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Goldstein, Howard; Thiemann, Kathy 

Effects of Visually-Mediated Intervention on the Social 
Communication of Children with Pervasive Developmental 
Disorders . Final Report , 

Florida State Univ., Tallahassee. 

Special Education Programs (ED/OSERS) , Washington, DC. 
2000-08-12 
44p . 

4230-525-21 

Reports - Research (143) 

MF01/PC02 Plus Postage. 

♦Communication Skills ; * Developmental Disabilities; 
Elementary Education; Generalization; Inclusive Schools; 
Instructional Effectiveness; Interpersonal Competence; 
♦Intervention; Peer Relationship; ♦Social Integration; 
♦Training Methods; ♦Visual Learning 
♦Pervasive Developmental Disorders 



ABSTRACT 



This study investigated the effects of a visually mediated 
intervention (i.e., social stories, written social phrases, pictures of 
social skills, and videotaped feedback) on the social communication of five 
elementary students with pervasive developmental disorders . Five triads, each 
with one subject and two typically developing peers were formed. A multiple 
baseline design across triads and social behaviors revealed that the 
intervention was effective in increasing the frequency of four specific 
social communication skills for the five focus children. Two participants 
demonstrated generalization of social improvements and parents and naive 
judges reported improvements in social interactions for all triads. 

Class-wide sociometric ratings increased for four of the five participants. 
Overall, the intervention was judged effective in teaching social skills 
necessary for participation in conversations and positive social interactions 
with peers in inclusive settings. (Contains 37 references.) (Author/DB) 



Reproductions supplied by EDRS are the best that can be made 
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Effects of Visually-Mediated Intervention 
On the Social Communication of 
Children with Pervasive Developmental Disorders 



FINAL REPORT 



Office of Special Education Programs 
U. S. Department of Education 
Grant Number: 4230-525-21 
CFDA: 84.023 



Howard Goldstein, Ph D, Principal Investigator 
Kathy Thiemann, Student Investigator 
Florida State University 
107 Regional Rehabilitation Center 
Tallahassee, FL 32306-1200 

I 



August 12"’, 2000 




^ U.S. DEPARTMENT OF EDUCATION 

■ NATIONAL INSTITUTE OF EDUCATION 
I EDUCATIONAL RESOURCES INFORMATION 
I CENTER (ERIC) 

; 0^his document has been reproduced as 
received from the person or organization 
originating it. 

□ Minor changes have been made to Improve 
i reproduction quality. 

• Points of view or opinions stated in this docu- 
, ment do not necessarily represent official NIE 

‘ position or policy. 






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II. ABSTRACT 



Effects of Visually-Mediated Intervention On the Social Communication of 
Children with Pervasive Developmental Disorders 

This study investigated the effects of a visually-mediated intervention (i .e., social stories, written 
social phrases, pictures of social skills, and videotaped feedback) on the social-communication of 
five elementary students with pervasive developmental disorders. Ten typical peers participated 
as communication partners, with two peers paired with one focus child to form five triads. 
Additional goals focused on (a) determining if social skill improvements would generalize to 
new settings and social partners, (b) measuring parents’ and naive judges’ perceptions of changes 
in the quality of the children’s social interactions with peers following intervention, and (c) 
examining changes in class wide sociometric status ratings. 

A multiple baseline design across triads and social behaviors revealed that visually-mediated 
intervention was effective in increasing the frequency of specific social communication skills for 
the five focus children. Treatment effects were replicated across four different social behaviors 
with the initiation of the intervention. Two participants demonstrated generalization of social 
improvements in the classroom and naive judges reported improvements in the quality of social 
interactions for all triads. Class wide sociometric ratings increased for 4 of the 5 participants with 
social impairments. 

The findings support recommendations for using visually-cued instruction to guide the social 
development of children with pervasive developmental disorders. Involving typical peers as 
conversational partners contributed to the children’s success and peer acceptance increased 
among classmates not involved in the intervention. This intervention was effective in teaching 
social skills necessary for participation in conversations and positive social interactions with 
peers in inclusive settings. 

The results of this project have been presented at National conferences, and within the state of 
Florida in the form of in-service training for teachers, speech-language pathologists, and special 
educators. Recommendations were incorporated in a manual entitled “Picture My Words. Visual 
Strategies for Improving Social Skills of Elementary School-Age Children”. This manual was 
distributed to the Center for Autism and Related Disabilities at FSU, and other interested 
agencies. 



