JASH
2000, Vol. 25, No.1, 18-28
copyright 2000 by
The Association for Persons with Severe Handicaps
Increasing Early Social-Communicative
Skills of Preverbal Preschool Children
With Autism Through Social
Interactive Training
Bogseon Hwang
Ewha Woman's University
Carolyn Hughes
Vanderbilt University
We evaluated the effects of a social interactive training
program on early social-communicative skills (i.e., eye
contact, joint attention, motor imitation) of three preverbal preschool children with autism. Training was conducted in the children's classroom during naturally occurring daily activities. Findings indicated that implementation of social interactive training components (i.e.,
contingent imitation, use of naturally occurring reinforcement, expectant look, environmental arrangement)
was associated with increases in target behaviors across
participants. In addition, generalization of eye contact
and motor imitation behavior were found across an additional setting and different interactive partners, although joint attention rarely generalized. Social validation measures provided by 30 raters indicated that perceived positive changes in performance had occurred in
child behaviors and that training procedures were considered acceptable. Results are discussed in terms of implications for research and practice.
interpersonal interchange (Klinger & Dawson, 1992).
Specifically, the exchange of early mutual gaze provides
an opportunity for reciprocal interaction and turn taking experiences between mothers and infants (Stern,
1985). Nonverbal joint attention serves as a foundation
for the subsequent development of referential communication and language skills (Mundy, Sigman, & Kasari,
1990). Motor imitation functions as an aspect of interpersonal interaction, which provides a means of communicating and expressing a shared understanding with
a partner (Rogers & Pennington, 1991). In addition, the
imitative aspects of early mother-child play increase
children's imitative responses, maintain mother-child
interactions, and facilitate the development of attachment (Uzgiris, 1981).
Children with autism, however, typically experience
profound delays in these early social-communicative
behaviors - the simplest reciprocal interactions that
normally develop in the first few years of life (Zager,
1999). They use less eye contact or eye-to-face gaze
with their interactive partners than do their counterparts without autism (Baker, Koegel, & Koegel, 1998;
Phillips, Baron-Cohen, & Rutter, 1992). In addition,
many rarely use nonverbal gestural joint attention or
indicating behaviors to coordinate attention toward objects or events of interest with their caregivers (Sigman,
Mundy, Sherman, & Ungerer, 1986) and other individuals (McEvoy, Rogers, & Pennington, 1993). Further, many children diagnosed with autism often display specific deficits in imitation of simple motor movements, such as clapping their hands, playing "patty
cake,"or waving goodby (Stone, Ousley, & Littleford,
1997). These reports suggest that delays in social and
communicative functioning are a distinguishing characteristic of the early development of children with autism.
Given the importance of early social-communicative
skills that have been associated with social reciprocity
and communicative functioning, several early language
DESCRIPTORS: autism, preschool children, socialcommunicative skills, social interactive training
Over the past two decades, numerous studies have
emphasized the importance of early development in social-communicative skills as a necessary foundation for
subsequent development in social and communicative
functioning (e.g., Guralnick, Connor, Hammond, Gottman, & Kinnish, 1996). Eye contact, joint attention, and
motor imitation are regarded as early social-communicative skills that enable young children to engage in
Supported in part by funding from the U.S. Department of
Education, Office of Special Education and Rehabilitative
Services (Student-Initiated Grant), and from a grant from the
John Merck Foundation.
Address all correspondence and requests for reprints to Dr.
Bogseon Hwang, Department of Special Education, Ewha
Woman's University, 11-1 Daehyun-Dong, Seodaemun-Gu,
Seoul, South Korea 120-750. E-mail: bshwang@mm.ewha.
ac.kr
18
19
Early Social-Communicative Skills
intervention programs have been developed to address
the interrelationship between social interaction and
language development in children (e.g., Hepting &
Goldstein, 1996; Klinger & Dawson, 1992; Koegel,
1995; McGee, Morrier, & Daly, 1999). Social interactive training programs incorporate naturally occurring
patterns of early social interactions, which are developmentally appropriate and allow a child to take the active role of initiator in interactions. Interactive teaching
techniques are used, such as contingent imitation, naturally occurring reinforcement, and expectant look.
They provide instructor responses that are simple, predictable, and contingent on the child's initiations
(Klinger & Dawson, 1992). In addition, the environment
is arranged with rich materials to increase a child's interest in activities and the child's motivation to use social
and communicative behaviors in meaningful ways.
