Strategies to Enhance the Social Reciprocity of Young Children with Autism

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Strategies to Enhance the Social Reciprocity of
Young Children with Autism

• Debra Leach, Ed.D., BCBA
• Winthrop University
• leachd_at_winthrop.edu
• 803-323-4760

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Outline

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

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Defining Social Reciprocity
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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)

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In other words

• Social reciprocity involves an individual
  participating in long chains of back and forth
  interactions.

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Social Reciprocity

• Typical Child Video
• Child with Autism (5 years old)
• Child with Autism (2 years old)

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Review of the Literature
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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

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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)

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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)

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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)

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Benefits of Involving Parents in Intervention

• Promotes increases in generalization and
  maintenance of skills over time (Koegel,
  Schreibman, Britten, Burke, ONeill, 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
  childs development (Koegel et al, 1996 Koegel
  et al, 1982)

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Strategies
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Contextual Support

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

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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)

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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)

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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 childs belly with a
  washcloth then offer the washcloth to the child
  to imitate.

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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.

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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.

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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)

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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.

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Data Collection
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Types of Communicative Intentions Used to Measure
the Social Reciprocity of the Child

• Verbal
• Gestural
• Physical Response

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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

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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.