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TABLE OF CONTENTS 



Goals and Objectives ........ 1 

Theoretical Framework ........ 2 

Method ......... 4 

Participants ........ 4 

Setting and Session Organization ..... 8 

Procedures ........ 9 

Experimental Design . . . . . . . 11 

Data Collection and Coding ...... 12 

Reliability . . . . . . . . 14 

Methodological Changes . . . . . . . 15 

Results . . . . . . . . . 15 

Discussion . . . . . . . . . 19 

Appendices ......... 24 

A. Social Conversational Skills Checklist 

B, Social Story Stimuli 

Tables ......... 26 

Figures . . . . . . . . . 31 

Project Impact ........ 36 

Planned Future Activities . . . . . . . 37 

Assurance Statement . . . . . . . . 37 

References . . . . . . . . 38 



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GOALS AND OBJECTIVES 

Objective 1: To investigate the effects of an intervention utilizing static and dynamic visual 
stimuli for instructing, modeling, and providing feedback to improve the social conversational 
skills (i.e., securing attention, initiating comments and requests, and responding contingently) of 
elementary school children with social impairments. 

Objective 2: To investigate generalization and maintenance of treatment effects to new settings 
and conversational partners. 

Objective 3: To assess social validity through (a) measures of parents’ and naive judges (i.e., 
teachers and graduate students) perceptions of changes in the quality of interactions between the 
focus children and the typical peer participants following the intervention, and (b) changes in 
class wide sociometric status ratings. 

Objective 4: To produce training materials and in-service programming for teachers, speech- 
language pathologists, and special educators, and disseminate results in state and national 
conferences and selected Journals. 





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THEORETICAL FRAMEWORK 

Much research has described the restricted range of social communication skills for 
children with Pervasive Developmental Disorders (PDD), including autism, such as limited 
speech acts to request information from others, acknowledge others, or comment (Volkmar, 
Carter, Grossman, & Klin, 1997; Wetherby & Prutting, 1984). Other researchers have 
documented a lack of nonverbal or verbal initiations to greet/say farewell or engage others 
(Hobson & Lee, 1998), and impaired abilities to ask questions, listen and respond to others, and 
interact in simple social games (VanMeter, Fein, Morris, Waterhouse, & Allen, 1997). This 
limited repertoire of social communicative behaviors may negatively influence a child’s ability 
to enter into and maintain positive interactions with peers in inclusive education settings, 
resulting in fewer opportunities to practice and learn important socialization skills. 

Studies focusing on unique cognitive and language competencies of children with PDD 
have revealed particular strengths in visual-perceptual skills (Lincoln, Courchesne, Kilman, 
Elmasian, & Allen, 1988), processing and interpreting static visual stimuli (Hodgdon, 1995), and 
early word recognition skills (Whitehouse & Harris, 1984). Quill (1997) discussed learning 
styles and instructional considerations for children with autism and stated, “the specific 
communicative functions used by autistic children appear to be related to the presence or absence 
of visible retrieval cues” (p.701). She recommended using visually-cued instruction (e.g., graphic 
cues) to improve children’s social communication. Interventions that capitalize on cognitive 
strengths and learning styles of students with PDD using visual stimuli may improve areas of 
impairment such as social communication. Identifying effective social interventions in the early 
elementary grades may significantly impact a student’s ability to develop friendships and engage 
in successful classroom or extracurricular social activities across the school years. 

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Different types of visual cues or stimuli that have been effective in improving social 
communication of children with autism or related developmental disabilities have included: 

(a) written prompts or pictorial cues (Bryson, Landry, & Smith, 1994; Kistner, Robbins, & 
Haskett, 1988; Krantz& McClannahan, 1998; Schuler, 1995), (b) peer self-evaluation books 
(Sainato, Goldstein, & Strain, 1992), (c) videotape feedback of behaviors and conversations 
(Charlop & Milstein, 1989; Kem-Dunlap et al., 1992), (d) videotaped peer models (Haring, 
Kennedy, Adams, & Pitts-Conway, 1987), and (e) video self-modeling (Heptig & Goldstein, 
1996). Kistner and colleagues (1988) capitalized on the superior word recognition skills of a 
young girl with autism and hyperlexia, to improve her functional language skills. Hyperlexia has 
been described as a preoccupation with letters and words at an early age, and exceptional reading 
and word recognition skills with delayed comprehension of meaning (Healy, 1982). Results 
indicated that written prompts (e.g., verbal prompt: “What do you want?” written prompt: “Want 
cookie.”) were successful in teaching functional language skills such as responding to questions. 
Progress was maintained with removal of the written cues. Charlop and Milstein (1989) assessed 
the effects of video modeling on conversation skills of children with autism between the ages Of 

6 to 7 years. The authors reported that not only did all 3 participants’ conversational speech 
improve, but also new skills generalized to different settings and social partners. 