Recent studies indicate that social interactive strategies may promote early social and communicative skills
in children with autism. Positive change has been reported in social behavior and affect, requesting assistance, greeting and social amenities, eye gaze, joint attention, and motor imitation (e.g., Charlop & Trasowech, 1991; Dawson & Galpert, 1990; Hwang &
Hughes, 1995; Klinger & Dawson, 1992; Pierce &
Schreibman, 1995). In addition, these studies suggest
that combining social interactive strategies may increase the effectiveness of social-communicative skills
training. For example, Klinger and Dawson (1992) systematically evaluated the effects of a "package" of social interactive strategies, which combined contingent
imitation, naturally occurring reinforcement, expectant
look, and environmental arrangement. Results indicated that the social interactive training package was
effective in promoting social-communicative skills
among verbal and preverbal 5-year-olds with autism,
including eye contact, joint attention, and motor imitation. Pierce and Schreibman (1995) investigated a peermediated interactive procedure that combined environmental arrangement and naturally occurring reinforcement among verbal elementary school children with
autism. Treatment resulted in increases in joint attention by participants that generalized across settings and
peers.
Little information is available, however, regarding
the effectiveness of social interactive training packages
among preverbal children with autism who are functioning at early developmental levels (Dawson & Galpert, 1990). In addition, limited generalization of targeted skills has been demonstrated, particularly outside
clinical settings and across additional interactive partners (Pierce & Schreibman, 1995). In order to determine if changes in social interactive behavior are durable, it is important to know if behaviors learned under training conditions generalize to children's
interactions with the important others present in their
daily environments (e.g., teachers, parents, peers).
Therefore, further investigation of the generalized effects in everyday, nonclinical settings of social interactive training among children with autism at early developmental levels is needed.
Therefore, we sought to demonstrate that early social-communicative skills of preverbal preschool children with autism could be increased through the use of
social interactive strategies introduced in a natural
classroom environment. The social interactive training
package developed by Klinger and Dawson (1992; i.e.,
contingent imitation, naturally occurring reinforcement, expectant look, environmental arrangement) was
adapted to promote the acquisition and generalization
of early social-communicative skills among young children with autism (i.e., preverbal 3-year-olds at early
developmental levels). Specifically, we sought to (a) increase the early social-communicative skills of the participants during naturally existing classroom activities
and (b) promote generalization of intervention effects
across an untrained situation and different interactive
partners. In addition, we obtained social validation
measures of perceived changes in participants' performance and appropriateness of training procedures.
Method
Participants
Three young boys with autism who were enrolled in
a university-based early intervention program for children with developmental delays participated in this
study. A diagnosis of autism was made by community
agencies according to criteria listed in the 4th ed. of the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV; American Psychiatric Association, 1994).
The boys (ages 32-43 months) were selected because
they displayed low or nonexistent rates of eye contact,
joint attention, and motor imitation, as determined by
the first author through 2 months of direct observation
conducted prior to taking baseline data. During observation, the children did not vocalize any meaningful
words and expressed few communicative intents nonverbally and/or vocally. For example, they protested,
greeted, or requested assistance only with gestures.
They did not attend consistently to the classroom
teacher, imitate body movements, request action or information, or make comments. Additional participant
characteristics are found in Table 1.
Interactive Partners
Two graduate students in special education served as
interactive partners for the participants during baseline
and intervention sessions. During generalization sessions, two of the participants' classroom teachers who
expressed interest and willingness served as interactive
partners. The graduate students had at least 3 years of
paid experience working with people with severe developmental disabilities and the teachers had over 5
years teaching experience with children with autism.
20
Hwang and Hughes
Table 1
Participant Characteristics
Participant, age,
ethnicity, and gender
Diagnosis" and
cognitive development"
Noel, 37 months, Caucasian
male
Autism, sensorimotor
stages IV and V
Expressive
Receptive
=
9 months
12 months
Vocalized no meaningful words;
occasionally showed temper
tantrums that included making
fists and shaking his body
James, 43 months,
African-American male
Autism, sensorimotor
stage V
Expressive
Receptive
=
=
12 months
12 months
Expressed a combination of
vocalization and gestures; was
impulsive and easily distracted
during structured and
unstructured activities
Louis, 32 months, Caucasian
male
Autism, sensorimotor
stage V
Expressive
Receptive
=
=
8 months
12 months
Did not yet produce any consistent
word approximations; occasionally
displayed arm flapping behaviors
when he enjoyed playing with toys
(e.g., spinning fans)
Language development"
=
Communication and
behavioral characteristics
Note: Sensorimotor stages: Stage IV = 8- to 12-month age range; Stage V = 12- to 18-month age range (Uzgiris & Hunt, 1975).
a Primary diagnosis of autism was identified by pediatricians or psychologists in the community.
b Uzgiris-Hunt Ordinal Scales of Intellectual Development (Uzgiris & Hunt, 1975).
