practice sessions and one advanced practice session. The clinician was present during the controlled practice sessions to prompt interaction between the TS and trained peers. TS Behaviors with T1 & T2 Figure 3.100 depicts the total behaviors of the TS with Trained Peer Group 1, T1 and T2. T1 and T2 are in a different class than the TS. The TS showed an increase in behaviors to T1 and T2 from the baseline to the final session, as well as increased interaction during controlled practice sessions. Figure 3.100 TS Behaviors with T1 & T2 TS Behaviors with T1 & T2 40 # of Behaviors 35 30 25 20 15 10 5 0 3-­‐12-­‐TP1TS-­‐baseline 4-­‐9-­‐TP1TS-­‐CP1 4-­‐16-­‐TP1TS-­‐CP2 4-­‐30-­‐TP1TS-­‐AP 5-­‐10-­‐TP1TS-­‐=inal Session Title TS Behaviors with T3 & T4 Figure 3.101 depicts the total behaviors of the TS with Trained Peer Group 2, T3 and T4. T3 and T4 are in the same class as the TS. The TS showed an overall increase in 107 behaviors towards the TP2 over the course of the study. It should be noted that the sessions marked with an asterisk occurred later in the afternoon. TS was noted to disengage from activities, and struggled to interact despite clinician support. Figure 3.101 TS Behaviors with T3 & T4 # of Behaviors TS Behaviors to T3 & T4 40 35 30 25 20 15 10 5 0 Session Title 108 CHAPTER IV DISCUSSION This study set out to investigate the effects of communication partner training for preschool-aged peers of children with Autism Spectrum Disorder (ASD) communicating in part with augmentative and alternative communication (AAC). It proposed to answer two questions. Can training increase preschool peers’ awareness of children with ASD during play, as demonstrated by an overall increase in interactions, use of trained strategies, and awareness of AAC use by the child with ASD? While the sample size of this study is small, the findings support the hypothesis that peers can be trained to be more aware of children with ASD during play, increasing their overall amount of interactions and use of trained strategies. Secondly, do children with ASD increase appropriate communicative behaviors when interacting with trained peers? The results support this hypothesis that by training peers to be more supportive communication partners, the child with ASD will increase their overall participation and communication during shared play situations. In a small scale study of the sort presented here, a randomized controlled intervention for preschool peers is nowhere near possible. Although, this study was controlled to the extent possible, there are factors present in the daily lives of the preschool children with and without ASD, for which it was not possible to control, likely impacting some of the results of this study. Therefor the following discussion will speak to the qualitative observations as they relate to unforeseen classroom dynamics, the impact of individual personalities on the intervention, the training itself, and conclude with a discussion of study limitations and future directions. Qualitative Results Control Peers with Subjects With the exception of Control Peer 3 (C3), the interaction between control peers and both subjects decreased throughout the course of the study. Personality conflicts, to 109 be discussed later, can likely be attributed to the variable performance demonstrated by C3. Furthermore, no control peers exhibited an increase in strategy usage with either the target or control subject over the course of the study. If control peers were to use a strategy with either subject, it was primarily classified as “tell.” This lack of change noted in control peer performance suggests that any changes seen by the trained peers, are a result of the training and not a result of general growth or development. Trained Peers with Subjects Interaction Overall interactions between trained peers and the target subject increased. T1 & T2, trained peers in KidTalk I, continued to increase in their amount of interactions with the training subject with ASD, and showed generalization to the control subject. T3 & T4 increased up through the advanced practice session, dropping off in their amounts of interaction with the target subject after that point. T3 and T4, trained peers in KidTalk II, did not exhibit any carryover from the training with the target subject to the control subject. T1 and T2 came from a classroom separate from the classroom of the target and control subject and so did not have daily interactions with the subjects. T3 and T4 were in the same classroom as the subjects, and interacted with them on a daily basis. Strategies Peers showed variable performance in training and usage of strategies. T1-T3 showed a strong performance in controlled practice sessions, and implemented all three strategies upon clinician request. However, upon withdrawal of clinician support in the advance practice session, T1-T2 showed a significant drop in strategy usage with the target subject. At that point in time, a sticker reinforcement chart