A Social Communication
Reciprocal Play Intervention for
Children with Autism and other
Communication Deficits
Jennifer Buxton
Libbey Horton
George Mason University
Literature Review
A moderate amount of research exists on peer-mediated facilitation
of Augmentative and Alternative Communication systems (AACs)
to improve social communication of adults.
However, according to the research specific to the use of Speech
Generating Devices (SGDs), Trottier, Kamp, and Mirenda (2011),
reported that no research exists on interventions combining the
peer-mediated use of an SGD to increase social communication
for elementary aged children.
Further, no empirical research exists testing the effects with the
family in the natural home environment.
The possible benefit of combining play in a social communication
intervention for children with an Autism Spectrum Disorder
(ASD) is supported by Helfin’s (2007) who posited that teaching
play has a direct impact on the acquisition of language and affects
social development suggesting (p. 280).
Purpose & Research Question
Purpose
The purpose of this single subject study was to test the effects of peer-mediated use
of an SGD, specifically an iPad, to increase the social communication and
reciprocal play skills of a child with Autism and limited verbal ability.
The main goals of the intervention were to:
1. Increase socialization and social communication
2. Increase reciprocal play skills
3. Increase use of an SGD in the home environment
4. Decrease maladaptive behaviors associated with the targeted skills
Research Question
What effects does a social communication reciprocal play intervention utilizing a
peer-mediated SGD have on the Prompted and spontaneous social
communication, reciprocal play skills, and maladaptive behaviors of a child
with autism?
Definition of Terms
Augmentative and Alternative Communication Device (AAC) – A
functional device, electronic or non-electronic, that helps nonspeaking or minimal speakers effectively communicate by
supplementing speech and/or writing. Examples of AAC systems
include: Picture Exchange Cards (PECS), Speech Generating
Devices (SGDs), sign language, vocalizations and gestures,
communication books/boards, etc.
Speech Generating Device(SGD) - An SGD is one of the many types
of AAC systems. It is a digital device that provides synthesized or
digitized voice output and can involve services such as graphics,
text-based flash cards, or voice recordings to enhance an
individual’s communication (Heflin, 2007, p. 247).
Social Communication - Social communication involves the types of
communication necessary to appropriately participate in social
activities.
Reciprocal Play – Reciprocal play is play involving turn taking and
sharing.
Examples of AAC Systems
Benefits of SGD Use
• Acts as an intermediary relieving the social aspect of
communication
• Reduce the pressure of speech development as the sole means
of communication
• Reduce behaviors related to communicative frustration
• Psycho-social benefits as a result of better understanding
others and being better understood
• Provides means for language comprehension that relies on
recognition rather than memory
• Provides visual and auditory information in a familiar, clear,
precise, static, and predictable form
• May be utilized in a variety of settings
• Adjustable levels of complexity to meet differentiated needs
• May stimulate brain development and symbol learning
Research Methodology
Research Design
Single Subject Case Study
Participant
9 year old Caucasian male diagnosed with Autistic
Disorder, Speech Language Impairment, and cleft
palate
Measures
-Parental interview using informal inventories
-Review of educational and behavioral reports
-Baseline/intervention data sheets tracking use of
prompted and spontaneous speech, turn taking
ability, and maladaptive behaviors
Overview of Intervention Procedure
One of three games (scrabble, dominoes, and checkers)
were chosen by the participant.
The participant’s mother or sister mediated game play
(with adjusted rules) using an iPad programmed with
terminology specific to the intervention.
Positive reinforcement (token economy) was used based
on turn taking.
Prompting was employed as needed to keep participant
engaged and take turns.
A visual timer was also used to inform participant about
time remaining in each session and for each reward
break.
There were a total of 29 data points; six baseline and 23
intervention (10 without/13 with a SGD).
Data Analysis
Qualitative Data
Information from the informal inventories was summarized and presented
based on the major categories of the interview and assessment.
Quantitative Data
Percentages and totals per round were calculated for all dependent
variables
Results were graphed and visual analysis was used to examine trends and
draw conclusions from the results.
- Each game play round was graphed as a different data point for a total
of 29 data points.
- The Percentage of Non-overlapping Data (PND) was calculated to
further support conclusions (Scruggs and Mastropieri, 2001).
- PND was not used to analyze Communication because the SGD was
not available for all data points, and increases would be better analyzed
and interpreted based on data trends.
Results – Prompted Speech
Prompted Speech
Number of CA
20
15
10
CA SGD Prompted
5
CA Gestural/Verbal - Prompted
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
Rounds
Note. CA = Communicative Acts – verbalizations, gestures, and SGD activations used for social communication. SGD = Speech
Generated Device.
Baseline
Per Round - Range – 0, Average - 0
Intervention without SGD
Per Round - Range – 0-1, Average - 0
Intervention with SGD
Per Round - Range – 4-15, Average – 9.1
Results – Spontaneous Speech
Number of CA
Spontaneous Speech
5
4
3
2
1
0
CA SGD Spontaneous
CA Gestural/Verbal - Spontaneous
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
Rounds
Note. CA = Communicative Acts – verbalizations, gestures, and SGD activations used for social communication. SGD = Speech
Generated Device.
Baseline
Per Round - Range – 0, Average - 0
Intervention without SGD
Per Round - Range – 0, Average - 0
Intervention with SGD
Per Round - Range – 1-4, Average – 1.2
Results – Turn Taking
Percentage of Independent Turns
120
Percentage
100
80
60
40
20
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Rounds
Note. Percentage = calculated because the number of total turns per round varied, Rounds = Turn taking activity to earn
each reward.
Baseline
Per Round – Range – 0-25%, Average – 9%
Intervention
Per Round – Range – 0-100%, Average – 65%
PND
75% - 18 points above baseline of 25%
29
Results – Maladaptive Behaviors
Maladaptive Behaviors
12
Behaviors
10
8
6
4
2
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Rounds
Note. Behaviors = head/leg hitting, wrist/knee biting, teeth grinding, whining, yelling, banging head on the floor, hitting floor with
hand, and leaving the game, Rounds = Turn taking activity to earn each reward.
Baseline
Per Round – Range – 0-100%, Average – 65%
Intervention
Per Round – Range – 0-10%, Average – 2.6%
PND
75% - 18 points above baseline of 25%
29
Discussion
Social Communication
When the SGD was introduced there was an immediate increase in
prompted and spontaneous speech.
By the end of the intervention, the participant occasionally used SGD
and verbalization to spontaneously communicate with family and
researcher.
This evidence supports Kluth’s (2010) assertion that students using
SGDs may benefit by gaining access to a voice (p. 125).
Reciprocal Play
75% PND was impressive due to the short duration and other
limitations of the intervention.
Maladaptive Behaviors
75 % PND indicates significant decrease in maladaptive behaviors
using a SGD.
Limitations
- Short duration of the study created a number of other
limitations including lack of sufficient time to:
Adequately plan for the intervention
Pair with the participant to develop a
relationship with the participant
Observe and identify the participant’s
strengths and weaknesses
Observe average time on non-preferred tasks
to avoid unnecessary frustration
Allow for baseline stabilization
- Treatment fidelity was not measured to ensure proper
intervention implementation
Implications and Future Research
In the short duration of the intervention, the
overall gains in social communication,
reciprocal play skills, and decreased
maladaptive behaviors are extremely
promising.
Interventions with a longer overall duration
including more time to plan the intervention,
pair with the participant, allow for baseline
stabilization, and span a longer timeframe
have the potential for even more significant
gains.
Contact Information
Jennifer Buxton
jenbuxton@rome.com
Libbey Horton
ehorton1@gmu.edu