In a study examining the effects of peer-mediated social intervention, Sainato et al. (1992) 
stated that the use of illustrations within self-evaluation books (containing cartoons of facilitative 
social strategies) (a) increased peer’s use of trained social strategies with children with autism, 

(b) provided a way for the trainer to compare his evaluations with the peer participants, and (c) 
assisted investigators in giving specific feedback for appropriate skill use. These studies provide 
preliminary evidence of the potential benefits of using visually-cued instruction to improve 



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social communication of young children with social impairments. Additional research is needed 
that examines the effectiveness of combining different types of visual stimuli to improve social 
relationships among elementary students with social impairments and peers without disabilities. 

In summary, given the unique qualitative differences in social, cognitive, and 
communication behaviors of children with PDD (Bristol et al., 1996; Lincoln et al., 1988) some 
intervention approaches may be more or less beneficial than others. Social intervention strategies 
that capitalize on children’s visual strengths may improve their ability to engage in conversations 
with peers; This could be accomplished through the use of visually coded information, especially 
for children with emergent or acquired literacy skills. Teaching social communication skills 
through concrete visual representations may enhance children’s understanding and accurate 
interpretation of different social rules and situations, thereby enhancing interactions with peers 
without disabilities. 

METHOD 

Participants 

Participants were 5 children with social and language impairments and 10 typical peers 
from a local elementary school. Two typical peers from each focus child’s classroom were 
assigned to a triad (consisting of 1 focus child and 2 peers). The 5 focus children were males, 
ranging in age from 6;6 (years;months) to 12;2, and enrolled in grades 1^ through S'*’. These 
participants were assessed with the following instruments: Childhood Autism Rating Scale 
(CARS) (Schopler, Reicher, DeVallis, & Daly, 1980), Peabodv Picture Vocabulary Test-Revised 
(PPVT-R) (Dunn & Dunn, 1981), the Test of Language Development-2 (TOLD-2, Newcomer & 
Hammill, 1988) or the Clinical Evaluation of Language Fundamentals-3'^‘* Edition (Psychological 
Corporation, 1994), the Test of Nonverbal Intelligence-2"‘* Edition (TONI-2, Brown, Sherbenou, 



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&. Johnsen, 1990), the Parent and Teacher Reports of the Social Skills Rating System (SSRS, 
Gresham & Elliott, 1990), and the Word Identification subtest of the Woodcock Reading 
Mastery Tests-Revised (Woodcock, 1998). Only the Teacher Report of the SSRS was re- 
administered post intervention, as minimal changes were expected on the other tests given the 
short duration of the intervention. Participant information and results of the assessments are 
summarized in Table 1. 

Participants were selected based on the following criteria: emergent or acquired decoding 
skills, functional verbal communication skills, fully or partially included in regular education, 
and social impairment. Social impairment was confirmed based on results from the SSRS (Parent 
or Teacher Report), the CARS, and a Social Conversational Skills Checklist (SCSC) designed by 
the first author (see Appendix A). A certified school psychologist diagnosed two children with 
autism, Casey and Greg. All children except Dan scored in the autistic range on the CARS. All 
of the children were registered with Florida State University’s Center for Autism and Related 
Disabilities (CARD). None of the focus participants or the typical peers demonstrated hearing, 
vision, or physical motor impairments. 

The SCSC was adapted from Prutting and Kirchner’s (1987) pragmatic protocol. Other 
social skills were added based on clinical observations and parent report of common social 
difficulties. The student investigator and a research assistant completed three checklists based on 
10-minute observations of the focus participants and their peers during (1) small group work in 
the classroom, (2) special area (e.g., music, art, or PE), and (3) recess. The total number of 
ina ppropriate and not observed social behaviors checked were divided by the total number of 
social behaviors possible that the child had the opportunity to express (i.e., maximum 20). This 
calculation resulted in a percentage of social deficits across nonverbal, paralinguistic, and verbal 




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discourse categories on the SCSC. For inclusion in the study, all participants had to demonstrate 
> 50% social deficits during a minimum of two out of three 10-minute observations. 

Casey was integrated in a regular r* grade classroom for part of the day (i.e., center time 
academics, recess, and special area). He exhibited average nonverbal intellectual skills, and 
above average decoding abilities. Casey demonstrated characteristics of hyperlexia (Healy, 

1982), with an interest in letters, reading, and writing at an early age but weak reading 
comprehension. His expressive language consisted of immediate echolalia and 2-4 word 
sentences to have personal needs met. Casey’s repertoire of different communicative functions 
was significantly limited, and his intelligibility was poor. Results from the SCSC revealed 
deficits across all nonverbal, paralinguistic, and verbal discourse categories, with 100%, 71%, 
and 79% social deficits noted during the three social interaction observations. 