C Sequenced Inventory of Communication Development-Revised (Hedrick, Prather, & Tobin, 1984).
Settings
The participants attended the early intervention program 3 days per week. All baseline and intervention
sessions took place in a play area (3 m x 2 m) within the
participants' classroom with one participant and one
interactive partner present. Two teachers and four
other children with developmental disabilities were
present in another area of the classroom. Generalization sessions were conducted in a different classroom,
which was used for individual and group speech therapy
sessions. Only one participant and one interactive partner were present. Both settings contained a child sized
table with several chairs and developmentally appropriate play materials.
Tasks and Materials
Partners interacted with the children using a variety
of play materials, including toys (e.g., bubbles, toy fruit,
wind-up toy), household objects (e.g., bowl, mirror,
toothbrush), art supplies (e.g., crayon, paper, play
dough), and musical instruments (e.g., drum, music box,
toy piano). During baseline and generalization sessions,
two to five play materials from a pool of materials typically used in early intervention classrooms were selected by the partners. The same materials were used in
baseline and generalization sessions. During social interactive training, play materials were chosen from the
same pool of materials based on participants' preference according to procedures recommended by Koegel,
Dyer, and Bell (1987) and Cronin, Hemmeter, and Kaiser (1990). First, the partner presented (e.g., handed or
demonstrated) to each child an object typically effective at facilitating social interaction (vs. parallel play)
used during interactive play in early intervention classrooms. An object was considered a preferred play ma-
terial if the child oriented himself toward or manipulated the object or expressed enjoyment nonverbally
(e.g., eye gaze, laughing, smiling, clapping). By repeating this process, a pool of preferred play materials was
identified for each child, from which items were introduced during social interactive training. If a child lost or
showed no interest in a play item (e.g., the child did not
play with the item or pushed it away), it was "removed
and replaced with another item from the child's pool of
preferred play materials. The total pool of preferred
play materials was 28 for Noel, 30 for James, and 27 for
Louis.
Outcome Measures
Three dependent measures were used to assess participants' social-communicative responses across all observation sessions: (a) frequency of eye contact, (b) frequency of joint attention, and (c) frequency of motor
imitation. As a measure of fidelity of treatment, social
interactive training strategies performed by partners
were also measured across all observation sessions.
Measures were defined as follows (coding manual available from the first author).
Eye contact. The child looked at the interactive partner's eyes or face for at least 2 continuous sec without
a prompt (e.g., the partner speaking the child's name or
saying "look at this" or "see"; Klinger & Dawson,
1992). Eye gaze directed toward any other part of the
partner's body (e.g., hands) was not included (Wetherby & Prizant, 1993).
Joint attention. The child directed the attention of
the partner toward an object or event (Wetherby &
Prizant, 1993). Participant behaviors scored as joint attention included (a) referential looking at the interactive partner and an object (e.g., the child alternated
Early Social-Communicative Skills
looking at a mechanical toy and at the partner's face
while manipulating the toy on the table); (b) pointing to
an object within reach (e.g., when the child spilled juice,
he pointed to the juice while looking at the interactive
partner); and (c) showing objects to the interactive
partner (e.g., the child held up a toy car and smiled
while looking at the partner; Mundy et aI., 1990).
Motor imitation. When the interactive partner modeled a simple familiar action with objects or body movements (e.g., the partner pushed a toy car across the
table), the child imitated the action within 5 sec without
prompting (Koegel et aI., 1987; Stone et aI., 1997). Motor imitation was scored as partial imitation if it approximated the partner's action or as complete imitation if the entire action was performed.
Social interactive training strategies. Social interactive training was composed of four strategies implemented by partners: contingent imitation, naturally occurring reinforcement, expectant look, and environmental arrangement. See "Social interactive training"
below for definitions.
Experimental Design and Conditions
A multiple baseline across participants design (Kazdin, 1982) was used to evaluate the effects of the social
interactive training package. There were two experimental conditions: baseline and social interactive training. Ten minute observation sessions were conducted
twice weekly across both experimental conditions during the 30 weeks of the study. In addition, throughout
the study, a multiple probe technique (Horner & Baer,
1978) was used to collect intermittent generalization
data every 2-3 weeks.
