Improving Engagement on the Playground and in the Classroom for School Age Children with ASD: A Multisite Randomized Trial

Background:  Impairment in social interaction has been recognized as a critical issue for children with autism spectrum disorder (ASD). Several interventions, implemented by research staff, improved child social outcomes in schools. However, little is known about the effectiveness of these interventions when delivered by paraprofessionals, especially the paraprofessionals who spend the most non-instructional time with these children.

Objectives:  This study aimed to evaluate the efficacy of a social skills intervention, Remaking Recess (Kretzmann, Locke, & Kasari, 2012), on peer engagement and social network salience for children with ASD using a multi-site, randomized, wait-list-controlled design when implemented by paraprofessionals.

Methods:  Eighty children with ASD (age 5-12 years) in grades K-5 recruited from three sites were randomized to Remaking Recess (RR: n=39) or a waitlist (WL: n=41) for 3-months with a 1-month follow-up.

Intervention (Remaking Recess): Paraprofessionals work with research staff over 3 months, held during children’s non-instructional time. Sessions consist of information sharing, active coaching, and systematic support. Paraprofessionals were trained with an hour-long group presentation on the social challenges of children with ASD at school and overview of the Remaking Recess intervention and then provided daily active coaching on the playground for two weeks (8-10 sessions). The researcher provided consultation for 6-8 more sessions over the next 6 weeks and completely faded consultation and coaching for the last two weeks.

Measures: The Playground Observation of Peer Engagement is an interval coding system that identifies durations of joint engagement with peers or solitary play.

The Friendship Survey is a questionnaire used to assess children's friendships and social networks of peer relationships in the general education classroom.

All measures are collected at pre/post intervention and at the 1-month follow-up.

Results:  Percentage of time spent in solitary engagement was modeled using the hurdle model (i.e. binary and truncated Gaussian). There was a significant overall treatment difference in the truncated Gaussian model (F(1,76)=4.01, p=0.049) from pre-treatment to post-treatment, but not in the binary model (F(1,76)=0.48, p=0.492). This showed that for those children who spent more time in solitary engagement (i.e. those who crossed the hurdle), the children in the RR group showed significantly more reductions in time spent in solitary play from pre-treatment to the post-treatment compared to children in the WL group.

There was no significant treatment difference or overall change in time from pre-treatment to post-treatment (F(1,67)=0.30, p=0.58 and F(1,67)=0.45, p=0.50 respectively) in social network salience within the classroom. However, there was a significant treatment difference from pre-intervention to follow-up (F(1,118)=1.97, p=0.05) where children in the Remaking Recess group, on average, became more salient in their classroom from pre-intervention to follow-up compared to the children in the WL group.

Conclusions:  These results suggest that a low dose, brief, and paraprofessionals mediated intervention conducted in schools can be beneficial in increasing peer engagement and classroom salience for children with ASD in inclusive settings. The benefits of Remaking Recess may require more time in order for children with ASD to become more engaged on the playground and salient in their classroom.