Running head: PEER-MEDIATED, SOCIAL STORY INTERVENTION
The Effects of Peer Mediated Social Story Intervention on the Social Interactions
of Preschoolers with Autism
Sanna Harjusola-Webb and Sophia Parke Hubbell
Kent State University
Kathleen Harris
Seton Hill University
November, 2010
PEER-MEDIATED, SOCIAL STORY INTERVENTION
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Abstract
Deficits in social communication skills are hallmark symptoms of autism spectrum
disorders. There is significant evidence to support the use of Social Stories in interventions to
address social communication skills in children with autism. However, there is little research on
the use of social stories with preschool children with autism spectrum disorders. This single
subject AB study extends the research on Social Stories to include the preschool age group.
Additionally, this study introduces a potentially effective social communication intervention to the
field of early childhood intervention in the form of a peer-mediated, Social Story intervention
delivered via interactive whiteboard, though the results of the study were inconclusive.
PEER-MEDIATED, SOCIAL STORY INTERVENTION
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Today, one-third to one-half of young children with disabilities are enrolled in child care
or preschool programs that include typically developing peers (Booth & Kelly, 2002; Diamond
& Huang, 2005). As a result, many young children with disabilities are educated in communitybased programs alongside children without disabilities (Causton-Theoharis & Malmgren, 2005;
Cook, Cameron, & Tankersley, 2007; Forlin & Hopewell, 2006; Hastings & Oakford, 2003;
Shonkoff & Phillips, 2000). Convincing evidence exists to support the notion that integrated
settings are “good” for all children and that they promote more positive peer interactions than
segregated settings (CITATION). Inclusion for children with disabilities, however, is not a
coincidental social experience and does not automatically translate into positive social
interactions. In fact, without specific teacher supports or targeted interventions, the typical peers
in inclusive classrooms tend to choose other typical peers as playmates instead of playing with
the children with disabilities (Beckman, 1983; Devoney, Guralnick, & Rubin, 1974; Peterson &
Haralick, 1977).
Children with autism spectrum disorders (ASD), in particular, are at greater risk for
experiencing loneliness, difficulty establishing and maintaining social relationships, and mental
health problems due to a pervasive social dysfunction (APA, 2000). Indeed the word autism
means within oneself (Kanner 1943), and the social impairments of children with ASD are often
present across environments, people, and behavioral manifestations. Young children with ASD
exhibit deficits in initiation, turn taking, joint attention and imitation behaviors (CITATION). As
a result, the quality and quantity of social interactions with peers and adults is very different for
children with ASD as compared to their typical peers. Some of these differences and deficits
present in children with ASD might occur because of a negative feedback loop; the children with
ASD produce fewer and poorer quality conversations, causing the adults and peers to respond
PEER-MEDIATED, SOCIAL STORY INTERVENTION
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less. This negative feedback loop has the potential to change the whole language and
communication-related skills learning context experienced by the child with ASD. Descriptive
research supports this theory by showing that the audio environments of children with ASD are
different and include significantly less communicative input by adults and other children than
audio environments of typical children (Warren at al, 2010).
One solution for teachers to promote peer interactions in the context of natural
environments is Peer Mediated Intervention. Peer-Mediated Interventions have been successfully
used in integrated settings to increase the quality and quantity of social interactions with the
children who have disabilities or limited skills in the area of social communication. PeerMediated Intervention (PMI) is an evidence-based strategy in which peers take on an
instructional role with classmates or other children (Chandler, Lubeck, & Fowler, 2002; Conroy
& Brown, 2004; Harper, Symon, & Frea, 2008; Harris, Pretti-Frontczak, & Brown, 2009; Kohler
& Strain, 1999). PMI includes training in various social communicative strategies to foster
socially appropriate behaviors. Research shows that using peers as role models has the potential
to be more advantageous for increasing the quality and quantity of social behaviors in natural
environments than teacher modeling (Guralnick, 2001; Utley, Mortweet, & Greenwood, 1997).
