For Young Children with Autism. Phillip S. Strain, Ph.D. And. Ilene S. Schwartz, Ph.D. University of Washington

Transcription

1 Applied Behavior Analysis and Social Skill Intervention For Young Children with Autism Phillip S. Strain, Ph.D. University of Colorado at Denver and Health Sciences Center And Ilene S. Schwartz, Ph.D. University of Washington Printed in Focus on Autism and Behavioral Disorders, 8,

2 Friendship is the thing most essential to life, for without it, who would choose to live, though possessed of all other things. Aristotle Friendships and good social relations are vital to the ultimate functioning of people with and without autism (Hartup, 1979; Strain & Hoyson, 2000). Why are friendships and social relations so vital for all children and youth? The answer comes from a wide variety of sources, including longitudinal and retrospective studies of adjustment in adulthood (Cowen, Pederson, Babijian, Izzo & Trost, 1973; Roff, Sells, & Golden, 1972), comparative studies of children with and without friends (Strain, 1983; 1984), qualitative studies of the value of children s friendships (Staub, Schwartz, Gallucci, & Peck, 1994) and efforts that have tied the presence of good social relations to pivotal indices (e.g., employment, independence) of quality of life (Strain, Storey, & Smith, 1991). From these various studies, four primary functions emerge. First, social relations and friendships serve a natural support function. That is, the participants have a ready, willing, and largely non-contingent source of support to accomplish tasks, gain entry into social groups, and establish yet other networks of social support. Second, social relations and friendships serve an informational or social learning function. In this case, the participants acquire information about social conventions and acceptable conduct through ongoing interactions and feedback from acquaintances. Relatedly, the context of peer interaction provides important opportunities for children to acquire and practice skills across developmental domains. Third, social relations and friendships serve a protective or advocacy function. On occasion, participants are the beneficiaries of advocacy in the form of statements and actions that promote the other s selfworth. Often this occurs in the presence of behavior(s) that may otherwise serve to ostracize the 2

3 participants. Finally, social relations and friendships serve an affirming function. Put simply, participants gain a sense of competence, belonging, and support, all of which seem to yield a level of behavioral competency that sets the stage for later success in life. What is key about these four functions is their importance across persons with and without disabilities. It also appears that persons with autism do not generally develop these essential building blocks for achieving quality of life outcomes (Strain, Storey, & Smith, 1991). The absence of good social relations early in life appears to set into motion a downward spiral of events that culminate in such poor adult outcomes as: a) decreased likelihood of employment: b) decreased likelihood of independent living; c) decreased life expectancy; and d) severe mental health problems (Strain, 1992). Our notion of what constitutes good social relations implies that all daily experiences of children with and without autism in the same settings must be purposeful, planned, supportive of all constituencies, and aimed at maximizing the growth and development of all participants. Today there are three primary obstacles to providing educational opportunities for children with autism that promote positive social relationships and meaningful quality of life improvements. First, there are major unresolved issues regarding the meaning of schooling and what constitutes meaningful outcomes for children with autism. These issues closely parallel some of the issues around general education school reform. A tension exists between the need to increase academic functioning as measured by standardized tests and the desire to attend to issues of character education, mental health, and moral development. This school reform debate, with all its furor, matches the sometimes antagonistic dialogue among practitioners and parents who debate the issue of what constitutes a free appropriate education for children with autism a hotly contested issue these days in special education. 3

