Strategies to Enhance the Social Reciprocity of Young Children with Autism

1. Strategies to Enhance the Social Reciprocity of Young Children with Autism Debra Leach, Ed.D., BCBA Winthrop University leachd@winthrop.edu 803-323-4760

2. Outline • Definitions • Review of the Literature • Strategies • Data collection • Video practice • Summary

3. Defining Social Reciprocity

4. Social Reciprocity • Being aware of the emotional and interpersonal cues of others • Appropriately interpreting those cues • Responding appropriately to what is interpreted • Being motivated to engage in social interactions with others (Constantino, Davis, Todd, Schindler, Gross, Brophy, Metzger, Shoushtari, Splinter, & Reich, 2003)

5. In other words… Social reciprocity involves an individual participating in long chains of back and forth interactions.

6. Social Reciprocity • Typical Child Video • Child with Autism (5 years old) • Child with Autism (2 years old)

7. Review of the Literature

8. Review of the Literature • DSM-IV • Qualitative impairment in social interaction. • Impaired use of non-verbal language • Failure to develop peer relationships • Lack of spontaneous seeking to share enjoyment • Lack of social or emotional reciprocity

9. Review of the Literature • Because children with autism display deficits in social reciprocity, their unresponsiveness has negative effects on the parents’ ability to establish synchronous, contingent interactions with their children. (Shapiro, Frosch, and Arnold,1987) Thus… • Children with autism may not receive the quantity or quality of attention from others that typically developing children receive limiting their opportunities to develop social reciprocity. (Hile and Walbran, 1991; Koegel, Koegel, & Surratt,1992; Reddy, Williams, & Vaughan, 2002)

10. Review of the Literature Deficits in social reciprocity can have a lifelong negative effect on the social communication and cognitive development of children with autism.(Mundy, 1995)

11. Review of the Literature Parents of children with autism have been successfully taught to implement intervention to improve parent-child relationships, increase communication skills, and decrease inappropriate behaviors. (Mahoney & Perales, 2003; Koegel, Bimbela, & Schreibman, 1996; Harris, 1986; Marcus, Lansing, Andrews, & Schopler, 1978)

12. Benefits of Involving Parents in Intervention • Promotes increases in generalization and maintenance of skills over time (Koegel, Schreibman, Britten, Burke, & O’Neill, 1982) • The quality of life for the family may improve by reducing parental stress, and parents may be more optimistic about their ability to influence their child’s development (Koegel et al, 1996; Koegel et al, 1982)

13. Strategies

14. Contextual Support • Position yourself to maximize face-to-face interactions with the child • Follow the child’s lead to enhance engagement • Identify materials, actions, and objects that are interesting to the child • Ensure requests are at the child’s developmental level (Zanolli, Paden, & Cox, 1997)

15. Environmental Arrangements • Giving only a small amount of a desired item • Interrupting a sequence of activities • Doing something unexpected or different when interacting with the child • Placing desired items out of reach to encourage social communication • For example, If the parent knows a child is going to look for a particular video after naptime, placing the video out of reach will also encourage the child to interact to get the desired video. The parent may then put in the wrong video on purpose to provide more opportunities for interaction. (Koegel et al., 1999; McGee et al., 1985)

16. Time Delay • Use a brief pause accompanied by a positive look or facial expression to indicate that a response is expected • Long enough for processing to take place, but not too long that you “lose” the child • Example: The parent says “Look what I have!” Then the parent pauses with an expectant look to encourage the child to respond verbally and/or with gestures. (Halle, Marshall, & Spradlin, 1979)

17. Model and Request Imitation • Demonstrating words, phrases, or gestures about objects and activities the child is interested in • Specifically requesting the child to imitate • Example: While giving the child a bath, the parent may wash the child’s belly with a washcloth then offer the washcloth to the child to imitate.

18. Contingent Imitation • The adult imitates the child to promote a reciprocal interaction • Once the child is engaged with the adult, the modeling/request imitation strategy may be used to enhance the interaction • Example: The child is banging a block on the table. The adult takes another block and bangs it on the table to encourage the child to attend and respond. Once reciprocal interactions are taking place, the adult may begin stacking the blocks and use modeling/request imitation.

19. Repetition • Providing multiple opportunities back to back for the child to practice a response/skill • Also disperse multiple opportunities throughout the day to promote generalization • Example: While jumping on a trampoline, the parent stops the child from jumping and says, “jump.” The child says “jump” and the parent allows the child to jump. This is repeated several times back to back allowing the child to practice saying “jump” and eventually doing so independently.

20. Balanced Turn-Taking • The child and adult participate in a balanced, back and forth fashion to increase the length of attention and engagement (MacDonald & Carroll, 1992) • Playful obstruction • Playful construction • Playful negotiation (Greenspan & Weider, 1998)

21. Prompting / Fading Procedure • The adult helps the child interact or communicate by using extra cues and supports and gradually reducing the level of support to allow the child to be more independent in routines and social interactions • The support can be verbal, physical, or in the form of gestures • Example: A parent asks a child a yes or no question with no response from the child. The parent may shake or nod to give the child assistance in answering the question. Then the parent will gradually fade out the intensity of the shaking or nodding prompts.

22. Data Collection

23. Types of Communicative Intentions Used to Measure the Social Reciprocity of the Child • Verbal • Gestural • Physical Response

24. Social Reciprocity Data Collection • Parent use of the strategies • Social Reciprocity Data Sheet / Sample • Rating system such as… 0: Does not engage in any back and forth exchanges 1: Usually engages in no more than one back and forth exchange 2: Usually engages in 2-3 back and forth exchanges 3: Usually engages in 4-5 back and forth exchanges 4: Usually engages in 6 or more back and forth exchanges

25. Summary • While social reciprocity was the focus of this workshop, the strategies the parents learned are useful for teaching many communication skills, social interaction skills, and positive behaviors • Providers can utilize the interventions to help parents teach their children various skills within their everyday routines.