Various approaches have been used to change the social communicative behaviors of
peers and target children with autism. The PMI framework typically includes: (a) arranging the
social and physical classroom environment to foster the use of PMI, (b) teaching peers specific
strategies and social skills for initiating and responding to the target children, and (c) teaching
appropriate social skills to the children with ASD. Peer-mediated intervention is technique in
which typically developing peers receive training to support the development of a specific skill
in a peer with a disability. The efficacy of peer-mediated interventions for children with autism
PEER-MEDIATED, SOCIAL STORY INTERVENTION
5
in early childhood settings has been well established (Betz, Higbee, & Reagon, 2008; Gena,
2006; Kalyva & Avramidis, 2005; Kohler, Greteman, Raschke, & Highnam, 2007; Nelson,
McDonnell, Johnston, Crompton, & Nelson, 2007; Trembath, Balandin, Togher, & Stancliffe,
2009).
Across the literature, the common types of PMI strategies include: a) peer proximity, b)
peer prompting and reinforcement, and c) peer initiation (Odom and Strain, 1984). The present
study relied primarily on the peer proximity strategy. Peer proximity, is based on the premise
that placing peers with children with disabilities increases the opportunities for social interaction.
Peer proximity allows a natural interaction between children (Odom & Strain, 1984). For
example, Christopher, Hansen, and MacMillan (1991) examined the impact of having a peerhelper assigned to a child with a disability. The peer helper was instructed to play near a child
with a disability, for example, bringing a ball outside during recess and bouncing it next to the
child with a disability. Peers can also interact by remaining close and having the child with a
disability watch how a peer performs classroom activities and routines (Whitaker, 2004).
Children with autism and peers met in weekly interaction sessions to promote shared play
together and positive social behaviors. Peers were instructed to remain close and model
appropriate play behaviors (e.g., following his/her lead, waiting for a turn, and turn taking) to
children with autism during shared play. Peers encouraged play behaviors for children with
autism using games and popular children activities. Carter, Cushing, Clark, and Kennedy (2005)
found peer proximity successful with social activities during school hours. Peers assisted
children with disabilities to learn a school locker coding system by remaining close and
observing peers open and shut the lockers and encouraged children with disabilities to attend
extracurricular activities together. In a similar study, peers were paired up with children with
PEER-MEDIATED, SOCIAL STORY INTERVENTION
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disabilities to be peer buddies during lunch and recess (Kamps et al., 2002). Overall, peer
proximity has been investigated and has demonstrated results in increasing positive social
behaviors with children with autism (McHale, 1983), withdrawn preschool children (Furman,
Rahe, & Hartup, 1979), and mainstreamed academically handicapped children (Madden &
Slavin, 1983). In addition, peer proximity has been shown to be successful with increasing
positive social behaviors of children and youth with behavioral disorders (Bierman, 1986; Lord
& Hopkins, 1986; Mathur & Rutherford, 1991).
A Social Story is a story comprised of specific elements (i.e. types of sentences arranged
according to a formula) that is used as a social skills intervention (The Gray Center, 2009).
Social story interventions are simple to design and easy to implement in a classroom setting.
Moreover, the use of peers as intervention agents is both practical in inclusive settings, and adds
justification to the inclusive model of service delivery. In just the past five years, several studies
have examined the use of social story interventions for improving social communication skills in
children with autism (e.g. Delano & Snell, 2006; Ozdemir, 2008; Sansosti & Powell-Smith,
2008; Scattone, 2008; Scattone, Tingstrom, & Wilczynski, 2006). However, there is only one
published study that examines the efficacy of such interventions on preschool children with
autism (Crozier & Tincani, 2007).
The primary purpose of this study is to examine the effects of a peer-mediated, Social Story
intervention, delivered via an interactive whiteboard, on the social engagement of three
preschool children with ASD during play with typically developing peers. The research
questions therefore are (1) Does the peer training session increase the peer’s social
communication attempts towards the children with ASD (target children)? (2) Does the peermediated, Social Story intervention increase the frequency of the target children’s social
PEER-MEDIATED, SOCIAL STORY INTERVENTION
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communication attempts toward their peers? (3) Does the peer-mediated, Social Story
intervention increase the frequency and duration of mutual activity between the target children
and their peers?