4 The second challenge facing educators and parents of children with autism is how to select instructional strategies and educational settings that will provide support and opportunities for children to develop meaningful social relationships. In the current debate over instruction for children with autism, many parents and practitioners are advocating for intensive programs using applied behavior analysis exclusively. Although this should be good news for those of us who identify themselves as behavior analysts, in fact it is causing turmoil because many parents and practitioners are adopting an extremely narrow and erroneous view of applied behavior analysis (ABA). ABA is not a curriculum or an instructional strategy. It was not invented by one person, and most importantly it was not developed to be used exclusively with children with autism. Applied behavior analysis is a scientific discipline that is interested in the application of behavioral principles to socially important problems. As Baer, Wolf, and Risley (the clear patriarchs of the field) (1968) state in their seminal description of the discipline applied behavior analysis must be applied, behavioral, and analytic; in addition it should be technological, conceptually systematic, and effective, and it should display some generality (p. 92). When applied in this context, applied behavior analysis is the methodology of choice for children with autism (McIlvane, 1996). However, when applied in a manner that is neither analytical nor behavioral this approach may be damaging for children, families, and ultimately the field of applied behavior analysis. A third constellation of challenges to providing comprehensive and effective services that promote meaningful social outcomes for children with autism and their families are the resources available to school districts. Nationwide there is a shortage of special education teachers; those with specialized training in applied behavior analysis are indeed a rare commodity. In addition to the shortage of trained staff are the resources to pay them. Providing a free, appropriate public 4

5 education for children with autism is an expensive proposition. Although much less expensive than many private schools or home-based programs (Cohen, 1998), an appropriate program for children with autism often costs more than allocated by most school districts. Another type of resource desperately needed by school districts are curricular materials and validated instructional strategies that can be used with children with autism to address academic and social goals. A Brief History of ABA and Social Relationship Development The last 25 years has witnessed a major increase in the quantity, range, and quality of ABA intervention procedures for improving the peer interaction skills of young children with autism. While there are literally dozens of instructional procedures and materials that have been designed to improve peer social interactions, the data base accompanying most procedures is scant at best (Strain & Kohler, 1998). In deciding on the specific social interaction procedures to highlight in this review, studies were selected according to the following criteria: Was the procedure/material accompanied by multiple empirical demonstrations of effectiveness? Was the procedure/material replicated successfully across investigators, range of disabilities, and intervention settings? Was the effectiveness (outcome) data accompanied by data on the implementation of the intervention? These criteria reduced the field to four global interventions: 5

6 1. Procedures in which teachers prompted and reinforced an individual child for positive overtures toward peers (e.g., Buell, Stoddard, Harris & Baer, 1968; Baer & Wolf, 1970; Koegel & Frea, 1993; Strain & Timm, 1974). 2. Procedures in which children were provided with certain toys, materials, or instructions that lead to greater opportunities for positive peer interaction (e.g., Frea & Odom, 2000; Hendrickson, Strain, Tremblay, & Shores, 1982; Hulston, 1980; Lovinger & Haring, 1989; Quilitch & Risley, 1973; Taylor & Levin, 1998); 3. Procedures in which typical and/or mildly disabled children were taught specific skills by which to engage their peers with autism in positive interaction (e.g. Odom, Hoyson, Jamieson, & Strain, 1985; Strain, 1981; Strain & Odom, 1986); and 4. Procedures in which reinforcement contingencies were applied to groups of children, contingent upon a certain level of social interaction (Hops, Walker, & Greenwood, 1979; Walker, Hops, Greenwood, & Todd, 1975; Walker, Street, Garrett, Crossen, Hops, & Greenwood, 1978) Because previous research had uncovered certain negative effects with adult prompting and reinforcement of individual children (Shores, Hester, & Strain, 1976), this tactic was eliminated from review herein. Moreover, because toys, materials and instructions have produced only transient impacts (Strain, 1975; Strain & Wiegerink, 1975), this tactic was also eliminated from review. On the other hand, because there are no data to suggest that ABA procedures function differently for children with autism, a number of seminal studies are included that did not involve children with autism. What level of success can be attributed to the two remaining procedures of interest? 6