Greg was integrated in the same grade classroom as Casey for part of the day. Because 
the intervention involved the use of written visual cues, Greg’s teacher was interviewed and 
reported that he knew all letter names, was starting to associate sounds to beginning letters of 
words, and recognized some sight words. Greg communicated using simple sentences to request, 
comment, and respond; however, a significant number of his utterances were scripted or rote 
(memorized from favorite movies or video games). He received weekly home-program services 
from a behavioral consultant. Greg exhibited 60%, 65%, and 22% social deficits based on the 
SCSC observations. His social communication with peers improved during recess (i.e., 22%). 

John was fully integrated in a regular 1®* grade class and had received ongoing 1-1 
academic support since Kindergarten. He had an expanding sight word vocabulary, emergent 
knowledge of sound-letter correspondence, and comprehended simple written sentences. John’s 
expressive language contained a significant amount of memorized scripts from favorite movies 







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or video games; however, he was capable of using complete sentences to talk about a variety of 
topics. During the SCSC observations, John exhibited 55% and 50% social deficits during recess 
and PE respectively, and 37% social deficits during a small group center activity in the 
classroom. A discrepancy was noted between Parent and Teacher report of social difficulties on 
the SSRS (see Table 1). John and his family had received ongoing consultation from CARD for 
issues related to social and academic functioning since he was in preschool. John was included in 
the study based on his long history of social problems, continued parent report of social 
interaction difficulties, and results of the CARS and SCSC observations. 

Ivan was fully integrated in 2 "^ grade, and received resource room services for reading and 
math. Although Ivan’s decoding skills on the Woodcock were less than 2 standard deviations 
below the mean at the beginning of the study, his literacy skills improved markedly by the time 
he began the intervention. He had a large sight word vocabulary, knowledge of sound-letter 
correspondence, was beginning to segment and blend sounds to read words. Ivan communicated 
using multiple, complete sentences, and evidenced advanced vocabulary for topics of personal 
interest; He had a high degree of awareness of his social and academic difficulties. On the SCSC, 
Ivan demonstrated 53%, 59%, and 58% social deficits during the three social observations. 

Dan was fully integrated in a regular 5'*’ grade classroom and had participated in regular 
education since Kindergarten. He received resource support for reading, language arts, and math. 
His decoding skills were within normal limits, and he comprehended simple paragraphs. Dan 
communicated using full sentences and responded to simple questions appropriately. He had 
difficulty understanding lengthy verbal directions, language that required abstract reasoning, and 
answering complex questions (e.g., why, how). Although Dan’s score on the CARS placed him 
in the non-autistic range, a social impairment was confirmed with the SSRS, Parent and Teacher 



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report and the SC SC. On the SC SC, Dan exhibited 68%, 63%, and 61% social deficits during the 
three social observations. The majority of inappropriate social behaviors were observed in the 
paralanguage (e g., low volume, flat intonation, and a fast rate of speech) and verbal discourse 
categories. He was not observed to initiate activities or topics, maintain topics, ask questions, or 
repair communication breakdowns with peers. 

The 10 typical peers were identified and recommended by the focus children’s regular 
classroom teachers. The teachers were asked to recommend children who: (a) did not evidence 
social communication difficulties, (b) could provide appropriate social models, and (c) 
consistently completed their assignments so they could leave the classroom twice per week to 
participate. There were mixed genders (i.e., one girl and one boy without social impairments) in 
each of the triads except for Greg’s group, which were all boys. 

Setting and Session Organization 

All of the sessions took place in an average-sized media room in the school library. Three 
triads met during regular scheduled morning center-time, and two triads met in the morning prior 
to the start of classes. During baseline, the triads attended two 10-minute sessions each week. 
Once a group started treatment, they attended two 30-minute intervention sessions each week. 
Each intervention session included: 10-minutes reading the social story followed by instruction, 
discussion, and modeling of appropriate social phrases, 10-minutes engaging in a social activity, 
and 10-minutes of videotaped feedback of the social interaction. 

Social activities selected were mainly familiar social routines with unifying themes, 
predictable turn-taking sequences, and exchangeable participant roles. A rotation of three types 
of activities centered on (1) thematic or pretend play (e g., restaurant, grocery store), (2) board 
games, and (3) art/science projects. To assist with participant motivation and interest, a minimum 



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of five different activities for each type of social play were used. Activity agendas were used to 
assist with knowledge of task expectations. 

Procedures 

Peer orientation. Two peers without social impairments from each triad met with the 
investigator for a 30-45-minute orientation session before beginning intervention. Each child was 
given a notebook with pictures and sentences that described skills related to “How you can talk 
to your friends.” These skills consisted of (a) get your friend’s attention, (b) start talking about 
what you are doing, (c) ask questions, and (d) solve problems together. The children wrote 
examples of appropriate social phrases that matched the pictures of the social skills. Specific 
examples of positive or negative social behaviors observed in the baseline sessions for each 
focus child were discussed with the peers. Peers were told they would receive occasional prizes 
for using positive social skills with their friends. 

