Effectiveness of a peer-helper intervention to increase children's social interactions. Generalization, maintenance, and social validity

Peer-mediated interventions are being used increasingly with a variety of populations. This study examined the impact of a peer-helper intervention on the low rates of prosocial interactions of three-elementary-school children. Two peers from each child's classroom were trained as helpers to increase the social interactions of the socially isolated children. A multiple-baseline across-subjects design was used to demonstrate the impact of the intervention, and a within-subject A-B-A withdrawal design was used to assess maintenance. Behavioral observations during recess periods indicated that positive interactions with peer helpers and other classmates increased during intervention and were maintained in withdrawal and follow-up phases. Increases in positive interactions generalized to a second recess setting in which the peer-helper intervention was not introduced. The positive social interactions of all subjects reached social-validation levels of comparison groups of peers in the observation settings. Classroom sociometric assessment and teacher and self-report measures provided variable support for the effectiveness of intervention.     

Improving generalization of peer socialization gains in inclusive school settings using initiations training

Social engagement by children with autism spectrum disorder (ASD) in unstructured school settings generally occurs at very low levels, if at all. Although many interventions improve peer socialization, generalization and maintenance of such gains when interventions are faded are typically low. The present study employed a multiple baseline design across participants to target generalization in the absence of interventionists in elementary school children with ASD at recess. Teaching initiations has been suggested as one method to increase generalization. The results of the present study showed that when initiations were targeted during intervention for social play, the participants demonstrated generalized peer social engagement, increases in unprompted peer-directed initiations, and more positive affect during peer interactions. Results are discussed in terms of theoretical and applied implications of incorporating initiations training into social interventions.     

Recess is Time-in: Using Peers to Improve Social Skills of Children with Autism

Children with autism face enormous struggles when attempting to interact with their typically developing peers. More children are educated in integrated settings; however, play skills usually need to be explicitly taught, and play environments must be carefully prepared to support effective social interactions. This study incorporated the motivational techniques of Pivotal Response Training through peer-mediated practice to improve social interactions for children with autism during recess activities. A multiple baseline design across subjects was used to assess social skills gains in two elementary school children. The results demonstrated an increase in important social skills, namely social initiations and turn taking, during recess.     

Peer-related social competence of young children with Down syndrome

The peer-related social competence of children with Down syndrome was examined in an observational study. Dyadic interactions with peers of children with Down syndrome were compared with the dyadic interactions of matched groups of typically developing children and with playmates differing in both familiarity and social skills. Results suggested that both risk and protective factors influenced the peer interactions of children with Down syndrome. Recommendations are made for applying contemporary models of peer-related social competence to etiologic subgroups to better understand the mechanisms involved and to provide direction for the design of intervention programs.     

Efficacité des interventions de pair-aidants (schizophrénie,trouble bipolaire). Revue systématique de la littérature

ObjectiveThe effectiveness of programs integrating trained and paid peer helpers on symptoms, quality of life and recovery of persons with bipolar disorder or schizophrenia is still poorly understood. The factors influencing the integration of peer helpers into healthcare teams are also poorly understood.MethodA systematic review of the literature was performed. We systematically searched multiple electronic databases for articles: (i) exploring the effectiveness of the intervention of trained and paid peer helpers in bipolar disorder and schizophrenia (ii) reporting barriers and facilitators to the integration of peer helpers.ResultsForty-eight articles were included, 24 on the effectiveness of the intervention of peer helpers, 18 on barriers and 13 on facilitators to the integration of peer helpers in health teams. Of them, 25 were based upon qualitative methods (7 concerning the effectiveness of the intervention of peer helpers, 14 the barriers and 7 the facilitators to their integration); 23 were based upon quantitative methods (9 studies focused on the effectiveness of peer helper intervention, 2 on barriers and 6 on integration facilitators). The 23 quantitative studies included 8 randomized controlled trials.ConclusionIn spite of their heterogeneity, the results suggest that that interventions of peer helpers have a positive impact on the recovery, quality of life, social functioning, physical health and clinical outcome of persons with bipolar disorder or schizophrenia. The results also showed that the integration of peer helpers is favored by caregivers’ awareness about the role of peer helpers and knowledge about the recovery model. The results highlight the need for peer helpers to have a well-defined role and to be supervised, preferably by another peer helper.     