was introduced to encourage the peers to use strategies with the subjects. In the final baseline session with both the target and control subject, the clinician cue “Remember to use your strategies so you can earn stickers,” was provided to all trained peers every 3 minutes. The implementation of this support resulted in an increase in strategy usage by T1 & T2 with 110 the target subject. Only T1, showed the ability to generalize these instructed strategies, implementing them with the control subject. It should be noted that T3 and T4 did not appear to benefit from the addition of the sticker chart. T3 showed maximum independent interaction and strategy usage with the target subject in the advanced practice session. Overall interaction of T3 and T4 with the target subject dropped off after the advanced practice session. It is hypothesized that this drop is a result of overall time spent with the target subject (discussed later). These results suggest, consistent with McGregor (2000), that adult support is beneficial in peer-mediated instructional programs. In summary, 75% of trained peers (T1, T2, and T3) demonstrated the ability and/or willingness to implement the trained strategies upon clinician request. T4, demonstrated variable performance, and was generally resistant to training. T4’s performance will be discussed later. T1 implemented the most strategies, and was the only peer to show generalization. T2 also showed an increase in independent strategy usage with the target subject. T3 demonstrated the strategies upon direct request and clinician assistance in the controlled practice session; however, implemented few strategies independently. T4 was overall resistant to the training. The trained peers’ interaction and strategy usage with other peers remained stable or decreased over the course of time from the first to the last session. 4 months elapsed over the course of the study, with training beginning in February and ending in May. The difference between trained peers and control peers supports the hypothesis that changes in amount of interaction and strategy usage by the trained peers could not be attributed to general development. The types of strategies used with peers versus subjects are worth noting. In interacting with other peers, both trained and control peers typically exhibited use of the “tell” strategy. However, all trained peers, including T4, were noted to exhibit a wider variety of strategy usage when interacting with the children with ASD. Although 111 primarily “tell,” both “show” and “wait” were exhibited by all four trained peers. “Show” and “wait,” were not behaviors typically seen in natural interaction between peers; therefore, the presence of these strategies suggests that the use of these strategies were learned in training and associated with interactions with the target and control subject, and not with peers. It should be noted, and will be discussed in detail later, that there was a large discrepancy in performance between trained peers in KidTalk I versus KidTalk II. Trained peers in KidTalk I were more engaged in training and interacted more with the target and control subject than trained peers in KidTalk II. Both the target and control subject were students in the KidTalk II classroom. Target Subject Behavior Over time, the target subject increased his overall interaction with all trained peers. However, the amount of interaction that the target subject exhibited with trained peers showed a large increase over time, in comparison to the relatively stable interaction with control peers. The target subject interacted minimally with C1 and C2, control peers in KidTalk I, over the course of the study. The total behaviors of the target subject towards C3 increased from 0 to 72 total behaviors between the initial and baseline sessions. Although this is coded as an increase in interaction between the participants, the behaviors demonstrated were not interpreted as functional. The two participants engaged in what appeared to be a self-stimulatory game in which they were pushing items down the stairs in a dollhouse. The participants’ were taking turns and both laughed throughout the activity, but they did not make eye contact or engage in any verbal, gestural, or augmentative behaviors with each other. During this interaction, C4 was resistant to any attempts by C3 or TS to interact, possibly resulting in the increased amount of time C3 spent with the target subject. The target subject’s behaviors towards trained peers appeared to be impacted by three possible factors. First, the target subject showed an overall increase in interactions 112 with trained peers, as the skills of the trained peers increased. T1 and T2 demonstrated a superior performance to T3 and T4, likely impacting the overall higher levels of interaction between the target subject and T1 and T2. As the trained peers increased their interactions with the target subject, the target subject responded with purposeful