Teaching use of social stories, written phrases and pictures of social skills . Four social 
stories (Gray & Garand, 1993) were written to describe the four social skills targeted during 
intervention. The content of the social stories included: (a) securing attention (i.e., title: “Getting 
Friends to Look”), (b) initiating comments (i.e., title: “Start Talking to My Friends”), (c) 
initiating requests (i.e., title: “Ask My Friends Questions”), and (d) contingent responses (i.e., 
title: “Keep Talking to My Friends”). The social stories were written according to Gray’s rules 
for including descriptive, perspective, and directive sentences (see Appendix B for an example of 
a social story). For the older children (i e., John, Ivan, and Dan), a hand-drawn, colored picture 
depicting two children performing the target social skill was placed at the bottom of the story, 
along with empty topic bubbles (as in a cartoon) above the children’s heads. Real photos were 
used for the two youngest children. The pictures of the social skills were laminated on a separate 



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single page. Two to three social utterances (e g., sentence starters, phrases, or simple sentences) 
appropriate to the target social skill were written in laminated topic bubbles, and velcroed onto 
the empty topic bubbles. For example, for the skill securing attention the picture was of one child 
tapping another child on the shoulder and words such as “Look,” “Watch this,” or a child’s name 
were written in the topic bubbles. These utterances were rehearsed a minimum of three times 
before starting the activity. The visual cues were left on the table throughout the group 
interaction to provide the children with constant access to the visual prompts. 

At the beginning of each intervention session the participants read one social story 
targeting a specific social skill. The clinician then asked 4-5 simple interrogative and wh- 
questions to monitor and improve participant’s understanding of the story content (see Appendix 
B). The social story was left on a flip chart on the table during the social activity. Parents were 
given a copy of each social story (as it was introduced) to read daily with their child at home. 
Daily readings of the story were monitored through completion of weekly checklists that the 
parents mailed in. 

Once per minute during the 10-minute treatment session, the examiner provided a visual 
(or if necessary verbal) prompt by pointing to one of the written social phrases if the focus child 
did not spontaneously use the targeted social skill. Otherwise, the investigator remained at a 
distance from the group. Casey’s peers were taught to prompt him to use the written phrase cues 
due to a high level of adult dependency observed during the first few sessions. 

Videotaped feedback . After the 10-minute social activity, children self-evaluated their use 
of targeted social skills. The examiner taped the picture of the social skill and the written social 
phrases (topic bubbles) on the bottom of a television. Each child had a clipboard with the social 
skill written at the top of a sheet of paper (e.g., “1 started talking” for initiating comments). The 




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paper also had two columns marked “Yes” circled in green and “No” circled in red with a line 
crossed through it: The examiner played the videotape of the interaction, paused it after one 
conversational exchange, and asked the children if they heard examples of the targeted social 
skill. The tape was paused a minimum of three times. Checks were exchanged for tickets and 
used collectively to obtain small toys or other reinforcers 
Experimental Design 

A multiple baseline across two to three social language skills replicated across five triads 
(i.e., one participant with social delays and two typical peers) was used to assess changes in 
conversational skills for the participants with social impairments. The possible pool of targeted 
social skills included; (a) secures for attention, (b) initiating comments, (c) initiating requests, 
and (d) contingent responses. The discourse skills taught were counterbalanced among the triads 
to control for possible order effects. 

During baseline, each triad engaged in one 10-minute social activity per session. No 
attempts were made to reinforce or influence interactions. Following stable performance or no 
upward trend in a specific social behavior, the first social story, written cues, and picture stimuli 
were implemented (e g., targeting secure for attention). Baseline measurement of the other three 
social skills continued. When an observable and notable upward trend in the targeted social skill 
was observed over a minimum of four sessions, treatment was initiated for the second social skill 
(e.g., initiating comments) and maintenance data were collected on the first social skill (i.e., 
secure for attention). Baseline data continued to be collected for the other two social skills (i.e., 
initiating requests and contingent responses. If improvements in social behaviors occurred only 
when intervention was initiated, then one can claim treatment effects. If these effects were 
replicated consistently across behaviors and across triads, one can make a convincing case for 



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experimental control. 

For two children, a modified treatment approach was implemented for the final 5-6 
sessions because of reduced maintenance on previously targeted social skills. Three social skills 
were combined into one social story and represented by the original social skill pictures or 
photos. One social phrase was written as a visual cue for each targeted skill. Thus, there were 
three possible social skills and three possible written phrases that the children could choose to 
use in the social interaction. Videotaped feedback forms also were modified to allow for self- 
evaluation and feedback on all three social skills. 

