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Goals. Explore current methods of assessing socialization among children with autism.Learn about the Friendship Survey" as an assessment tool and intervention guide.Examine differences in the level of social inclusion of high functioning children with autism across the elementary school years u
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1. Exploring the Social Inclusion of High Functioning Children with Autism in Regular Education Classes: Current Interventions and Future Needs Erin Rotheram-Fuller, Ph.D.
Temple University
2. Goals Explore current methods of assessing socialization among children with autism.
Learn about the “Friendship Survey” as an assessment tool and intervention guide.
Examine differences in the level of social inclusion of high functioning children with autism across the elementary school years using the Friendship Survey.
Review the preliminary results of a new intervention trial to improve social inclusion.
3. Social Lives of Children at School
School is about academics….
Unless you ask children…..
More about connecting to friends, and having fun
Extensive data on connection between social ability and academic success
4. Social Lives of Children with Autism Social impairment--huge disadvantage for children entering school
Consistent across age, ability
Families invest great amounts of money to tutor children with ASD on “social skills”
5. What does high-functioning autism look like? http://www.youtube.com/watch?v=m5x0aJ3xIrw&feature=related
6. Adapted from Wing, L. (1995). The relationship between Asperger's syndrome and Kanner's autism. In U. Firth (Ed.), Autism and Asperger Syndrome (pp. 93-121). Cambridge, MA: Cambridge University Press.
8. What we know about children with autism’s desire for socialization. Report a desire for social connectedness (Bauminger & Kasari, 2000; Chamberlain et al., 2007)
9. Loneliness at School Replicates previous workReplicates previous work
10. Loneliness at School Replicates previous workReplicates previous work
11. Loneliness at School Replicates previous workReplicates previous work
12. Inclusion ? Intervention? Push for inclusion
(Fuchs & Fuchs, 1994)
Inclusion vs. Specialized Services Debate
Exposure to:
Typical models
Standard curriculum
Activities
But is inclusion enough to be considered THE intervention?
13. Inclusion ? Intervention Inclusion is insufficient to socially engage children with autism with their typical peers.
(Burack et al., 1997; Chamberlain et al, 2007)
More often neglected & rejected
(Church et al., 2000; Ochs et al., 2001)
More isolated, & less responsive to others on playground
(Sigman & Ruskin, 1999)
Teachers less willing to accept children in regular classrooms
(McGregor & Campbell, 2001)
14. Reciprocated Best FriendsChamberlain, Kasari, & Rotheram-Fuller, 2007
15. How do we measure the success of inclusion?
16. Current Methods to Evaluate Inclusion Academic success
Grades (keeping up with peers)
Standardized testing
Social success
Measure specifically targeted social skills
Initiations, responses, number of interactions
Does the child interact with peers socially?
Anecdotal reports from teachers and TSS
Does the child feel socially successful?
Self-report of friendships by the child with autism
Self-report of loneliness
Do other peers in the class feel the child is an important part of the class?
Social networks from correlated student reports.
17. Social Networks Ecological structure within which friendships develop
Focus on reciprocity of classroom social relationships & peer acceptance
Simple nomination procedure that has been previously validated, and effective with as few as 50% of the class
(Cairns & Cairns, 1994)
18. Friendship survey Are there any kids in your class that you like to hang out with?
Circle the top 3, & star the best friend.
Do you see that best friend just at school?
Are there any kids in your class that you don’t like to hang out with?
Are there kids in your class who like to hang out together?
Draw a circle around each group.
Prompt: be sure to think of both boys and girls.
19. 1. Are there any kids in your class that you like to hang out with? Indegrees: number of classmates that nominate a child as one of their friends.
Acceptance: z-score within the class of the number of indegrees received by each student.
Outdegrees: number of classmates that a child nominates as a friend.
Reciprocal Top 3: Number of times a child nominated a classmate as in their top 3 closest friends in the class, in which that classmate also nominated them (if the classmate did not complete the measure, the result is missing data, not counted as a non-reciprocal friendship).
Reciprocal Best Friend: Same as Top 3, but with top 1.
20. 2. Are there any kids in your class that you don’t like to hang out with?
Rejection: Number of times a child was nominated as being not liked by classmates.
21. 3. Are there kids in your class who like to hang out together? Class of:
Chris
Jane
John
Lisa
Mark
Rebecca
22. Drawing the social network map
23. 3. Are there kids in your class who like to hang out together? Number of Social Connections
Male and Female connections
Social Network Centrality
0 = Isolated
1 = Peripheral
2 = Secondary
3 = Nuclear
24. Social Network Map
25. Study Design
26. In Los Angeles Unified School District, there are about 750,000 children.
LAUSD spans a distance of 30 miles East to West, and 55 miles North to South. Containing 219 year-round and 429 traditional schools.