7 Teaching of peers to be intervention agents. Given the limitations associated with adult-mediated intervention (Shores, Hester & Strain, 1976; Walker, Greenwood, Hops, & Todd, 1979) a systematic series of investigations began to better understand the potential use of peers as instructional agents. From both naturalistic (e.g., Charlesworth & Hartup, 1967; Guralnick & Paul-Brown, 1977; Kohn, 1966; Kopstein, 1972) and intervention (e.g., Johnston & Johnston, 1972; Wahler, 1967) research, it was clear that children exert a powerful influence on each other s social behavior. Sometimes this influence yields positive, maturing outcomes and sometimes it does not. If, indeed, peer influence plays a dominant role in the natural development of social and communicative competence, then it seems logical and reasonable to enlist peers in the purposeful development of children s social skills. A fine-grain analysis of existing normative data on the social interactions of preschool children revealed that social exchanges were not begun by prompt-like statements from children, nor were they maintained by praise-like statements from children. Rather, the available developmental data indicated that interactions were begun and maintained by specific social overtures that were exchanged on an equitable, or reciprocal basis (see Mueller, 1972 for a thorough review). Thus, initial intervention efforts were aimed at evaluating the functional effects of an increased level of social overtures or initiations on the social behavior of withdrawn children, who by definition rarely were exposed to any positive approach behaviors from peers. In the first study of peer social initiations, four 20-min. training sessions were conducted with each of two typical peers (Strain, Shores, & Timm, 1977). In these sessions the two boys learned and rehearsed a number of verbal and motoric behaviors to engage children with autism in social play. First, the peers learned to initiate play by emitting phrases such as, Come play, Let s play ball. Next, the children were taught to engage in those motor behaviors that would 7

8 naturally accompany specific verbal play overtures. For example, the peers would say, Let s play ball and then roll a ball to the adult instructor. During the initial baseline period the six target children rarely engaged in any positive interaction and their peers initiated only occasional social behaviors toward them. When the peers were first instructed to play with the target children, two results were obtained. First, each target child s responses to initiations immediately increased; and, second, the positive initiations of all but one child increased also. Intervention effects were replicated during subsequent return to baseline (low levels of initiations) and intervention phases. In order to determine whether the effects produced by this peer-mediated intervention would generalize to another setting and maintain across a short time-span, a systematic replication with three preschool-age boys with autism was conducted (Strain, 1977). The intervention sessions in the withdrawal of treatment design took place in a small playroom. Generalization was assessed by observing the children in a regular free-play period in their classroom (the peer trainer was absent from this setting). Maintenance of behavior change across time was assessed by conducting generalization setting observations either immediately or 23 hours after intervention. Data from both intervention and generalization sessions showed an increase in social responding when intervention was in effect. For two of the boys, a 5-fold increase in the frequency of positive social behavior occurred during intervention sessions. The remaining child s level of positive behavior improved only marginally. For the first two boys, an increase in positive social behavior was noted in the generalization sessions. Their positive contacts occurred at twice the level observed during baseline. The child who was affected minimally in the treatment setting showed no sign of generalized behavior change. Maintenance 8

9 effects were obtained in the first two children, as evidenced by consistent performance in generalization sessions that occurred immediately after treatment or 23 hours later. The non-programmed generalization and short-term maintenance of effects with the social initiation strategy represented a dramatic and positive departure from earlier adultmediated treatment studies. What remained the same was the wide inter-subject variability in responsiveness to intervention. The child who showed little improvement had a lower baseline level of positive social behavior than his peers. However, clinical judgment suggested that other behavioral characteristics may have operated to diminish intervention effects with this child. This boy engaged in a high rate of self-stimulatory activity and on occasion he would scream loudly when a peer interrupted his repetitive behavior. In a third experiment in this series a more precise study of the interaction between children s inappropriate behaviors and the impact of peer social initiations was undertaken (Kerr, Ragland & Strain, 1978). When compared with children treated in earlier studies using peer social initiations, the children with autism in this investigation engaged in more active social withdrawal from peers and adults and more extensive forms of challenging behavior. The original peer training approach was modified slightly to accommodate the maladaptive behaviors exhibited by the target children. When the experimenter did not respond positively to initiations by the peer trainer she exhibited some of the selfstimulatory and avoidance behavior typical of the target subjects. The peer social initiation strategy produced an immediate increase in positive social behavior by each child. In return to baseline and subsequent intervention conditions the treatment effect was replicated. Besides an increase in positive responding, the social initiation treatment had a tendency to increase negative interactions by two of the children, especially during the first several days of each intervention phase. The peer trainer often interrupted these children while they were engaged in 9