Methods
Participants
The target participants in this study are three children who have been diagnosed with an
autism spectrum disorder and who currently receive preschool special education services. The
target children are all boys and all live in monolingual, English-speaking homes. Their ages
ranged from 5-0 to 5-4 when the study began. They attend the same half-day, four-day per week,
afternoon preschool special education class.
Ethan uses short phrases and sentences to communicate. He is able to interact with peers
appropriately at times, but more often requires adult support to engage meaningfully with peers.
Ethan often sings to himself while working or playing. He perseverates on routines, going
through specific motions repetitively (such as swiping an imaginary key card at each card reader
he passes in the hallway without fail).
Zachary relies on gestures paired with one- and two-word utterances to communicate. He
will also imitate longer phrases and complete sentences, but rarely uses more than two-word
utterances spontaneously. He frequently wanders the classroom, observing other children, but
rarely joining them. Zachary depends on his routine to function and often has tantrums of
screaming and throwing items when his routine is disrupted.
Michael communicates using phrases and short sentences. His language is clear and
easily intelligible. He prefers quiet solitary play, and rarely communicates with others unless he
has a physical need (i.e. hunger, thirst, needs to use the toilet). Michael enjoys sorting and
PEER-MEDIATED, SOCIAL STORY INTERVENTION
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sequencing activities, particularly those dealing with letters or numbers. He is able to attend to
an individual activity for more than 10 minutes at a time. He is able to read familiar and
unfamiliar words by sight. He does not audibly sound-out new words. Although his word
recognition skills are above age-level, his functional behavior skills are far below ageappropriate. Michael is able to follow one-step directions consistently, but inconsistently follows
two-step directions.
Seven peer models ages 4-9 to 5-1 participated in this study. Two peer models were
identified and matched to each target child based on recommendations from the children’s
teachers. One peer model acted as a substitute when any matched peer was absent. All of the
target children demonstrated typical social and language skills for their ages. Additionally, their
teachers reported that they were cooperative and likely to follow the directions of the research.
Setting
The study took place in a self-contained, preschool special education class for children
with autism spectrum disorders or related needs in a public elementary school in Northeast Ohio.
A media room in the school library was used during the intervention phase. Seven children were
enrolled in the class. The adults in the class included one intervention specialist and two
assistant teachers daily. Related service providers including a speech therapist, occupational
therapist, vision therapist, and physical therapist were also in each of the classrooms occasionally
during observations and data collection.
The peer models were classmates in a half-day, afternoon, blended preschool program led
by a general education teacher, an intervention specialist and two assistant teachers. The blended
preschool classroom was two doors down the hall from the special education classroom. The
students in the blended classroom included 7 children on IEPs and 14 children not on IEPs.
PEER-MEDIATED, SOCIAL STORY INTERVENTION
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Children from the blended class and the special education class interacted regularly during
arrival and dismissal, and shared playground time together.
Intervention Procedures
This study used a single subject, AB, multiple-baseline across individuals design
(Kazdin, 1982, p.132). The intervention (phase B) is a peer-mediated, Social Story intervention
delivered using interactive whiteboard technology. The researchers created an interactive Social
Story that addressed the target social engagement behaviors being measured. The interactive
storybook format was created in PowerPoint and projected onto an interactive whiteboard.
Interactive whiteboards (e.g. SMART™ Board, Promethean ActivBoard) are rigid presentation
screens that are digitally connected to a computer and function similar to a touch screen
computer monitor. When a user touches the interactive whiteboard with a special pen or wand,
the whiteboard transmits information to the computer. Interactive whiteboard technology is
well-suited for young children and individuals with special needs because it allows users to
navigate digital content without the use of a mouse or keyboard. The interactive storybook
allows the user to move through the story by touching the whiteboard with the special tool and
clicking a button on the tool. When the child taps the board and presses the button, the story
advances to the next page. A sound file automatically begins to play when the page advances.
The sound file is the voice of a researcher reading the words on the page.