27. LAUSD Demographics
28. Demographics of Children with Autism
29. Reciprocal Top Friendships by Grade Group
30. Acceptance by Grade Group
31. Rejection Nominations from Peers by Grade Group
32. Social Outcomes by Grade
33. Social Network Centrality
34. Grade Related Differences in Social Inclusion Social inclusion of children with autism shows a different pattern to typical peers.
Social difficulties are especially apparent for children with autism in the older grades.
Some possible explanations:
Delayed cognitive
skills
Decreased school
resources
Shared Activities
35. Shifts in School Activities
36. So what do we do once we have identified the problem?
37. Current Interventions ABA
Floortime
Gluten Free, Casein Free Diet (GFCF)
Occupational Therapy
PECS
Relationship Development Intervention
SCERTS
Sensory Integration Therapy
Speech Therapy
TEACCH
STAR
Verbal Behavior Intervention
38. Current Interventions
In practice….most standardized programs are done off campus, and by private clinicians.
Video-self-modeling (Bellini et al, 2007)
Friendship training (Frankel, 2008)
Emotion knowledge/regulation training (Bauminger, 2002; Solomon, et al., 2004)
On-school campus
programs include:
Lunch bunch
approach
1:1 aide (TSS)
39. Common Targets of Social Interventions Communication skills
Initiations, responses, joint attention, conversations, pragmatics, prosody, etc.
Play skills
Symbolic play, interactive play, collaborative play, competitive play
Challenging/Disruptive Behaviors
40. Evaluation of Current Interventions
Several recent reviews:
Conclusion-- “not very effective” (Bellini, 2007; Rao, et al, 2008; White et al, 2008).
Why?
Treatments mostly limited:
In focus….child alone
In time….little follow up
In generalization….
to new contexts
In transfer….
to more global skills
Not connected to
individual needs of children. So 2 of our treatment studies focus on children’s peer interactions and friendships. We think this is a particularly important area because of what we currently know of children’s peer relationshipsSo 2 of our treatment studies focus on children’s peer interactions and friendships. We think this is a particularly important area because of what we currently know of children’s peer relationships
41. How are interventions selected in daily practice?
42. How are interventions selected in daily practice? Familiarity
Ease of implementation
Available resources
43. How can we improve the use of validated interventions in practice? Know what to target: Good assessment of skill deficits or social problems.
Make interventions adaptive to multiple environments.
Compare interventions to identify which is most effective with which children, in which settings.
44. Recently Completed Randomized Control Trial 60 Children with autism
6-week intervention
2x/week for 20 min, in school
4 groups:
Child with Autism
3 Typical Peers
Combination: separate but concurrent
Control
3 month follow-up evaluation
45. Baseline Social Network Results
Unique part of this research is that each child is seen within their own classrooms.
As you can imagine, classrooms differ greatly, and it is important to obtain accurate information at a particular time in the child’s lifeUnique part of this research is that each child is seen within their own classrooms.
As you can imagine, classrooms differ greatly, and it is important to obtain accurate information at a particular time in the child’s life
46. Picking typical peers for intervention Teacher nomination – suggesting report of likelihood to participate and interact with the child with autism.
High salience within the class network
Other students likely to follow the model peer’s behavior.
47. Primary Intervention Components Interactive play with the children in natural environment.
Concrete description of desired behavior.
Modeling of desired behavior.
Opportunities to practice.
49. Preliminary Treatment Changes
Combination Tx: Effect size large (1.0)
Peer Tx: Effect size medium (.60)
Unique part of this research is that each child is seen within their own classrooms.
As you can imagine, classrooms differ greatly, and it is important to obtain accurate information at a particular time in the child’s lifeUnique part of this research is that each child is seen within their own classrooms.
As you can imagine, classrooms differ greatly, and it is important to obtain accurate information at a particular time in the child’s life
50. How do the children with autism see their Friendship Quality? Feelings of ‘Closeness’ with peers before to after the intervention.
51. How do the children with autism rate their loneliness?
Change in Dyadic Loneliness from before to after treatment.
52. Change in the number of Social Connections before to after treatment.
Unique part of this research is that each child is seen within their own classrooms.
As you can imagine, classrooms differ greatly, and it is important to obtain accurate information at a particular time in the child’s lifeUnique part of this research is that each child is seen within their own classrooms.
As you can imagine, classrooms differ greatly, and it is important to obtain accurate information at a particular time in the child’s life
53. Key Findings
Can make changes with brief intervention (6 weeks, 12 sessions)
Peer and combination treatments most effective
Suggests that typical peers should be involved in treatments at school for children in inclusive settings
To truly change situation for children at school we must try to improve the school environment
With peers and teachers
54. Next Steps Identify the specific resources needed to implement the interventions in school settings.
Use class-wide interventions to improve classroom cohesion for all students.
Develop more studies to directly compare interventions in the same settings.
55. Acknowledgements Connie Kasari, Ph.D.
Tracy Guiou
Steve Johnson
Jill Locke
Amanda Gulsrud
Brandt Chamberlain
Nirit Bauminger
Lisa Lee
Nancy Huynh
Eric Ishijima
Mark Kretzmann