Baseline. During baseline, partners interacted with
the participants the same as teachers in the early intervention program typically did. However, if the participants did not interact, the partners did not prompt
them to do so. During baseline, two to five play materials were available to each participant. Baseline continued until stability in level and trend of the dependent
measures was obtained.
Social interactive training. Following baseline, social
interactive training was introduced to Noel, with training for the other two participants following sequentially. At the beginning of each training session, partners brought participants to the play area and presented play materials from each participant's pool of
preferred play materials. Next, partners followed participants' leads by playing with toys in which participants indicated an interest (e.g., by facial expression or
gestures). When participants lost interest in play items,
they were removed and replaced with other items from
the participants' pool.
Social interactive training was implemented by partners as they interacted with participants and play materials. Training consisted of the following four strategies: contingent imitation of participants' actions (e.g.,
21
interactions with toys) within the participants' field of
vision immediately following participants' interactions
(Klinger & Dawson, 1992); naturally occurring reinforcement (i.e., participants gained access to objects or
events in which they demonstrated an interest by use of
facial expressions, vocalizations, or gestures; Koegel &
Johnson, 1989); presenting an expectant look for 5 sec
before responding to participants' actions or requests
(i.e., before responding to participants, partners waited
and looked expectantly at participants for 5 sec (MeGee et aI., 1999; Zager, 1999); and environmental arrangement (e.g., providing materials of interest to participants, presenting two or more options to allow participants to choose, removing materials that were of no
interest to the child; McGee et aI., 1999). The four strategies were implemented in response to partners' behavior rather than on the basis of a predetermined schedule.
Social interactive strategies were implemented as follows. First, to promote participants' eye contact, partners imitated participants' actions using toys, body
movements, and vocalizations simultaneously or as
soon as possible after a participant initiated an action.
Partners performed actions within view of participants
in order to engage their attention (e.g., partner kept her
face near toy with which she was interacting). In addition, they smiled and expressed enjoyment when participants looked at them. Second, to promote joint attention and spontaneous communication, partners arranged the environment to require participants to use
gestures or sounds to draw partners' attention toward
objects (e.g., partner removed a piece of a toy). To
provide opportunities for participants to comment or
act, partners waited and looked expectantly for at least
5 sec. In addition, partners followed participants' line of
vision to look in the direction of objects or events at
which participants were looking. Third, to increase the
children's motor imitation, partners waited until participants were looking at them and then modeled a
simple, familiar action that was already in a participant's behavioral repertoire. The action was one that a
participant had performed recently (e.g., pushing a toy
car, blowing bubbles, clapping hands). Fourth, partners
prompted participants to respond if participants did not
interact with partners within 30 sec.
Generalization probes. Generalization data were collected in the speech therapy classroom during which
only a participant and another partner, the child's classroom teacher, were present. Social interaction trainers
were not present. As during baseline, social interactive
training strategies were not implemented. The classroom teachers interacted with participants in the same
manner in which they typically did during individual
speech therapy sessions. Two to five play materials
were chosen by the classroom teacher from the same
pool of materials present in baseline rather than from
the pool of preferred materials used during training.
22
Hwang and Hughes
Generalization probes were taken on randomly chosen
days every 2-3 weeks for a minimum of 150/0 of each
participant's sessions across all experimental conditions.
Partner Training
During the first 2 weeks of the social interactive
training condition and using a group format, partners
were trained by the first author to implement the social
interactive strategies. Training sessions lasted 2 hours
and occurred 5 days a week. Training consisted of discussions of the social interactive strategies, role play,
and in vivo training with a child not participating in the
study. Following a brief discussion of the four social
interactive strategies (i.e., contingent imitation, naturally occurring reinforcement, expectant look, and environmental arrangement), the first author modeled
each strategy and the partners practiced using the strategy with the first author and each other. The first author provided feedback on the correctness of the partners' performance and partners were given opportunities to critique each other. During in vivo practice
sessions, partners practiced until they were able to
demonstrate correct independent use of the strategies
on three consecutive opportunities.
Observers and Observer Training
Two graduate students in special education served as
the primary and the reliability observers, respectively.
To limit sources of observer bias, observers did not
interact with participants. Prior to collecting data, both
observers read and discussed the definitions of the dependent and independent measures and observation
and recording procedures. They then practiced data recording procedures for each of target behaviors by
watching videotapes of adult-child social interaction.