10 some self-stimulatory activity. When this happened, these children would often scream and run away. After the first day that this situation occurred, the experimenter made sure to remind the peer after each session that sometimes children would respond this way. A particularly significant outcome of the Ragland et al. (1978) study was the abrupt and substantial change in each subject s positive behavior. A number of our colleagues suggested that these low functioning children could not, in fact, have been truly autistic and respond as they did to the social initiation procedure. Subsequently, three independent psychiatric evaluations were obtained on the three children in which each assessor used DSM-III diagnostic criteria. The psychiatrists were unanimous in their diagnosis of autism. Two hypotheses are offered to explain the participants sudden behavioral change. First, the behavior patterns of children with autism in non-structured settings may suggest a preference for stereotypic as opposed to social activity, not an active aversion for peer contact. Second, the isolate behavior of these children must be viewed, in part, as a function of the developmentally homogenous, socially unresponsive environments in which they are most often taught. We are not suggesting that developmentally segregated programming is an etiological variable in these children s withdrawn behavior, but it certainly serves to maintain socially unresponsive behavior. Because of the controversy surrounding the application of the peer social initiation tactic with low functioning children with autism, a systematic replication was undertaken (Kerr, Ragland & Strain, 1979). Four elementary-age children with autism served as participants. One-half of the peer training was identical to that employed by Ragland et al. (1978). During the remaining portion, the peer was taught a prompting and reinforcement strategy. Here, the experimenter told the peer that he would be getting two of the children at a time to play with each other. The peer was instructed to rehearse such prompting statements as: Roll the ball to, Give a 10

11 block, Push the truck to. Later, the peer began to practice such praise statements as: Good, That s the way to play, Very nice. Results showed that: a) both treatment procedures resulted in an immediate and substantial increase in the level of positive social behavior by each child; b) both procedures resulted in brief, slight increases in subjects negative interactions; c) a comparable level of positive and negative behavior change was associated with the two treatment procedures; and d) no generalized behavior change was associated with either treatment procedure. In several studies using social initiations, a direct relationship between initial baseline performance and the immediate and generalized outcome of treatment was found (Strain, 1977; Strain et al., 1977). Withdrawn children who displayed lower baseline levels of positive social behavior were somewhat less responsive to treatment (although differences were slight) than youngsters with a relatively higher baseline performance. However, when the social initiation treatment was applied to children who engaged in a high level of stereotypic activity, no relationship was noted between subjects initial baseline performance and immediate or generalized outcomes (e.g., Ragland et al., 1978; Strain et al., 1979). One explanation for these divergent findings is that stereotypic behavior may compete with or mask an existing social repertoire. In addition to demonstrating the overall efficacy of the peer-mediated strategy, other studies have begun to examine the specific components that are responsible for the consistent impact of peer initiation procedures. In one study, Strain and Kohler (1995) investigated the impact of four different variables. Seven preschool staff rated 24 sociodramatic, manipulative, and gross motor activities for their likelihood of facilitating interaction from three children with autism. Nine different activities rated as high, moderate, and low were then incorporated into 11

12 daily play activities involving a child with autism and two typically developing peers. Immediately prior to each session teachers also predicted each focal child s likely responsiveness or sociability for the upcoming activity (1-5 point Likert Scale). Teachers were asked to base their prediction on the child s general performance during the their preceding 1.5 hrs of the day rather than on the type of play materials of selected or participating peers. Following an initial baseline, all children in the class participated in social skills training to learn shares, play organizers, assistance, and general comments. Teachers then implemented an individual contingency to reinforce children s use of these skills. All three target children showed considerable variability in their day to day interaction with peers. Results indicated that the amount/percentage of peer overtures and degree of reciprocity correlated highly with target children s levels of social interaction. In contrast, teachers selection/ratings of play materials and predictions about sociability did not correlate with children s daily interaction levels during either the baseline of intervention phases. This study represented an important step in understanding the range of person-and environment-specific variables that may contribute to the variability in children s social skill performance. In another investigation, Kohler, Strain and Shearer (1992) examined the form and function of social overtures that typical children directed toward three preschoolers with autism. All children received social skills training for play organizer suggestions, share offers and requests, assistance offers and requests, and general comments. Results indicated that the four peer behaviors had differential topographical and functional properties. Shares and play organizers occurred on an average of 5.5 times per session, while assists and general comments averaged less than two occurrences. Shares and play organizers also generated the highest percentage of positive responses from all three children with autism (averages of 73% and 86% 12