Data Collection and Coding 

Observational coding . A direct observation coding system with a 15-second audio- 
recording interval was used to code frequency of occurrence of all appropriate and inappropriate 
social language measures (see Table 2) within the 10-minute social activity. All sessions were 
audio- and videotaped. The four primary dependant social measures included securing attention, 
initiating comments, initiating requests, and contingent responses. These social discourse skills 
were selected based on a review of the literature on normal and disordered development of topic 
maintenance skills (Brinton & Fujiki, 1984; Foster, 1985; Mentis, 1991,1994; Prutting, 1982; 
Prutting & Kirchner, 1987). Other measures of interest included frequency of inappropriate 
discourse skills such as topic changes, unintelligible responses, other, and no responses. 

, The average length of multiple-turn conversational episodes was determined by totaling 
the number of the focus child’s sequential utterances related to the same topic or action (ending 
with a minimum of a 3 -second pause or a change in topic) and dividing by the total number of 
episodes during the 10-minute coding interval. These data were collected and averaged over the 
last five baseline sessions (just prior to initiation of treatment of the first social skill) and the last 



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five treatment sessions for each participant. 

Generalization probes . Generalization data were collected in the classroom setting for 3 
participants (Casey, Greg, and John) over 3-4 days. In the classroom, social story instruction and 
videotaped feedback were omitted from the procedures. Written social phrases were rehearsed a 
minimum of three times prior to the triad engaging in an already scheduled 10-minute center 
activity. Activities ranged from reading big books , working on computers, completing math 
worksheets, and doing art projects. If peers became too directive they were provided with 
occasional prompts to use previously trained social skills. 

Assessment of social validity. A parent questionnaire was administered pre- and post- 
intervention. This questionnaire was designed to assess parent’s perceptions of meaningful 
changes in their child’s social functioning. The questionnaire consisted of 10 questions (based 
loosely on social interaction behaviors described in the SCSC) rated on a 5-point Likert scale 
(i.e., 1 = Never observed, and 5 = Always observed). Seven regular education teachers and six 
graduate students in speech-language pathology provided additional subjective ratings of 
meaningful changes in social interactions between children with social impairments and their 
peers by observing pre- and post-intervention videotape segments. Each baseline and treatment 
segment lasted approximately 2-minutes and the sessions were counterbalanced. Judges rated the 
quality and quantity of (1) the focus child’s social behaviors towards their peers, and (2) the 
peer’s social behaviors toward the focus child. The questionnaire consisted of six questions rated 
on a 5-point Likert Scale (i.e., 1 = No active involvement, 5 = Better than average involvement). 

Sociometric status. The sociometric status of the focus children and the regular education 
peers were determined by asking all classmates to rate each other using Polaroid pictures or 
name cards. Three boxes with slots (to place the pictures/cards) were placed in front of the child. 



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Each child was individually instaicted to place a photo or name card in the box associated with 
whether or not they liked to play with that person at school. Happy, neutral, and sad faces were 
drawn on the front of each box to represent likes to play with , sometimes play with , and don’t 
like to play with respectively. These procedures were completed pre- and post-intervention in a 
quiet area of the classroom. 

■ Reliability 

Prior to the beginning of the study, the examiner trained two research assistants using 
previously recorded videotapes of other friendship groups. Once the interobserver agreement for 
identification of the social language measures reached a minimum agreement criterion level of 
80% over three days, the assistants were considered familiar enough with the coding procedures 
to code on-line. A primary coder reviewed the audiotape and videotape of each session, and 
made corrections as necessary prior to secondary coding and graphing. Interobserver reliability 
was calculated by dividing the number of agreements by the agreements plus disagreements, and 
multiplying by 100. Interobserver agreement was calculated separately for 30% of the baseline 
and treatment sessions, and 30% of home videotape samples. Interobserver agreement was 
consistently above 80% for all participants. Agreement ranged from 83 to 100% for Casey, 81 to 
94% for Greg, 80 to 100% for John, 84 to 95% for Ivan, and 87 to 100% for Dan. Interobserver 
agreement results for 30% of the home videotaped social samples ranged from 81 to 87%. 

Treatment fidelity was monitored for 20% of the intervention sessions using a checklist of the 
proposed intervention procedures. Treatment fidelity was consistently above 82%, with a range from 82 
to 100%. 



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METHODOLOGICAL CHANGE 

Originally, implementation of the intervention was planned at the FSU Speech and 
Hearing Clinic. This project eventually occurred at a local elementary school for the following 
reasons: (a) to improve probability of enlisting same-age typical peers to participate in the social 
groups, (b) to provide the intervention in a more natural social context, and (c) to increase the 
likelihood of generalization of trained social behaviors to different peers and social settings. 