Observer training continued until the observers
reached a criterion of 80% interobserver agreement as
calculated on a point-by-point basis (Kazdin, 1982) for
both dependent and independent measures for three
consecutive practice sessions before beginning baseline
observations.
Observation and Recording Procedures
A video camera was used to record partnerparticipant interactions during each 10 minute observation session. During baseline and training, the video
camera was placed in the play area. During generalization, the camera was hidden behind a one way mirror.
The videotaped sessions were subsequently analyzed
using the Multiple Option Observation System for Experimental Studies (MOOSES) software program
(Tapp, Wehby, & Ellis, 1995). MOOSES is designed for
MS-DOS compatible computers and allows for simultaneous recording of event and duration measures
based in real time. Cumulative duration of event behaviors is also collected because the termination of
each event is signaled by entering a new code (or a code
for "no target behavior occurring"). At the onset of
each observation, the observer recorded the participant's and partner's name, session number, and date.
During the session, the observer recorded the occurrence of all outcome measures (i.e., participants' eye
contact, joint attention, and motor imitation and partners' use of social interactive strategies). Play materials
used and activities engaged in were also recorded.
Interobserver Agreement
Interobserver agreement on all outcome measures
was assessed by having the two observers record target
behaviors simultaneously, but independently, while
watching the videotapes of the participants. To reduce
reactivity due to the presence of a second observer,
observations of the primary observer were monitored
throughout the study. Interobserver agreement was
taken for a minimum of 28 % of sessions per participant
per experimental condition. To assess percentage
agreement for all outcome measures, the point-bypoint agreement method (Kazdin, 1982) was computed
by dividing the number of agreements by the number of
agreements plus disagreements and multiplying by 100.
In addition, to examine agreement on occurrence and
nonoccurrence of target behaviors corrected for chance
agreement, kappa (Cohen, 1960) was calculated using
the following formula: agreement on occurrences and
nonoccurrences minus the expected agreement divided
by the total number of agreements and disagreements
minus the expected agreement.
Overall mean interobserver agreement across participants on the frequency of social-communicative behaviors was 920/0 for eye contact (range: 670/0-100 %),860/0
for joint attention (range: 67 %-100 %), and 92 % for
motor imitation (range: 75%-1000/0). Kappa values
were .87 for eye contact (range: .63-1.0), .79 for joint
attention (range: .50-1.0), and .88 for motor imitation
(range: .71-1.0). Overall mean interobserver agreement
on fidelity of treatment measures across partners was
900/0 for contingent imitation (range: 75 %-1000/0), 870/0
for naturally occurring reinforcement (range: 71 % 1000/0), 91% for expectant look (range: 86 %-1000/0),
and 90% for environmental arrangement (range: 82%1000/0). Kappa values were .87 for contingent imitation
(range: .62-1.0), .83 for naturally occurring reinforcement (range: .69-.93), .81 for expectant look (range:
.73-.92), and .86 for environmental arrangement
(range: .67-1.0).
Social Validation
To assess the social validity (Wolf, 1978) of the social
interactive training package, 30 individuals were recruited by asking for volunteers to participate in a social skills study. Respondents represented three groups
who had experience with children with autism (i.e., 10
special education teachers or educational assistants, 10
23
Early Social-Communicative Skills
Table 2
Mean and Standard Deviation of Respondents' Ratings on Social Validation Measures
Video 1: baseline
Items
The child frequently uses eye contact to respond to the interactive
partner's social/communicative exchanges.
The child frequently uses joint attention behavior to direct the interactive
partner's attention toward an object or event.
The child frequently imitates familiar actions with toys and body
movements made by the interactive partner.
The training is appropriate for facilitating the child's social-communicative
skills, such as eye contact, joint attention, and motor imitation.
The training and materials appear to be positive and interesting to the
child.
Mean score
a
Video 2: intervention
M
SD
M
SD
1.1a
.3
4.3
.5
1.5
.6
4.4
.7
2.0
.8
4.6
.5
1.8
.6
4.6
.5
2.3
1.7
.7
.4
4.7
4.5
.5
.4
1 = strongly disagree; 2 = mildly disagree; 3 = do not feel strongly either way; 4 = mildly agree; 5 = strongly agree.
parents of children with developmental disabilities, 10
graduate students in hearing and speech science or special education). To minimize bias, respondents were not
informed of the purpose of the study. We developed
two 3-minute videotapes, each of which was composed
of randomly selected segments from each child's complete set of videotapes. One videotape contained a 1minute segment taken from the middle of a randomly
selected 10-minute observation session of each child's
performance during baseline. The other videotape contained a J-minute segment derived in the same fashion
from observation sessions of each child's performance
during training. The order of the children's performance on the baseline tape was random; however, this
same order was followed for the training tape. All respondents viewed both the baseline and training videotapes; however, the order of presentation of the videotapes to respondents was randomized. The 30 respondents observed the segments and completed a 5-item,
5-point, Likert-type rating scale (1, strongly disagree; 5,
strongly agree; see Table 2).