13 respectively). Conversely, assistance and general comments produced positive responses on only 60% of their occasions. Yet, the assists that did produce positive responses led to interactions averaging 33.4 seconds in duration, compared to only seconds for shares and play organizers. Self-monitoring represents one viable strategy for enhancing children s independent social exchanges with peers. In one investigation, Shearer et al., (1996) examined the effects of a self-monitoring procedure on the engagement and social interaction of three preschoolers with autism. Each child participated in daily play activities with one typical peer. Following an initial baseline, two different interventions were implemented in an alternating fashion. A first procedure required an adult to prompt the children to exchange social overtures and move beads to record children s social interactions. Each child also received a small post-session reward if they had completed a criterion number of exchanges. On alternating days, children moved their own beads while the adult provided fewer prompts and continued to present the post-session reward. The child monitoring procedure was then implemented without any adult prompts during a maintenance phase. Results indicated that the adult and child monitoring procedures were equally effective in maintaining children s social engagement and interaction during the alternating treatment phase. In addition, the child procedure maintained children s independent exchanges during the maintenance phase. In a related study, Strain et al., (1994) utilized a self-monitoring intervention to increase the social interactions of three preschoolers with autism. Each child participated in five minute play activities within both a home (siblings) and school (peers) setting. Following an initial baseline, teachers and parents conducted an intervention involving adult prompting, edible reinforcement contingent on children s positive exchanges, and target children s self-monitoring 13

14 of their social behaviors. Results indicated that this package increased each child s interactions with his/her peers and siblings. Interestingly, the school and home procedures produced comparable effects on some dimensions of children s social performance, while other outcomes were affected differentially. Finally, adult prompts and reinforcement were successfully faded within both the home and school settings. Initial peer-mediated procedures were very structured and prescribed with regard to teacher and child involvement. Despite its effectiveness, however, several concerns arose related to the efficiency of this procedure. For one, the high degree of structure restricted the range of classroom activities where peer-mediated procedures could be incorporated. Indeed, early studies were limited to sociodramatic, manipulative, gross motor, and other activities that related directly to children s play. Second, the high degree of structure limited teachers role in planning and contributing to the development of peer-mediated interventions. Given these issues, research over the past several years has addressed two questions: (1) can teachers implement peer-based procedures in a spontaneous fashion; and (2) what are the benefits of this method of implementation? In an initial pilot study, Kohler, Strain, and Goldstein (1994) asked four preschool teachers to identify naturally occurring opportunities to facilitate children s social interaction during 30 min. gross motor activities (dancing, climber, slide, tricycle, etc.). Teachers organized large group games or activities involving all children in the classroom. Throughout the course of these activities, teachers looked for natural or ideal opportunities to facilitate peer interaction, such as holding hands, telling another child to jump, tossing your friend the ball, etc. In contrast to our earlier interventions, teachers employed methods that appeared natural or suited to children s ongoing actions, such as giving suggestions for new play roles/themes, 14

15 adding materials to activities that matched children s interest, and so forth. The four teachers showed considerable variability in their overall success, as children s mean percent of interaction ranged from 15% to 45% across teachers. In addition, each teacher also showed a great deal of variability in their individual effectiveness, as children s daily interaction levels ranged from 5% to 65%. When interviewed after the study, all four teachers reported that they used the same basic strategies, which appeared to work on some days, but not on others. Teachers also thought that this approach generated high quality forms of peer interaction, but was difficult to implement successfully on a consistent basis. In a second investigation, Kohler et al., (in press) compared two methods to address preschool children s IEP objectives. Six teachers conducted their sessions during a variety of different classroom activities. In accordance with the tactics described by Bricker and Woods- Cripe (1992), teachers were asked to employ the following practices: (a) embed antecedents for children s IEP objectives into the context of ongoing play activities and areas; (b) utilize or follow children s ongoing actions and interests as the impetus for providing instruction; and (c) provide antecedents and consequences that were natural and logically suited to children s actions. Teachers provided all antecedents for addressing children s skills during an initial baseline phase. Conversely, both the teacher and peers (under the teacher s directions) provided antecedents in a second phase. Results indicated that the combined naturalistic and peermediated procedure produced high levels of social interaction from nine of ten children with autism. Interestingly, teachers also addressed more IEP skills with the combined method. The involvement of typically developing peers apparently provided teachers with a richer context for facilitating children s social interaction and related developmental skills. 15