Figure X
Reasons for selecting in interactive Social Story:
1. Addresses the social domain
 Global deficit of children with ASD
2. Teaches a social script
 Individualized and models appropriate social behavior
3. Promotes socially responsive behavior
 Conversational turn taking (dance)
PEER-MEDIATED, SOCIAL STORY INTERVENTION
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4. Provides sensory stimulation
 Visual, auditory, and tactile technology
5. Fosters socially reciprocal behaviors
 Sustained joint attention
 Turn-taking
 Children with ASD can potentially lead (not subservient)
6. Optimizes social interactions between peers and children with disabilities
 Fully inclusive and integrated setting
 Requires active participation
The first component of the intervention phase was a training session with the two peer
models who were matched the first target child receiving the intervention. During the training
session, the researcher navigated through the Social Story, modeling and describing the expected
peer behavior during intervention. After listening to and watching the Social Story, the peers
were instructed to retell the story as a method of checking their comprehension. Peers were
instructed to talk to and play with the target child during the subsequent free-play time after each
Social Story session. Peers were informed that they would receive a sticker for their
participation each day. This process was repeated until, as a pair, the peers were able to navigate
the story without adult assistance, retell the Social Story, and restate the directions. The training
session was replicated for each set of peers just prior to the intervention onset for each target
child.
Dependent variables. The primary dependant variable is the time spent in mutual
activity between the target child and peer(s). For the purpose of this study, mutual activity
includes both parallel play and shared play. For parallel play, the target child and at least one of
his peers must be engaged in related activities in the same activity center. The classroom had
clearly defined activity centers for housekeeping, blocks, reading, art, computer, and table top
work. For shared play, the target child and at least one of his peers must be engaged in the same
activity.
Table X
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Social Engagement Measures
Communication Category
Initiation
Response
Turn-taking
Definition
A spontaneous word, phrase, sentence, vocalization, gesture, or
eye contact directed towards a peer with communicative intent.
A word, phrase, sentence, vocalization, gesture, or eye contact
directed towards a peer in reply to the peer’s initiation.
Two or more initiation/response combinations on the part of one
child (i.e. initiation-target child, response-peer, response-target
child would be one instance of turn taking for the target child).
Data collection
Before beginning the baseline phase, background data about target children and peers
was collected through teacher interviews, observations, and a review of relevant school records
for the target children and the designated typical peers. During baseline and intervention phases,
data was collected on both the target children and their corresponding peers. Each of the target
children wore a LENA device during baseline and intervention sessions. LENA is a
sophisticated, voice-activated audio recorder that also gathers information about the speaker and
the distance between the conversation participants. The LENA device secured in a vest was put
on children just prior to playtime during baseline and just before reading the Social Story during
the intervention phase. Additionally, all sessions were video-taped for reliability purposes. One
of every five sessions (including baseline and intervention phases) was coded by second
researcher for interrater reliability purposes.
The Social Story component of each session lasted between 5 and 10 minutes. If the
target child was still engaged in the Social Story at 10 minutes, the researcher announced that it
was time for play and guided the target child and peers to the door to leave the media room for
play in the special education classroom. Data was collected during playtime for 10-15 minutes
per session for all phases of the study.
PEER-MEDIATED, SOCIAL STORY INTERVENTION
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Results
Figures and 1 and 2 illustrate the time Ethan, Zachary, and Michael spend engaged in a
mutual social activity and frequency of their expressive communication with their trained peers
during baseline and intervention conditions.
INSERT FIGURES 1 and 2
Mutual Social Activity
During baseline, Ethan spent most of the observed time not interacting with the other
children present in the classroom. During the baseline, Ethan averaged 20 seconds per 10 minute
observation (approximately 97% of the total observed time) session in baseline socially engaged
in a mutual activity with the other children in the classroom. In summary, he spent most of the
time engaged in solitary activity, not communicating verbally in the classroom setting. After the
PMI training and interactive Social Story intervention phase begun, Ethan immediately increased
the time he spent in mutual, social activity with the trained peers. Ethan’s data trend is variable
in both baseline and intervention. However, the level change is positive and during the
intervention condition his time spent in mutual activity with a trained peer increased to 3 minutes
and 12 seconds on average.