Social validation data analysis included descriptive
and inferential statistical tests. To summarize findings,
means and standard deviations were computed for responses to the five quantitative questions. In addition, a
two way split plot analysis of variance was conducted to
test for significant differences among respondents'
mean ratings for the two videotaped segments. To determine the extent of interjudge agreement, Kendall's
coefficient of concordance (W) was calculated (Siegel,
1956).
Results
Changes in Social-Communicative Skills
Table 3 represents the means and ranges of frequency of social-communicative behaviors displayed by
participants during baseline and training conditions.
The frequency of social-communicative behaviors per
session during baseline and training is displayed in the
upper panels for each participant in Figure 1. As shown
Table 3
Mean and Range of Frequency of Social-Communicative
Behaviors During Baseline and Training Conditions
Eye
contact
Participant
and condition
Noel
Baseline
Training
James
Baseline
Training
Louis
Baseline
Training
Joint
attention
Motor
imitation
M
M
M
(range)
(range)
(range)
2.1
(0-6)
9.7
(4-25)
0
(0)
4.8
(0-12)
0
(0)
6.1
(0-14)
0.9
(0-3)
3.7
(0-8)
0.1
(0-1)
4.4
(2-9)
0.4
(0-3)
7.6
(3-14)
0.6
(0-3)
7.5
(3-13)
0.1
(0-1)
5.0
(1-10)
0.2
(0-2)
9.7
(3-19)
in Table 3 and Figure 1, participants rarely engaged in
eye contact, joint attention, or motor imitation behaviors with their partners during baseline. In contrast,
during training, all participants increased the frequency
of their social-communicative behaviors, although increases in joint attention were generally less pronounced than increases in eye contact or motor imitation across participants.
Generalization of Treatment Effects
Table 4 shows the means and ranges of frequency of
social-communicative behaviors displayed by participants during generalization probes. The frequency of
social-communicative behaviors per session during generalization probes is shown in the lower panels for each
participant in Figure 1. As can be seen, changes in behavior from baseline to training were similar to training
effects, although increases for joint attention were
more modest.
24
Hwang and Hughes
Baseline
~
30
Social Interactive Training
25
20
15
10
5
o
~
30
25
20
15
30
IJamesl
25
20
15
10
5
o
30
25
20
15
10
5
0
30
25
20
15
10
5
0
30
25
o Eye Contact
20
o Joint Attention
15
6. Motor Imitation
~_-----~-------o_-----
10
_---
5
__-==:
~&----~----------~~------D~---
0
0
5
10
15
20
25
30
35
__ ~
~-------b------~-D
_------G---___ ~
40
45
50
__D
55
60
Observation Sessions
Figure 1. Frequency of early social-communicative behaviors (eye contact, joint attention, motor imitation) during baseline and
training sessions (upper panels) and generalization probes (lower panels) for participants. Dotted lines in upper panels indicate
participant absence.
25
Early Social-Communicative Skills
Table 4
Mean and Range of Frequency of Social-Communicative
Behaviors During Generalization Probes
Participant
and condition
Noel
Baseline
Training
James
Baseline
Training
Louis
Baseline
Training
Eye
contact
M
(range)
Joint
attention
M
(range)
Motor
imitation
M
(range)
1.5
(1-2)
9.7
(4-15)
0
(0)
1.0
(0-2)
1.0
(0-2)
4.1
(1-9)
2.3
(2-3)
5.2
(2-9)
0
(0)
2.0
(0-4)
0
(0)
7.5
(4-11)
0.3
(0-1)
8.2
(7-11)
0
(0)
1.4
(0-3)
0
(0)
4.4
0-7)
Social Interactive Training Strategies Implemented
(Fidelity of Treatment)
Figure 2 shows the number of social interactive strategies implemented correctly by partners per session
during baseline and training. Table 5 displays the
60
means and ranges of social interactive training strategies implemented per baseline, training, and generalization conditions. During baseline, partners did not
implement contingent imitation, naturally occurring reinforcement, or expectant look. They implemented environmental arrangement at low levels. Partners' implementation of all strategies during baseline averaged 1.5
times with Noel, 2.6 times with James, and 2.1 times
with Louis per 10-minute session. During training,
implementation of all strategies increased to an average
of 31.1 times with Noel, 37.7 times with James, and 42.9
times with Louis per session. During generalization
probes, classroom teachers implemented social interactive strategies with partners at relatively low levels, although mean implementation of strategies was slightly
above baseline levels (i.e., means for all strategies
implemented per session were 5.6 times with Noel, 5.8
times with James, and 4.2 times with Louis).
