DOES Naturalistic ONE-to-ONE Training without FOCUSED Peer INTERVENTION Have Collateral EFFECTS On PLAY and Peer ENGAGEMENT?

Background:  

A variety of naturalistic interventions aim to account for an increasing adult’s responsiveness to the child and the quality of social engagement with the therapist and parent. Anyhow, social isolation is one of the most enduring challenges facing children with autism spectrum disorders (ASD), experiencing complex social difficulties in school. It is suggested that without direct naturalistic behavior intervention in the school setting, any naturalistic behavior intervention neither professional nor parent-mediated at home may be sufficient to fully engage children in peer activities and as such include them into a social structure.

Objectives:  

This study examined collateral effects of staff-and parent-mediated naturalistic interventions without direct milieu teaching in the class room setting on peer interactions and play engagement.  

Methods:  

The Playground Observation of Peer Engagement (POPE) has been used to obtain information about the nature of child play behaviors and level of engagement of 16 low-functioning children with ASD in the course of 12 weeks. All 16 children followed staff- and parent-mediated naturalistic interventions that yielded remarkable decrease in autism symptom severity, and gains in mental developmental state as well as in early language skills and adaptive functioning. At baseline, and each 4 weeks (4 total measurement-points) children’s social play and peer engagement was observed and rated in free play conditions.  

Results:  Preliminary results give insight in the areas of play and social engagement that can be facilitated by naturalistic adult-mediated interventions, highlighting at the same time skills areas that are lacking benefit and focused peer-mediated intervention is demanded. Play and peer engagement observation show after three month of one-to-one intervention a decrease in non-play behaviors and an increase in play behaviors, with increased quality and duration of functional toy-play while adult prompts decrease. Children demonstrate significant decrease in challenging behaviors such as stereotypes and auto-stimulation during free play, as well as an increase in child initiated interactions and directed communication with functional use of mutual eye contact and response of joint attention initiations. Nevertheless, these increases in pro-social reciprocity are related to social engagement with adults. It was shown that without adult initiation of parallel or group play, children with ASD engage in functional play at a solitary level of engagement.   

Conclusions:  

The preliminary results verify that adult-mediated naturalistic intervention without focused peer-intervention facilitates the child’s functional play and pro-social engagement with limitation to the presence of an adult. Similar, finding to peer engagement are lacking. Anyhow, further analysis will account for the examination of collateral effects of behavior changes resulting from one-to-one intervention on social engagement. We will examine which areas addressed in one-to-one intervention (e.g. communication, cognitive skills, adaptive functioning) leads to collateral changes in non-targeted social engagement skills. Results will be presented at the conference.