Enhancing Social Skills of Kindergarten Children with Autism Through the Training of Multiple Peers as Tutors

Many students with autism are being served in inclusive settings. Early intervention programs, traditionally home-based, are beginning to create center-based options which incorporate typically developing peers. One of the arguments for the use of inclusive programs is that students with autism will benefit from their exposure to and interactions with typical peers. Unfortunately, research suggests that in inclusive settings, typical peers and peers with autism do not always interact without prompting from an adult. This study used an ABAB design to determine if a peer buddy approach in which all students were trained to interact in dyads would increase non-adult-directed interactions. Data collected on the students with autism indicate that the peer buddy approach significantly increased their appropriate social interactions. Follow-up data on one of the students indicates generalization of appropriate social interactions to a new classroom.     

Impact of Cognitive Behavioral Therapy on Observed Autism Symptom Severity During School Recess: A Preliminary Randomized,Controlled Trial

This study compared cognitive behavioral therapy (CBT) and treatment-as-usual (TAU) in terms of effects on observed social communication-related autism symptom severity during unstructured play time at school for children with autism spectrum disorders (ASD). Thirteen children with ASD (7–11 years old) were randomly assigned to 32 sessions of CBT or community-based psychosocial treatment (TAU) for 16 weeks. The CBT program is based on the memory retrieval competition model and emphasizes the development of perspective-taking through guided behavioral experimentation supplemented with reflective Socratic discussion and supported by parent training and school consultation to promote generalization of social communication and emotion regulation skills. Trained observers blind to treatment condition observed each child during recess on two separate days at baseline and again at posttreatment, using a structured behavioral observation system that generates frequency scores for observed social communication-related autism symptoms. CBT outperformed TAU at posttreatment on the frequency of self-isolation, the proportion of time spent with peers, the frequency of positive or appropriate interaction with peers, and the frequency of positive or appropriate peer responses to the target child (d effect size range 1.34–1.62). On average, children in CBT were engaged in positive or appropriate social interaction with peers in 68.6 % of observed intervals at posttreatment, compared to 25 % of intervals for children in TAU. Further investigation of this intervention modality with larger samples and follow-up assessments is warranted.     

Peer mediation to increase communication and interaction at recess for students with autism spectrum disorders

Recess plays an integral role in the social and emotional development of children given the time provided to engage in interactions with others and practice important social skills. Students with ASD, however, typically fail to achieve even minimal benefit from recess due to social and communication impairments as well as a tendency to withdraw. Implementation of evidence-based interventions such as peer-mediated social skills groups, are necessary to ensure recess is an advantageous learning environment for students with ASD. A multiple-baseline design across participants was used to determine if a functional relationship exists between a social skills instructional program combined with peer networks with school staff as implementers and increases in level of communicative acts for participants with ASD at recess. Results indicate all participants demonstrated an immediate increase in the number of communicative acts with the introduction of the intervention. Implications for practice are discussed.     

Measuring Changes in Social Behavior During a Social Skills Intervention for Higher-Functioning Children and Adolescents with Autism Spectrum Disorder

The social behavior of children and adolescents with Autism Spectrum Disorder was evaluated weekly over 19 weeks of a social skills training program. Participants’ vocalizations were coded as initiating, responding, or other (e.g., self-talk). Participants’ interactions were coded as dyadic peer interactions, dyadic leader interactions, interactions with a group of peers, interactions with a group of peer(s) and leader(s), or time spent by self. Over the course of the intervention, participants made fewer initiating and other vocalizations, more responding vocalizations, spent more time interacting with a group of peers, and spent marginally less time interacting with a leader. Gender, age, and intervention attendance effects on social behavior are also noted.     

Use of LEGO© as a Therapeutic Medium for Improving Social Competence

A repeated-measures, waiting list control design was used to assess efficacy of a social skills intervention for autistic spectrum children focused on individual and group LEGO© play. The intervention combined aspects of behavior therapy, peer modeling and naturalistic communication strategies. Close interaction and joint attention to task play an important role in both group and individual therapy activities. The goal of treatment was to improve social competence (SC) which was construed as reflecting three components: (1) motivation to initiate social contact with peers; (2) ability to sustain interaction with peers for a period of time; and (3) overcoming autistic symptoms of aloofness and rigidity. Measures for the first two variables were based on observation of subjects in unstructured situations with peers; and the third variable was assessed using a structured rating scale, the SI subscale of the GARS. Results revealed significant improvement on all three measures at both 12 and 24 weeks with no evidence of gains during the waiting list period. No gender differences were found on outcome, and age of clients was not correlated with outcome. LEGO© play appears to be a particularly effective medium for social skills intervention, and other researchers and clinicians are encouraged to attempt replication of this work, as well as to explore use of LEGO© in other methodologies, or with different clinical populations.     