Social Validation
Table 2 displays the means and standard deviations
for respondents' ratings to each of the five Likert-type
questions for two videotaped segments (i.e., one baseline and one training). Low standard deviations associated with mean ratings reflected little variability across
the respondents. In addition, Kendall's coefficient of
Social Interactive Training
Baseline
[]2ill
50
40
30
20
10
o
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L
,
I
60,...
I
I
I
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50 f-IJamesl
I
I
I
I
40
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30
20
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40
30
--
I
---I
•
T
... _-
I
I:
I
I
I
-------------,
I
I
I
I
I
I
''''
I
I
o Contingent Imitation
1m Naturally Occurring
Reinforcement
• Expectant Look
• Environmental Arrangement
20
10
oOb-a.....IAJ....I..af=--.JII-DI..-..-..I.....- - i a . l
5
10
15
~. .._............l..aJULll.l1...llJl,l.l..lULll..1.UULlllJL.l.l,.lL.ll...ll.Jl.ll,)LlUL.ll..l;UL1U1.J....L.....,
20
25
30
35
40
45
50
55
60
Observation Sessions
Figure 2. Frequency of social interactive strategies (contingent imitation, naturally occurring reinforcement, expectant look, environmental arrangement) implemented correctly by partners during baseline and training sessions.
26
Hwang and Hughes
Table 5
Mean and Range for Frequency of Social Interactive
Training Strategies Across Conditions for Each Participant
Participant and
social interactive
training strategy
Noel
Contingent
imitation
Naturally occurring
reinforcement
Expectant look
Environmental
arrangement
Total
James
Contingent
imitation
Naturally occuring
reinforcement
Expectant look
Environmental
arrangement
Total
Louis
Contingent
imitation
Naturally occuring
reinforcement
Expectant look
Environmental
arrangement
Total
Baseline
M
(range)
Training
M
(range)
0
(0)
0
(0)
0
(0)
1.5
(0-4)
1.5
(0-4)
6.7
(0-17)
5.9
(0-15)
8.2
(1-16)
0.05
(0-1)
0.3
(0-2)
0.7
(0-3)
1.9
(0-4)
2.6
(0-6)
9.5
(4-17)
8.0
(3-15)
0.04
(0-1)
0.2
(0-3)
0
(0)
1.8
(0-3)
2.1
(0-6)
lOA
(2-17)
31.1
(8-51)
Generalization
probes
M
(range)
004
(0-3)
1.3
(0-6)
1.9
(0-6)
1.9
(1-6)
5.6
(6-16)
(5-18)
37.7
(9-52)
1.2
(0-6)
2.1
(0-6)
104
(0-5)
1.0
(0-4)
5.8
(3-16)
11.3
(6-16)
9.3
(6-14)
11.3
(7-16)
11.7
(7-18)
42.9
(35-49)
0
(0)
0.9
(1-6)
1.9
(0-6)
104
(1-4)
4.2
(3-15)
lOA
(4-17)
lOA
concordance (W) was calculated as 1, which was significant at p < .00001. This high value of W indicated that
all 30 respondents employed a similar standard in the
evaluation of the two videotaped performances.
To test for significant differences among respondents' mean ratings for the two video segments, a twoway split plot ANOVA was conducted. A significant
difference between mean ratings was found (F = 744.9,
df = 1, p < .01). There was no significant group effect
among three respondent groups on mean video ratings.
These findings suggest that increases in three socialcommunicative skills of the participants after implementation of social interactive strategies were associated with higher ratings by respondents.
Discussion
Findings in this study corroborated previous efforts,
indicating that social interactive training can increase
early social-communicative skills of children with autism (e.g., Klinger & Dawson, 1992; Pierce & Schreibman, 1995). In addition, social validation measures in-
dicated that a variety of judges perceived that positive
performance changes had occurred in child behaviors
and that training procedures were acceptable.