16 Use of Group-Oriented Contingencies. Our second intervention tactic of interest has its historical roots in teacher praise and attention (Barrish, Saunders, & Wolf, 1969; Hart, Reynolds, Baer, Brawley, & Harris, 1986; Milby, 1970; Reynolds & Risley, 1968; Strain & Timm, 1974). From these early studies in which individual children were the targets of reinforcement, grouporiented procedures which use standardized, dependent, and interdependent contingencies have evolved (Greenwood & Hops, 1981). Walker and his colleagues (Walker, Hops, Greenwood, & Todd, 1979) have conducted two of the landmark studies on standardized group contingencies. That is, the reinforcement systems were standardized across an entire classroom. In the first experiment, Walker et al. (1975) applied social praise and token reinforcement to six children in an experimental class. Increases in rate of interaction and percent of time engaged in positive interaction were observed. Three and six months later, after the children were returned to regular classes, the intervention effects were still apparent. In a follow-up study, Walker et al. (1979) found that standardized contingencies applied to starting interactions and responding to peer initiations did not affect the percent of time spent in interaction. However, when the contingency was applied to continuing positive interaction. percent of time spent in interaction increased substantially. In dependent group contingencies reinforcement for a group is tied directly to behavioral improvements by some, but not all members of the group. Usually, children who have specific social interaction needs must improve if the group is to receive some reward. For example, Walker and Hops (1973) made a low-interacting student s reinforcement contingent upon her peers social initiations to her. Additionally, these same investigators also made the peer groups reinforcement contingent on the target child s initiations. While both tactics were eventually effective, the latter resulted in an initial decrease in target child social behavior, presumably as a 16

17 result of being overwhelmed by the sudden and massive increases in social initiations directed toward her. Similar dependent contingencies have been incorporated in two packaged intervention programs. The first, known as PEERS (Hops, Walker, & Greenwood, 1979), provides for reinforcement of the subject(s) and group members following an increase in the target child s percentage of playground social interaction. The second program, RECESS, uses both dependent reward and response-cost procedures for reducing negative or aggressive peer interaction (Walker, Street, Garrett, Crossen, Hops, & Greenwood, 1978). A target child is awarded one point for each five minutes of recess (6 points for 30-min.) prior to each session, and points are withdrawn for each occurrence of negative peer interaction. If 80% or more of the rewarded points remain at the end of recess or free-play, the entire group participates in a special activity. Interdependent contingencies represent conditions in which reinforcement for any one child is partially dependent upon the behavior of peers. Based upon the successful use of these procedures (Walker, 1979; Walker et al., 1975), several replication studies have been undertaken. In the first study (Lefebvre & Strain, 1989) an interdependent contingency was applied to maintain social interaction gains that had been produced originally by a peer initiation tactic. Here, children with autism and typical peers shared in a special activity if each child met a pre-established performance criterion. The interdependent strategy produced a 100% increase in the level of positive interaction over a peer initiation only condition. In a follow-up study with three additional children with autism, the effectiveness of interdependent procedures was replicated (Kohler, Strain, Maretsky, & DeCesare, 1990). Given the procedural differences that exist between the various group contingency arrangements, it is not surprising that several comparative studies have been conducted 17