RESULTS 

Focus Children’s Social Communication Progress 

Frequencies of targeted social language skills for the participants are presented in Figures 
1 through 5. Dan demonstrated low rates of securing attention during baseline, with clear 
improvements following treatment. During treatment on the next social skill, initiating 
comments, these improvements declined but still maintained above baseline levels in the absence 
of prompts. The intervention was effective in increasing Dan’s frequency of comments, and 
improvements were maintained in the absence of prompts. The frequency of initiating requests 
seemed to improve once intervention began on the first behavior targeted, suggesting generalized 
treatment effects. Prompts were mistakenly provided for comments and requests during 

treatment of secures for attention (e.g., written cue: “Michelle, can I ?”). However, when 

written cues for initiating requests were removed during treatment on initiating comments, 
generalized improvements continued for requesting behaviors. Moderate improvements were 
noted once treatment began on initiating requests. Contingent responses were not targeted in 
treatment as this social skill steadily improved over the course of intervention. 

During baseline, Greg demonstrated a generally low rate of securing attention with the 
exception of Session 10. Following treatment, there were noticeable increases in his use of this 



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social skill. These improvements were maintained as prompts were faded in treatment; however, 
Greg’s continued use of securing attention without visual cues during treatment of the next social 
skill was variable. Greg emitted a higher number of comments during a number of baseline 
sessions that involved playing a board game. The treatment resulted in higher and more stable 
initiation of comments across different social activities (i.e., thematic play and art/science 
projects). These improvements endured as prompts were faded. Once treatment began on 
initiating requests, Greg’s number of comments as well as requests increased dramatically. 
Generalized treatment effects may explain these improvements. However, generalization data 
revealed no clear maintenance of improved target behavior performance in the modified 
classroom activities. 

Initiating comments and requests were combined into one category (i.e., initiations) and 
targeted simultaneously for John and Casey due to low baseline performance and related 
definitions; Immediate treatment effects were observed for John for initiations and securing 
attention. John’s improved ability to initiate to peers continued as prompts were faded. 
Transitioning to treatment on a new social skill resulted in a reduction in initiations and 
especially securing attention during maintenance conditions. However, improvements were 
largely recovered for initiations and somewhat recovered for secures for attention during the 
combined treatment condition, (i.e., visual cues available for all previously targeted skills). 

During baseline, John’s contingent responses to peers were highly variable. Treatment was 
effective in stabilizing his performance on this social skill, although not at a noticeably higher 
level. These results may reflect an increased amount of peer-initiated requests directed towards 
John. Generalization to the classroom setting was minimal for all social skills, except for 
securing attention. 



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Casey demonstrated low baseline performance on all targeted social behaviors. For 
example, he expressed an average of 2.7 initiations (both comments and requests) during 
baseline. The treatment was effective in more than doubling Casey’s unprompted initiations to an 
average of 6.3 per treatment session. Slight improvements were observed following treatment on 
securing attention, as prompts were faded. Casey’s average number of unprompted secures for 
attention increased from 0 in baseline to 1.8 per treatment session. Treatment effects for 
initiations and secures for attention were not maintained without visual cues or prompts. Once 
treatment began on contingent responses, Casey demonstrated marked improvements in his 
ability to answer peer’s ves/no questions. These results may be somewhat inflated due to 
increased peer-initiated requests to Casey. Combined treatment led to improvements in all 
previously targeted social skills with the exception of responding contingently to peers. 
Decreased use of this skill may be partly explained by increased initiations to peers, and fewer 
peer-initiated requests directed to Casey. In the classroom, Casey demonstrated good 
generalization for all trained behaviors. 

Ivan demonstrated variable initiation of comments during baseline, which did not change 
with the onset of treatment. This lack of improvement was attributed to the following: (1) his 
reading skills were emergent and he often became fhjstrated when asked to read the social story 
or written social cues out loud, and (2) he disliked being singled out from his peers during the 
instruction time. Thus, the original treatment was modified slightly in the following manner: (1) 
all children took turns reading parts of the social story, and (2) a written cue was placed in front 
of each child. Following implementation of “Treatment 2,” Ivan’s frequency of comments 
steadily increased and he maintained these improvements. The treatment also was effective in 
improving Ivan’s ability to secure attention. Initiating requests and contingent responses were 





18 

relatively high frequency behaviors in Ivan’s repertoire, thus these skills were not targeted. 
Maintenance and generalization data were not assessed due to the end of the school year. 