This investigation extends prior research in several
important ways. First, we introduced the social interactive training program to a novel population: 3-year-old
preschool children with autism who were functioning at
early developmental levels. Previous investigations included school-aged (5-10 year old) participants with
verbal language abilities. Our findings indicated that
eye contact, joint attention, and motor imitation could
be increased among preverbal 3-year-olds with autism
by implementing a combination of social interactive
strategies (i.e., contingent imitation, naturally occurring
reinforcement, expectant look, environmental arrangement). These findings are important in light of the role
that early social reciprocity and social-communicative
skills play in the development of children's subsequent
language acquisition (Yoder & Warren, 1993). To minimize cumulative effects of language delay over time,
one solution may be to introduce social interactive
training during the initial stages of social-communicative development of preverbal children with autism.
Second, we introduced social interactive training in
the children's everyday classroom rather than in a clinical setting, as occurred in previous studies (e.g., Dawson & Galpert, 1990; Klinger & Dawson, 1992). Participants were able to request, reject, comment on, and
interact with objects and events with which they came
in contact on a daily basis. If children are removed from
their everyday environments and placed in highly structured training settings, the functional utility of acquired
communication skills is questionable (Dattilo & Camarata, 1991). Introducing social interactive training in the
children's everyday classroom setting may have promoted the acquisition of social-communication skills
observed in this study because the acquired skills likely
were functional in the children's daily environments. In
addition, training in the children's everyday classroom
may have promoted the generalization of skills across
settings and partners observed in this study. Unlike in
the Pierce and Schreibman (1995) study, however, we
found only modest generalization of joint attention behavior. Differential effects across the two studies may
exist because children in the previous study were older
(10 years) and verbal. Participants in our study may
have been less proficient at attending simultaneously to
an object and an interactive partner. We found that
even during training, increases were more modest for
joint attention than for eye contact or motor imitation.
It may be that joint attention is a more complex skill
that develops more slowly and requires additional
training than other social-communicative skills.
Third, only two prior investigations of early social
interactive training assessed fidelity of treatment of interactive partners' implementation of prescribed strategies (Charlop & Trasowech, 1991; Wolery, Gast, Kirk,
27
Early Social-Communicative Skills
& Schuster, 1988). This is unfortunate because social
interactive training consists of multiple strategies that
require precise implementation by an interactive partner in order to support the child as initiator of interactive play. In our study, interactive partners' implementation of training strategies was assessed in real time
from videotaped performance. This allowed us to investigate the use of the strategies in relation to changes
in children's social-communicative behaviors. During
training, partners were found to implement strategies
as prescribed. In addition, the onset of implementation
of strategies across participants was related to observed
increases in participants' social-communicative behaviors.
Several limitations to the study are worth noting.
First, although increases in targeted skills did occur
across participants, considerable variability occurred in
children's performance. James, for example, increased
his eye contact less than did his peers. Participants'
characteristics may account for some of this variability.
James, for example, was more distractible than his
peers. An additional factor relating to this variability
could be that training was provided only twice weekly.
Social-communicative skills typically develop as an ongoing process of children's daily interactions with important others in their environment rather than through
infrequent, short-term efforts (Rowland & Schweigert,
1993). Changes in participants' behavior may have been
more consistent if training had been provided across
the day during different activities, in multiple settings
with a variety of interactive partners. Second, increases
in targeted behaviors occurred at a slower rate than
anticipated, perhaps because of the infrequency of
training. Consequently, the 7 month duration of the
study ended before training could be withdrawn.
Therefore, maintenance of training effects was not assessed, although durability of behavior change is a critical criterion for evaluating the efficacy of intervention
efforts. Future researchers should anticipate the delayed effects that may occur when teaching early socialcommunicative skills to young, preverbal children with
autism. Ample time should also be allowed to assess the
maintenance of targeted skills over time.
In summary, this study provides both empirical and
subjective support of social interactive training in increasing acquisition and generalization of early socialcommunicative skills of preverbal preschoolers with autism. A critical question, however, warrants further investigation: Does early social-communicative skills
training promote later language development in children with autism? The ultimate demonstration of the
long-term value of the social interactive approach will
be established through repeated assessments of its effect on children's language development over time as
observed during functional, reciprocal interactions in
children's everyday lives.
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Article received: June 17,1999
Final acceptance: January 6, 2000
Editor in charge: Joseph R. Scotti