interactions (e.g. verbal or gestural responses), and did not demonstrate any increase in non-desired behaviors (e.g. walking away, aggression). The results suggest that, as peers become more competent in meeting the complex communication needs of children with ASD, the child with ASD responds positively and increases his or her overall participation in play situation. An additional factor to consider may be that the target subject’s interaction with trained peers is influenced by the presence of the clinician. Generally, the target subject interacted with trained peers more when the clinician was providing prompts to respond to communication attempts made by peers. It is hypothesized that the clinician’s influence centers on drawing the attention of the child with ASD to the peers. Throughout the study, it was noted that peers initiated interactions with the target subject, only to have him be unaware of the communication attempt, or to respond “yes,” but not follow through with the request made by the peer. The persistence exhibited by the trained peers was variable in continued attempts to engage the target subject. However, when the clinician was able to draw the target subject’s attention to attempts made by the peers the target subject responded more consistently, prolonging interactions. Clinician mediation of peer and subject interaction comes as no shock, considering the ongoing development of Theory of Mind by both the target subject and trained peers, and the nature of typical teacher involvement in interactions that take place within the classroom. The naturalistic play setting without continual clinician input employed in this study is rarely seen in the typical classroom environment. With a lead teacher and multiple paraeducators in the classroom, peers and children with ASD are accustomed to adult 113 support during conversations. This leads us to the importance of peer training, increasing not only the agency of the child with ASD, but also the peers without ASD as well. A final factor influencing interaction between the target subject and trained peers may be related to the time of day in which the interaction occurred. The first three sessions between the target subject and T3 and T4 occurred later in the afternoon, approximately 20 minutes before the class is dismissed for recess. This is in contrast to the rest of the sessions that occurred approximately within the first hour of the school day. During these later sessions, it was noted that the target subject was difficult to engage and he remained isolated for the majority of the session. This remained true during controlled practice sessions in which the clinician was present to prompt interactions. Despite multiple clinician attempts, the target subject was resistant to participate. Not only did this impact the total interactions observed between the target subject and the trained peers in KidTalk II, but it may also have impacted the degree to which T3 and T4 exhibited that they learned strategies during the training. It could be hypothesized that T3 and T4 were less persistent in their attempts to engage and interact with the target subject in later sessions, as a result of discouragement obtained during the initial sessions due to poor communication reciprocity demonstrated by the target subject. Control Subject Behavior The behavior of the control subject supports the hypothesis that subject behavior is dependent on the performance of the trained peers. The control subject showed an increase in positive interaction only with T1 and T2, the peers who demonstrated the most learning of strategy use in the study. Classroom Dynamics Due to the design of the KidTalk I and II preschool programs, children with ASD are placed into the KidTalk II program. Children with speech and language impairments are placed into the KidTalk I program. Peer models with no diagnosed speech and language impairment or ASD are placed in both classrooms. Both the target and control 114 subject were students in KidTalk II. Half of the trained and control peers were students in KidTalk II interacting on a daily basis with TS and CS, and half of the trained and control peers were students in KidTalk I who interacted only intermittently with TS and CS. It was hypothesized that the trained peers in KidTalk II (T3 and T4) would exhibit superior performance compared to the trained peers in KidTalk I (T1 and T2) because of the greater daily contact with TS and CS. This hypothesis was not supported by the results of the study. Both T1 and T2 showed more strategy use than either T3 or T4. The former were more engaged in the training, exhibited by asking more questions and practicing strategies with less clinician requests to do so. Over time, T3 and T4 became increasingly disengaged during sessions; exhibited by active refusal to implement strategies. This is most clearly represented in analyzing the difference in T3’s and T4’s performance between the advanced practice and the final