Table X
Expressive Communication Means and Ranges
Ethan
Zachary
Michael
Baseline
101 (54-152)
92 (65-117)
11.2 (2-44)
Intervention
83.9 (61-134)
127.4 (98-186)
66.75 (57-77)
During baseline, Zachary spent, on average, 2 minutes and 37 seconds per 10 minute
observation session mutually engaged with his classroom peers. His data trend during baseline is
PEER-MEDIATED, SOCIAL STORY INTERVENTION
13
stable overall. However, during session 3, Zachary had a dramatic increase in the time spent
engaged with a peer due to a joint book reading activity he initiated. This was considered an
unusual behavior from Zachary. After the PMI training and interactive Social Story intervention,
Zachary’s data show a slight increase in time spent in a mutual activity with trained peers—an
average of 2 minutes and 48 seconds per 10 minute observation session. However, the data trend
remains variable.
During the baseline, Michael’s time spent in mutual activity with his peers was on
average 28 seconds per 10 minute observation sessions. During the intervention, Michael
increased the time he spent with his peers in a socially engaged and mutual activity to an average
of 5 minutes of 43 seconds per an observation. Michael’s data show increases during the
intervention condition, yet the data trend is variable.
Expressive Communication
The results from the automatic voice recognition tool, LENA, are presented in Figure 2.
LENA was used to analyze the child audio output for both the target children with autism as well
as their trained peers for conversational turn taking and word count. The results are somewhat
variable for Ethan, however, the Zachary and Michael increased the rate of expressive
communication after the onset of the intervention. Zachary and Michael’s data are stable with an
increasing trend in the occurrence of the expressive communication and a positive change in the
level. For Michael, no data overlap exists between the baseline and intervention phases. Ethan
engaged in echolalia and frequent signing behavior (session 6) and LENA automatically coded
this as expressive communication. In summary, the audio environment measured by expressive
communication for the children with autism changed for 2 out of 3 children after the onset of the
intervention condition.
PEER-MEDIATED, SOCIAL STORY INTERVENTION
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Discussion
We were interested in finding a practical intervention that might increase the likelihood
that children with significant social communication deficits participate more fully in inclusive
preschool social contexts. The specific purpose of this study was to determine if a peer mediated
interactive Social Story intervention could increase the duration and frequency of appropriate
social engagement of preschoolers with autism and their peers in integrated classroom settings.
This study extends the previous research on PMI and Social Story interventions by using an
interactive whiteboard as the medium for the Social Story, by increasing the duration of the
special engagement of children with autism and their peers, and without the addition of planned
behavior management system or deliberate teacher monitoring system. This is the first published
study to investigate the use of PMI with Social Stories. Further, it is the first study to examine
the use of Social Stories presented with interactive whiteboard technology.
Limitations
The teacher was not able to manage the intervention because all of target children were in
the same class. To maintain experimental control, it was necessary to remove each target child
from his regular classroom to watch the Social Story with his peers during the intervention
phase. The researcher implemented the Social Story component of the intervention and escorted
the children to and from their classrooms to the multimedia classroom in the school library
where the children watched and manipulated the Social Story on the interactive white board.
Also, it is impossible to tease out the effectiveness of the PMI, Social Story, and
interactive whiteboard components of this study. A larger study with control groups would be
necessary to determine the effectiveness of each component of the intervention used in this
study.
PEER-MEDIATED, SOCIAL STORY INTERVENTION
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Implications for practice
Previous research has shown that simply placing children with disabilities in classrooms
with their typical peers does not lead to meaningful interactions between children with
disabilities and their typically developing peers. Rather, typically developing children tend to
engage with each other. This study presents a potential model for meaningful inclusion of young
children with autism. However, more research is needed on combining technology with other
known effective intervention strategies for children with ASD, the efficacy of Social Story
interventions with preschool-age children who have ASD, and how to create effective peer
matches for PMI.
PEER-MEDIATED, SOCIAL STORY INTERVENTION
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