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
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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.