18 (Drabman, 1976; Hayes, 1976; Kazdin, 1977). Greenwood and Hops (1981) point out that the evidence is clearly in favor of no difference. It could hardly be any other way. Consider that for most studies the type of contingency employed for given subjects was a clinical decision, based upon prior observation and an educated guess about the probable effectiveness of a certain contingency arrangement. Also, none of the prior comparisons have attended to the development of supportive peer behaviors as a side-effect of these contingencies. What has remained a mystery is why these group procedures have been so effective in terms of maintenance of effects across time and generalization of effects across settings (Kohler, 1986). Most researchers in this area point to the development of behavioral traps as the best explanation. That is, it is often reported anecdotally that children in the contingency arrangements verbally encourage and support one another s behavioral improvements, without being instructed or trained directly to do so. Kohler et al., (1990) have shown that these peer behavioral traps do, in fact, exist. Also, these traps seem limited to interdependent contingencies. To date, however, behavioral traps have only been studied in school contexts. Kohler et al., (1990) found that individual and group-oriented procedures produced equal increases in the social interactions between two preschoolers with autism and their peers. However, neither contingency generated consistent levels of supportive behaviors from typically developing peers involved in play sessions. Given this finding, children were taught to provide supportive prompts to their typical friends and playmate with autism (e.g., Remember to share so that we can earn a happy face ). Following this brief training, children continued to exhibit high levels of social and supportive exchanges with very few teacher prompts during a second group contingency phase. 18

19 In a follow-up study, Kohler et al., (1995) once again found that an interdependent group contingency generated few supportive behaviors until children had received explicit training for these responses. Once trained, however, children exhibited an average of 5-10 supportive overtures per six min session during two subsequent group contingency phases with no teacher prompting. Data analyses indicated that peers directed an equal proportion of supportive prompts to their playmates with autism and typically developing youngsters. In addition, these prompts generated positive/compliant responses from their recipients on over 90% of occasions. Surprisingly, target child-peer interactions occasioned by supportive prompts lasted for over 20 sec, compared to 13 seconds for interactions lacking peer support. Summary and Future Directions In summary, while we have reviewed a number of instructional strategies that have been effective in producing changes in children s social behavior, the majority of these interventions have not been successful in building repertoires of social behaviors that result in meaningful lifestyle changes for children. Why have we not been more successful in achieving this goal? It is possible to identify a number of conceptual and assessment limitations that must be addressed before we can expect to achieve more favorable outcomes. First, while the majority of studies described in the paper view social behavior as a set of discrete skills, we know that social behavior is complicated, dynamic, culturally-influenced, and contextually-based. Why then is there this mismatch between research and practice and what can we do to bridge this gap? Traditionally, applied behavior analysts have been trained to dissect behaviors into their smallest components stimuli and responses. Although this is a valuable academic and experimental exercise, it is not adequate for real children in real classroom settings. In these settings behavior occurs in streams, not in isolation. In these settings it is often 19

20 difficult to identify a clear antecedent or a clear consequence to behavior. In these settings adults and peers do not always respond in a positive manner to a clumsy initiation by a child with autism. In these settings children do not always share. Furthermore, in these settings multiple influences, some of which are temporally concurrent and others that may have occurred hours before, influence the social behavior of children and adults. The poorly developed social skills of young children with autism are a product of a variety of biological and environmental events. Against this complex background of skill deficits interacting with peer rejection and lack of attention by adults, it should not be too surprising that interventions focused exclusively on skill building are less than a complete success. Perhaps we have been conducting these molecular assessments because we are asking the wrong types of questions. We have learned a great deal about the social behavior of children with autism in the last 25 years. For one thing, we have learned that it is malleable and can be changed with intervention. We are no longer interested in knowing if children with autism can learn to make initiations to peers or respond to initiations; that question has been answered with an unambiguous YES. Now, we are interested in knowing what strategies are most effective in facilitating generalization and maintenance of these skills and if there are child characteristics that suggest specific treatment strategies. Guralnick (1997) suggests that we have moved on to the second generation of research questions about this topic. At this point we are interested in understanding the interactions between biology, environment, and behavior. As we move towards asking more complicated questions, we need to use more sophisticated assessment strategies. This does not mean that we abandon behavior analysis; rather it suggests that we take the lead from our colleagues conducting ecobehavioral assessments (e.g., Carta, et al., 1990; Greenwood, et al., 1992), and learn to observe and analyze behavior in context. Guralnick 20