training. Looking strictly at overall interaction with the target subject in the advanced practice session, T3 and T4 appear to use strategies more than T1 and T2. However, after the addition of the sticker chart in a final training session, both T3 and T4 showed a large drop in overall interaction with the target subject in the final testing session. It is hypothesized, that this drop in performance is not a result of failure to respond to the intervention, but instead a result of “too much time” spent with the target subject. Both T3 and T4 are asked by the classroom teacher on a daily basis to interact with and support the communication of both subjects in the context of the regular classroom activities, apart from the pull out play sessions for this study. This daily responsibility is a factor that T1 and T2 were not faced with. Subjectively, the primary investigator noted increased excitement from T1 and T2 over the course of the study each time they were pulled from the classroom to participate in the intervention. However, T3 and T4 appeared less interested as the study went on. Whereas T1 and T2 were noted to ask if the target subject would be attending the session, in hopes of interacting, T3 and T4 often complained about the target subject’s presence. 115 They preferred the two-on-one clinician training sessions, in which T3 and T4 received focused attention. During multiple sessions, T3 and T4 demonstrated active resistance to participate. During the second controlled practice session, T4 refused entirely to participate in the training. All clinician input to T4 during the second controlled practice session can be characterized as requests to engage T4 in the training. T4 actively refused these requests, playing separately from the target subject as much as possible. Furthermore, in the final test session, active refusal was noted by both T3 and T4 after the clinician cue, “Remember to use your strategies so you can earn stickers,” was administered every 3 minutes. After one delivery of this cue, both T3 and T4 demonstrated deliberate strategy usage to each other while looking towards the clinician for acknowledgement. However, T3 and T4 rarely attempted to implement these clearly learned strategies with the target subject. Although, this peer-mediated intervention was presented in the naturalistic context of play and peers were instructed to take on a friendship role with the subjects, it appeared that the purpose of the intervention was internalized differently by the different peers. Whereas, T1 and T2 appeared excited and willing to help while becoming friends with the target subject, T3 and T4 seemed to view this training more along the lines of work. These results suggest that rotating responsibilities of peers in the classroom to interact with and support the communication of children with ASD should be considered. Reducing the amount of “forced” interaction time between peer models and children with ASD may actually increase the quality and amount of interactions between children with and without ASD. Personality Differences A factor nearly impossible to control for is the personality differences across children. Each participant in this intervention presented at varying developmental stages and with variable personality profiles. Children have varying degrees of prosocial 116 behavior and subsequent Theory of Mind development (Eggum et al., 2010). Each of the four trained peers in this study varied in his or her level of willingness to participate, understand, and support the communication of someone different from himself or herself. These personality differences should not determine who should or should not receive partner training, but instead these differences may determine the dosage or type of training necessary to be successful in implementing the training. Additionally, it may be counterproductive to preselect or limit which peers receive training and are selected to support the complex communication needs of children with ASD. If only those children that appear to be “naturally” successful at implementing the protocol are selected, then it is possible the “too much exposure” problem seen in this study of could arise. This ultimately would not improve performance and may even deter the “naturally” talented children away from the targeted interactions. Among the trained peers, T1 was the most willing to engage in the training. The basis of this large dissimilarity between T1 and the rest of the trained peers appears almost impossible to pin point. There was no difference in age or mean length of utterance across children. T1’s willingness to interact with the target subject is not likely attributed to just a lack of interest in interacting with the other peers. During sessions in which peers alone were present, T1 showed consistent interaction with peers over time. However, in sessions in which a peer and a subject were present, T1 showed a preference for interacting with the target subjects. Furthermore, when