Measuring children’s emotional and behavioural problems: are SDQ parent reports from native and immigrant parents comparable?

Adolescence is characterized by developmental changes in social relationships, which may contribute to, or protect against, psychopathology and risky behaviors. Non-suicidal self-injury (NSSI) is one type of risky behavior that typically begins during adolescence and is associated with problems in relationships with family members and peers. Prior research on social factors in adolescent NSSI has been limited, however, by a narrow focus on specific interpersonal domains, cross-sectional methods, retrospective self-report of childhood experiences, and a failure to predict NSSI onset among as-yet-unaffected youth. We investigated these relationships in 2127 urban-living adolescent girls with no NSSI history at age 13, who were participating in a longitudinal cohort study (Pittsburgh Girls Study). We used discrete-time survival analyses to examine the contribution of time-varying interpersonal risk factors, assessed yearly at ages 13–16, to NSSI onset assessed in the following year (ages 14–17), controlling for relevant covariates, such as depression and race. We considered both behavioral indicators (parental discipline, positive parenting, parental monitoring, peer victimization), and cognitive/affective indicators (quality of attachment to parent, perceptions of peers, and perceptions of one’s own social competence and worth in relation to peers) of interpersonal difficulties. Parental harsh punishment, low parental monitoring, and poor quality of attachment to parent predicted increased odds of subsequent adolescent NSSI onset, whereas positive parenting behaviors reduced the odds of next year NSSI onset. Youth who reported more frequent peer victimization, poorer social self-worth and self-competence, and more negative perceptions of peers were also at increased risk of NSSI onset in the following year. When tested simultaneously, no single parenting variable showed a unique association with later NSSI onset; in contrast, peer victimization and poor social self-worth each predicted increased odds of later NSSI onset in an omnibus model of peer and parent relationship characteristics. In this urban sample of adolescent girls, both peer and parent factors predicted new onset NSSI, although only peer factors were associated with subsequent NSSI in combined multivariate models. Results further suggest that both behavioral and cognitive/affective indicators of interpersonal problems predict NSSI onset. These findings highlight the relevance of family and peer relationships to NSSI onset, with implications for prevention of NSSI onset among at-risk youth.     

Social communication effects of peer-mediated recess intervention for children with autism

Children with ASD face enormous challenges in the area of social functioning. Research has shown that impairments in social functioning distinguish this population from both typically developing children and children with disabilities. This study incorporated several evidence-based social skills-teaching procedures (i.e., direct instruction, priming, prompting, peer-mediation, contingent reinforcement, and token economies) directly in the recess setting to increase appropriate social behaviors for four children with ASD (ages 6–8). Elements of peer networks and pivotal response training (two types of social skills intervention packages in the literature) were included. Results showed significant increases in social communication between focus children and their peers, as well as generalization of skills to non-intervention recesses.     

Effects of group socialization procedures on the social interactions of preschool children

We investigated the effects of group socialization procedures on the social behavior of preschool children in two studies. Group socialization procedures consisted of teachers using antecedent and consequent events to promote social interaction during children's games. During intervention, teachers discussed friendship with the children and then prompted and praised child-child social responding within the context of games. Children's social behavior was assessed during two sessions, group game periods (i.e., intervention sessions) and nonintervention play periods (i.e., generalization sessions). In both studies, a multiple baseline design across two target children and peers in their respective group was used to evaluate the effects of group socialization procedures. During group game periods, after intervention, target children increased their rates of both prompted and unprompted social interactions with peers. Also, in nonintervention play periods, target children improved both the rate and the duration of their social responding with peers. Results indicated that group socialization procedures were a practical and effective method for improving young children's social interaction during both structured games and unstructured play activities.     