21 (personal communication) has shown, for example, predictable physiological changes (akin to classic fear responses) in young socially withdrawn children as they are approached by peers. In turn, these negative physiological responses quickly abate as children move to isolate play activities. A related problem exists with the assessment procedures used to determine what skills we are going to teach. For the most part, these decisions are made by teachers who may have never seen the child in their home. There is little evidence that people who are important in the lives of children (e.g., parents, siblings, child care providers, grandparents) have participated in identifying socially important behaviors for instruction. In the area of social behavior this is essential given the strong influence of culture on determining the appropriateness of social behavior. In order to select intervention targets that are meaningful, we need to work with parents, observe children in settings outside of school, and be experts in the social behavior of typically developing children. If we are going to attempt to teach a child with autism to enter a group of children who are playing, first we need to know what strategies typically developing children use to successfully accomplish this goal. Then, we need to modify the strategy, if necessary, so that the child with autism can learn to perform it fluently. Finally, we need to help the child learn to use the new skill across time, settings, and peers; making the necessary discriminations about when it is appropriate and not appropriate to use this skill. However, if entering a peer group is not a skill valued by the parents or a skill that the child will have the opportunity to employ, we need to think twice before we spend valuable intervention time teaching a target skill that will extinguish. Asking consumers (in this case parents) what we should be teaching has deep roots in applied behavior analysis. Wolf introduced the concept of social validity to ABA in The 21

22 purpose of social validity is to ask the consumers, that is people who are the intended beneficiaries of the program, to be involved in the evaluation of the program (Schwartz & Baer, 1991). Wolf suggested that we should ask consumers for feedback in: a) selecting the goals of an intervention; b) determining the appropriateness of intervention strategies; and c) assessing the outcomes of the intervention. If we want to make meaningful changes in the social lives of children with autism, then we need to involve families and other caregivers in the decisions about what to teach, how to teach it, and how we will know when the child has learned it. As we develop interventions to address social behaviors, we need to pay close attention to the acceptability and sustainability of these interventions. If an intervention is successful in a laboratory situation, but it is impossible to implement in a preschool classroom, then it is not a useful intervention. If an intervention is successful, but teachers hate it, they will not implement it correctly and it will not yield the intended outcomes. When planning interventions we need to consider the social ecology and the available resources in the setting. If the intervention violates either of these, we may be setting-up children and teachers for failure. Some guidelines for developing socially and ecologically valid interventions include: Insure that the intervention is doable in context Insure that reliable implementation of the intervention is feasible with available resources Insure that the intervention is sustainable over time Interventions should be owned and operated by the local constituency Interventions must be culturally inclusive Interventions should be intuitively appealing and acceptable to consumers (Meyer, Park, Grenot-Scheyer, Schwartz, & Harry, 1998). 22

23 Another factor to consider is the location, duration, and intensity of the current interventions focusing on social behavior. We live in a social world and children with autism must interact socially for most of their waking hours across a number of different settings. Why then, do a number of interventions occur for only a few minutes a day, in a few specialized settings, with a limited number of materials, and a carefully selected set of peers? Social behavior cannot be taught in isolation. Social behavior must be taught in the contexts in which it will be used. If we want to improve our ability to have an impact on the social lives of children with autism, then we must develop and evaluate interventions that can be implemented across settings, by a number of different providers, and within the context of ongoing activities and routines. This is the challenge facing the researchers, practitioners, and advocates who are ready to tackle the second generation of research questions about the social development of young children with autism. The above commentary in no way dismisses the value of the work done to date. We have discovered much about functional social skills (Strain, 1984; 1985), about motivational mechanisms to enhance skill display (McConnell, Sisson, Cort, & Strain, 1990), about the influence of socially-responsive environments (Fox, Gunter, Brady, Bambara, Spiegel-McGill, & Shores, 1984), and about the myriad ways one might legitimately assess social relationships (Greenwood, Todd, Hops, & Walker, 1982). Our argument here is simply this the easy experimental demonstrations of effect are now behind us, and we should proceed with designing, implementing, and evaluating the longitudinal, community-wide interventions that are necessary to achieve the magnitude, breadth, and longevity of behavior change that our clients need and the contextually complex social world demands. 23

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