walking down the hallway to sessions, T1 often requested to hold hands with TS, talking with him as they walked. Personality, and ultimately engagement, appears to have impacted the amount of clinician input during training that each trained peer received. Each peer received the same content during training sessions; however, the length of the training and additional practice opportunities on top of what was required was dependent on participant interest. This is most noticeably seen in the first training session. T1 and T2 received almost twice the amount of clinician input compared to T3 and T4. It should be noted that T3 117 and T4 nevertheless received the same amount of the core training of strategies hypothesized as necessary for learning the protocol based on Kent-Walsh & McNaughton’s (2005) proposed model for intervention designed to teach communication partners effective strategies to use with users of AAC. The difference in clinician input is explained by “extra engagement” noted in the behavior of T1 and T2. Both of these trained peers from KidTalk I were noted to ask more questions and offer more ideas during the training. The peers in KidTalk II were more passive throughout training; they sat quietly and watched the training videos, and did not offer any additional thoughts or ideas. It is hypothesized that this increase in clinician interaction during the training may by itself not be the cause of the peers' improved performance. However this observation of differences in clinician behavior suggests that the personality differences between children may impact the success of the peer training. Training There have been multiple preschool-peer interventions discussed in the literature proposing different strategies and training protocols. The strategies of “show, wait, and tell” selected in for this study were not unique to this design, but selected from the Trembath et al. (2009) study. This study aimed to instruct the strategies outlined by Trembath et al. using the evidence based practices of social narratives and video modeling, while controlling for the amount of clinician cues necessary to be successful. In general, peers were most successful in implementing the “tell” strategy, suggesting that “show” and “wait” are potentially difficult for this population, or need to be instructed differently. It is hypothesized that “show” and “wait” may be too abstract for the preschool population, and despite dosage or training method, these strategies are more difficult to learn. Furthermore, it is hypothesized that the use of strategies outlined by Goldstein and English (1997) of “stay, play, talk,” are potentially more appropriate for the developmental level of this population, allowing the preschool children to better understand and internalize the meanings. Future studies should explore introducing the 118 strategies outlined by Goldstein and English (1997) using the outlined protocol and training methods of the current study. Although future studies to replicate results are necessary, it does appear that portions of the current training protocol are appropriate for use with the preschool population. According to the National Autism’s Center, National Standards Report (2009) both social narratives and video modeling are evidence-based practices in assisting children in acquiring new behaviors. The peers in this study appeared to benefit from multiple practice sessions with the clinician present. This is supported by the observation of increased strategy usage during sessions in which the clinician was present modeling strategy usage. It is also appears that the introduction of a sticker chart along with reminders every 3 minutes, was helpful for some of the peers. Although the original aim of this study was to have peers implement these strategies independently, in an effort to reduce the need for teacher intervention during play activities, the data suggest that even the peers who were most “naturally” successful at using the strategies benefited from intermittent reminders to implement strategies. This is consistent with McGregor’s (2002) report that peer models are only one component of a training program for preschool age children. If an opportunity is present, but not captured by a peer, the clinician or teacher must prompt the trained peer to implement the strategy. What this study began to explore, was the lower limit of how often a teacher or clinician needs to intervene to allow both natural interaction and successful implementation of strategy usage by trained peers. Limitations The biggest limitation present in this study is the population, or available participants. This small sample size allowed for a descriptive report of results, but did not allow for a statistical analysis to determine significant differences between trained and untrained peers and the extent to which gains transferred to interaction with the control subject. However, even if additional peer models were available to