Brief Report: Group Social-Multimodal Intervention for HFASD

Current study is the second part of a 2-year cognitive-behavioral-ecological (CB-E) intervention for high-functioning (HF) children with autism spectrum disorder (ASD). We examined the utility of a group-centered intervention on children’s ability to interact cooperatively with peers during structured and non-structured social situations. Direct (e.g., social problem solving) and indirect (theory of mind; executive function) treatment effects on social cognitive capabilities were also examined. Participants were 26 preadolescent HF children with ASD. Study results demonstrated direct and indirect treatment effects on social cognition and mixed results regarding children’s social interaction capabilities. Although children’s cooperative capabilities within the intervention group improved, dyadic, and group social interactions during school recess did not. Discussion focused on the utility of such group-intervention in increasing social functioning.     

The family interview

Families of study children were interviewed, with a focus on parents' observations of the personality and behavior of their offspring. The family interview was also the primary source of information about the home environment and possible psychopathology in nonschizophrenic parents. By parental report, index children were more likely than controls to have developed psychopathological symptoms related to mood, social withdrawal, antisocial behavior, eating, and obsessive-compulsive behavior. Traits of self-esteem, adaptability, reliability, and degree of task orientation were more poorly developed in index than control subjects. Index subjects also tended to have poorer relationships with both peers and family members. While boys and girls showed similar patterns of psychopathology, boys tended to have somewhat higher levels of impairment. No differences or interactions due to type of rearing were found.     

Increasing social interactions of severely handicapped autistic children

A peer-initiation training procedure was implemented across multiple peer trainers to investigate social interactions between severely withdrawn autistic children and their nonhandicapped peers. For one subject, substantial increases in spontaneous interactions with training and nontraining peers occurred after the peer-initiation procedure was applied across two training exemplars. Spontaneous social interactions continued even after the training procedure was removed. Although experimental control was established with the second subject during training, spontaneous interactions during nontraining periods were primarily with training peers. The results contribute to an emerging data base on the social interactions of autistic and severely withdrawn handicapped children and on peer-initiation training procedures.     

Use of teacher prompts to increase social behavior: generalization effects with severely and profoundly retarded adolescents.

In a single-subject design with replication across subjects, teacher prompts were used in an attempt to increase the rate of social behavior of three severely and profoundly retarded adolescents who were legally blind. Training took place in the classroom on successive school days with the teacher prompting each subject to engage in positive social interaction with each peer. Observations for generalization effects immediately followed each training session. The remaining class members were brought into the room, and social interactions were observed in a free-play setting while the teacher was absent. During both phases, observers recorded the behavior of the three subjects for 5 minutes and recorded all units of social exchange that each subject initiated or responded to. Increased rates of social behavior were obtained for all three subjects during both training and generalization. Major factors that contributed to the generalization effects were discussed.     

Examination of a social problem-solving intervention to treat selective mutism

The authors examined the use of a social problem-solving intervention to treat selective mutism with 2 sisters in an elementary school setting. Both girls were taught to answer teacher questions in front of their classroom peers during regular classroom instruction. Each girl received individualized instruction from a therapist and was taught to discriminate salient social cues, select an appropriate social response, perform the response, and evaluate her performance. The girls generalized the skills to their respective regular classrooms and maintained the skills for up to 3 months after the removal of the intervention. Experimental control was demonstrated using a multiple baseline design across participants. Limitations of this study and issues for future research are discussed.     

The influence of nonhandicapped peers on the social interactions of children with a pervasive developmental disorder

This study investigated whether or not children with autism or a related pervasive developmental disorder (PDD) can benefit from regular opportunities to interact with a normally developing peer, matched as to sex and age. An experimental design with random assignment of subjects to treatment and control groups was used to demonstrate the impact of this peer-mediated intervention. In the treatment group, we found significant improvements in the social behavior of the children with PDD. Several gains were also generalized to interactions with an unfamiliar nonhandicapped peer, to interactions with another child with PDD, and to the large school setting. In the untreated control group, no positive changes were observed. Results suggest that children with PDD can develop peer relations if appropriate social contexts are made available for them.This work was supported by a grant of the Belgian National Fund for Scientific Research. I thank Catherine Lord, Yves Rosseel, Ina van Berckelaer-Onnes, and Paulette Van Oost who contributed greatly to the realization of this study.