participate in 119 the training, the time demands of the study pose another problem. To comply with the proposed training protocol, each trained peer required multiple interactions with the target subject. In an effort to keep the interaction group size small, the target subject would have been subject to substantial periods of time out of the classroom. Although participants were only removed from class during periods in which no direct instruction was occurring, any additional pullout from classroom would have interfered with the child's participation with many more curricular classroom activities. Another limitation of the current study relates to the difference in the number of interactions each participant in this study took part in. Ideally, controlled peers should have spent as much total time with the target subject as the trained peers. However, again it would have been unethical to remove the target subject from the classroom twice as often to control for this factor. Furthermore, the total time peers spent with the subjects outside of the study was impossible to control for due to the nature of the KidTalk classroom design. While the difference was considered to be a potential problem, it appears that this difference produced results that were unpredicted and will need to be explored further. While the study intervention occurred outside of the classroom in a large therapy room set up to mimic the classroom environment to the extent possible and allow for focused instruction, it did take away from the naturalness of a real classroom intervention. Because of limitations on the use of direct classroom video recording (IRB restrictions, requiring consent of all parents not just parents of study participants), this study could not measure generalization of performance to the classroom or be done within the classroom. Future Directions Clearly demonstrated in the discussion is that no two children with or without ASD are alike. It is impossible to predict all of the dynamics that might influence performance in a peer-training program. However, with repetitions of this study going 120 forward, trends can be established and used to best support the communication between all children in a preschool setting. Future studies should aim to increase the sample size while exploring the question of dosage. The presentation of different strategies and peers’ responsiveness to them should also be explored. Furthermore, it is critical to identify the frequency and duration of clinician prompting necessary for the peers to be successful. Future research should also examine children with autism who communicate with and without various types of augmentative and alternative communication, as this may also impact peer performance and type of training. Lastly, future research should aim to identify peers who “get it” and are more successful in training. To that end data should be obtained using a series of language and Theory of Mind measures prior to and following participation in training. These measures, in conjunction with parent and teacher questionnaires such as those presented in Eggum (2010), would allow for a better representation of the skills peers need to be successful. In the current study limitations on time and constraints of the IRB approved protocol precluded obtaining additional data on the participants. 121 REFERENCES Angelo, D., Jones, S., & Kokoska, S. (1995). Family Perspective on Augmentative and Alternative Communication: Families of Young Children. AAC Augmentative and Alternative communication, 11, 193-202. Banda, D., Hart, S., & Liu-Gitz, L. (2010). Impact of training peers and children with autism on social skills during center time activities in inclusive classrooms. Research in Autism Spectrum Disorder, 4, 619-625. Basil, C. (1992). Social Interaction and Learned Helplessness in Severely Disabled Children. AAC Augmentative and Alternative Communication, 8, 188-199. Beck, A., Bock, S., Thompson, J., & Kosuwan, K. (2002). Influence of Communicative Competence and Augmentative and Alternative Communication Technique on Children’s Attitudes toward a Peer Who uses AAC. AAC Augmentative and Alternative Communication, 18, 217-227. Beck, A., & Fritz-Verticchio, H. (2003). The Influence of Information and Role-Playing Experiences on Children’s Attitudes Toward Peers Who Use AAC. American Journal of Speech Language Pathology, 12, 51-60. Brady, N., & Halle, J. (2002). Breakdowns and Repairs in Conversations Between Beginning AAC Users and Their Partners. In J. Reichle & D. R. Beukelman & J. C. Light (Eds.), Exemplary Practices for Beginning Communicators Implications for AAC (pp. 323-351). Baltimore, Maryland: Paul H. Brookes Publishing Co. Chung, Y., Carter, E., & Sisco, L. (2012). Social Interactions of Students with Disabilities Who Use Augmentative and Alternative Communication in Inclusive Classrooms. American Journal of Intellectual and Developmental Disabilities, 117(5), 349-367. Choi, S. (2007). Peer Training Methods for Children and Adolescents with Autism: A Review. International Journal of Pedagogies and Learning, 3, 92-100. DiSalvo, C., & Oswald, D. (2002). Peer-Mediated Interventions to Increase the Social Interaction of Children with Autism: Consideration of Peer Expectancies. Focus on Autism and Other Developmental Disabilities, 17(4), 198-207. Eggum, N. Eisenberg, N., Kao, K., Spinrad, T., Bolnick, R., Hofer, C., Kupfer, A., & Fabricius, W. (2010). Emotion understanding, theory of mind, and prosocial orientation: Relations over time in early childhood. The Journal of Positive Psychology, 6(1), 4-16. Fisher, K., & Shogren, K. (2012). Integrating Augmentative and Alternative Communication and Peer Support for Students with Disabilities: A Social- 122 Ecological Perspective. Journal of Special Education Technology, 27(2), 23-39. Goldstein, H., & English, K. (1997). Interaction among preschoolers with and without disabilities: Effects of across-the-day peer intervention. Journal of Speech, Language & Hearing Research, 40(1), 33. Kent-Walsh, J., & McNaughton, D. (2005). Communication Partner Instruction in AAC: Present Practices and Future Directions. Augmentative and Alternative Communication, 21(3), pp. 195-204. Kent-Walsh, J., & Rosa-Lugo, L. (2006). Communication Partner Interventions for Children Who Use AAC. The ASHA Leader: February 28, 2006 Features. King, A., & Fahsl, A. (2012). Competence in Children Who Use Augmentative and Alternative Communication. Teaching Exceptional Children, 45(1), 42-49 Light, J., Roberts, B., Dimarco, R., & Greiner, N. (1998) Augmentative and Alternative Communication to Support Receptive and Expressive Communication for People with Autism. Journal of Communication Disorders, 31, 153-180. McConachie, H., & Pennington, L. (1997). In-service training for school on augmentative and alternative communication. European Journal of Disorders of Communication, 32, 277-288. McGregor, K. (2000). The Development and Enhancement of Narrative Skills in a Preschool Classroom: Towards a Solution to Clinician-Client Mismatch. American Journal of Speech-Language Pathology, 9, 55-71. Miller, C. (2006). Developmental Relationships Between Language and Theory of Mind. American Journal of Speech-Language Pathology, 15, 142-154. Patel, R., & Khamis-Dakwar, R. (2005) An AAC Training Program for Special Education Teachers: A Case Study of Palestinian Arab Teachers in Israel. Augmentative and Alternative Communication, 21(3), 205-217. Porter, G. & Cafiero, J. (2009). Pragmatic Organization Dynamic Display (PODD) Communication Books: A Promising Practice for Individuals with Autism Spectrum Disorders. Perspectives on Augmentative and Alternative Communication, 18(4), 121-129. Richle, J., Beukelman, D., & Light, J. (2002). Exemplary Practices for Beginning Communicators: Implications for AAC. Baltimore, Maryland: Paul H. Brookes Publishing Co. Reichle, J., Hidecker, M. J., Brady, N., & Terry, N. (2003). Intervention 123 Strategies for Communication. In J. Light & D. R. Beukelman & J. Reichle (Eds.), Communicative Competence for Individuals who use AAC From Research to Effective Practice (pp. 441-477). Baltimore, Maryland: Paul H. Brookes Publishing Co. Rotheram-Fuller, E. (2005). Age-related changes in the social inclusion of children with autism in general education classroom. Dissertation Abstracts International, 66, 2493. Rotheram-Fuller, E. & Kasari, C. (2011). Peer Relationships: Challenges and Interventions. In E. Hollander & A. Kolevzon & J. Coyle (Eds.), Textbook of Autism Spectrum Disorders (pp. 555-562). Arlington, Virginia: American Psychiatric Publishing Inc. Trembath, D., Balandin, S., Togher, L., & Stancliffe, R. (2009). Peer-medicated teaching and augmentative and alternative communication for preschool-aged children with autism. Journal of Intellectual & Developmental Disability, 34(2), 173-186. Trottier, N., Kamp, L., & Mirenda, P. (2011). Effects of Peer-Mediated Instruction to Teach Use of Speech-Generating Devices to Students with Autism in Social Game Routines. Augmentative and Alternative Communication, 27(1), 26-39. Wellman, H. & Liu, D. (2004). Scaling of Theory-of-Mind Tasks. Child Development, 75(2), 523-541. 124 APPENDIX A SOCIAL NARRATIVE “SOME KIDS USE PICTURE BOARDS TO TALK” Figure A1: “Some Kids Use Picture Boards to Talk,” page 1 125 Figure A2: “Some Kids Use Picture Boards to Talk,” page 2 126 Figure A3: “Some Kids Use Picture Boards to Talk,” page 3 127 Figure A4: “Some Kids Use Picture Boards to Talk,” page 4 128 Figure A5: “Some Kids Use Picture Boards to Talk,” page 5 129 Figure A6: “Some Kids Use Picture Boards to Talk,” page 6 130 Figure A7: “Some Kids Use Picture Boards to Talk,” page 7 131 Figure A8: “Some Kids Use Picture Boards to Talk,” page 8 132 Figure A9: “Some Kids Use Picture Boards to Talk,” page 9 133 Figure A10: “Some Kids Use Picture Boards to Talk,” page 10 134 Figure A11: “Some Kids Use Picture Boards to Talk,” page 11 135 APPENDIX B SOCIAL NARRATIVE “IT CAN BE FUN WHEN EVERYONE PLAYS TOGETHER” Figure B1: “It Can Be Fun When Everyone Plays Together,” page 1 136 Figure B2: “It Can Be Fun When Everyone Plays Together,” page 2 137 Figure B3: “It Can Be Fun When Everyone Plays Together,” page 3 138 Figure B4: “It Can Be Fun When Everyone Plays Together,” page 4 139 Figure B5: “It Can Be Fun When Everyone Plays Together,” page 5 140 Figure B6: “It Can Be Fun When Everyone Plays Together,” page 6 141 Figure B7: “It Can Be Fun When Everyone Plays Together,” page 7 142 Figure B8: “It Can Be Fun When Everyone Plays Together,” page 8 143 Figure B9: “It Can Be Fun When Everyone Plays Together,” page 9 144 Figure B10: “It Can Be Fun When Everyone Plays Together,” page 10 145 Figure B11: “It Can Be Fun When Everyone Plays Together,” page 11 146 APPENDIX C RELIABILITY CODER INSTRUCTIONS • Load the selected video • Use the scrolling tab on the bottom to find the specified time. o Double click where you want it to start. o A red line should appear on your desired start time. • Be sure the tiers are in the following order o Default o Transcription o Transcription o Actor o Actor Behavior o Actor Strategy o Recipient o Recipient Gender o Recipient Class o PODD Response o Clinician Cue Sometimes the tiers default in a different order, but this makes coding make difficult. Just single click and hold the tier title while dragging it into the order above. • Now you are set up to code! o Click the > arrow (play) under the video to start it playing. o Press the “stop” when you need to pause and code something. 147 o To back up and replay double click the screen (on the tiers) to move the red cursor. • Each code is called an “annotation” o To make an annotation: Left click on the screen where you want to make the annotation • It should line up with the thing you are coding • Drag the cursor (with the left clicker down) for how long the another lasts • Release the left cursor when you are done • A blue box should appear • Right click inside the box on the tier you want to code • Click “new annotation here” o Select 1 option from the drop down menu • Go down each tier, right clicking and adding “new annotations” until you have selected all relevant information for each tier • If you want to make a change: • Double left click the black line • The drop down menu will reappear and you can make changes When you are finished click “File-Save” 148 APPENDIX D RELIABILITY CODER CODE DESCRIPTIONS Vocabulary and Description by Tier • Default (done for you) o Here I coded any behaviors or things going on in the room I felt may have contributed to performance. • Transcription (done for you) o This is what the kids said. o You can use this to help code the other tiers. • Actor o This is who “initiated” the interaction. o C1-C4 (control peers), T1-T4 (trained peers), S1 (training subject), S2 (control subject) • Actor Behavior o Verbal- communicated verbally with words or vocalization o Gesture- any sign language or natural gesture o AAC- use of PODD o Hitting o Grabbing Toy o Walking Away o No response o Other • Actor Strategy o Show Shows another child an item they can play with 149 Shows another child how to do something Hands another child a toy o Wait Wait for the other child to take a turn Wait for the other child to respond Asks the question again if the child does not respond the first time o Tell • Tells another child how to do something Tells another child what to do (Any statements about themselves don’t count) Needs to be directive towards another child. • Don’t count: “I am going next.” • Count: “S1 put the car down the track.” Recipient o Peer- another peer o Subject- either the target subject or control subject o Peer and subject- if something is directed to both a peer and subject Be cautious of situations when the subject is in the same play area as the peers, but the peers aren’t directly addressing him. Try to distinguish if it is a general statement to the group, or a specific peerto-peer conversation while in the presence of the subject. o Clinician o Note: Sometimes there is no recipient. • That’s okay! Just mark the actor and don’t code for anything else. Self-talk while playing alone does not get coded as having a recipient. Recipient Gender o Male 150 o Female o Male & Female (if there is more than 1 recipient) o Note: If the recipient is a subject there is no need to code gender or classroom • Recipient Classroom o KidTalk I o KidTalk II o KidTalk I & II (if there is more than 1 recipient) • PODD Response o Specify which peer responded to the use of the PODD • Clinician Cue o Cue given When the clinician gives the peers a hint to use their strategies. During the controlled practice videos I directly hinted or modeled strategies the peers should be using. During the final test for the training peers, every 3 minutes they received a cue to remind them to use their strategies. o Don’t count: If the clinician talks to the participants, but doesn’t aid in their interactions with one another.