Multiple-turn interactions. Table 3 summarizes changes in the children’s average number 
of utterances per conversational episode during a sample of the last five baseline (before 
treatment on the first social skill) and last five treatment sessions. Numbers in the table represent 
the average number of utterances per episode for five sessions. By the end of treatment, all focus 
children demonstrated increases in expression of sequential utterances related to specific topics. 
Ivan and Casey more than doubled their utterances to maintain conversational topics. Given that 
Casey rarely engaged in conversational exchanges with peers, his improved ability to take almost 
three verbal turns per topic by the end of treatment is noteworthy. 

Assessment of Social Validity 

Minimal to no changes were noted in parents’ perceptions of their child’s social 
functioning based on pre- and post-intervention completion of a Parent Perception Questionnaire. 
Judgments of the quantity and quality of changes in specific social behaviors and interactions 
between the focus children and their peers are presented in Table 4. These data were collected 
from 13 teacher and graduate student ratings of 2-minute pre- and post-intervention videotaped 
segments of social interactions. Following intervention, all 13 naive raters consistently reported 
improvements in social behaviors and reciprocal interactions between the focus children and 
their peers. There were only two instances where a rater did not judge the post-intervention 
samples better than the pre-intervention samples. Thus, based on 63 of 65 judgments, 
improvements in social interactions were readily perceptible to these judges. 

Sociometric Status Changes 

Class wide sociometric ratings were completed for the focus children and their classmates 



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prior to and at the end of study. Table 5 shows before- and after-treatment ratings for the children 
with social impairments, and class averages. With the exception of John, classmates reported 
positive changes in sociometric status for all other participants with social impairments. Further, 
these changes were all greater than the class average pre-post sociometric status differences. 

DISCUSSION 

Visually mediated intervention was effective in increasing specific social language skills 
for five elementary school-age children with social impairments in small group interactions with 
typically developing peers. A combination of static and dynamic visual stimuli resulted in 
increased frequency and/or more consistent rates of targeted social behaviors compared to 
baseline data for each focus child. Treatment effects were replicated across four different social 
behaviors with the introduction of the visually-mediated procedures. Clear experimental control 
over three targeted social skills was demonstrated by three of the five focus children, and over 
two out of three social skills for two participants. For one child (Ivan), treatment effects were not 
initially observed after initiation of the treatment. However, a modification in intervention 
procedures resulted in eventual treatment effects across two trained social behaviors for this 
child. These findings demonstrate the importance of monitoring effects and applying clinical 
judgment to individualize social interventions. 

Two participants (Dan and Greg) generalized improvements across targeted social 
behaviors. For example, Dan generalized initiating comments and requests after being taught to 
secure attention. Once Dan started calling a peer’s name to gain their attention, he would then 
ask a question or give directions. Treatment on initiating requests led to an improved ability to 
initiate comments for Greg. This generalized treatment effect possibly reflects interrelated social 
behaviors underlying initiations in general. In the classroom setting, two participants generalized 




23 



20 



treatment effects (John and Casey). John generalized his ability to secure attention and Casey 
continued to use the visual cues to secure attention, initiate comments and requests, and respond 
contingently. All participants demonstrated improved conversational abilities by engaging in 
multiple-turn dialogues on different topics. These simultaneous improvements across related 
social language skills have promising clinical implications relating to goal setting and improved 
generalization for children with social impairments. 

Overall, maintenance data across participants was limited. In the absence of visual cues 
or as new treatment phases began, three of the five participants demonstrated maintenance of 
some previously targeted social skills. These three children maintained improvements in their 
ability to initiate comments to peers, and one out of the three also maintained the ability to gain a 
peer’s attention. Data showing a general lack of maintenance across targeted social behaviors 
have important clinical implications. First, the marked or gradual return to baseline performance 
observed for some participants following removal of visually-mediated cues for a target social 
behavior suggests that the visual cues were primarily responsible for initial treatment effects. 
Second, it appears that some participants with social impairments may require more intensive 
intervention to learn certain social communication skills. For instance, the extended length of 
time necessary to effect change in securing attention and the improvements observed following 
‘booster’ treatment sessions indicate that this particular skill may be more challenging for some 
children with social impairments to learn. Premature removal of adult or peer-mediated prompts 
may lead to loss of treatment gains. These findings underscore the importance of the adult’s role 
in structuring social opportunities for children to practice using new skills. 

Social validation results confirmed the clinical significance of this treatment approach. 

First, 13 naive judges perceived meaningful changes in social interaction behaviors for both the 



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focus children and their peers based on pre- and post-intervention videotaped interactions. The 
second positive social validation finding came from the focus children’s classmates. The 
classmates, including children not involved in the triads, reported positive changes in sociometric 
status ratings for 4 of the 5 children. The lower sociometric ratings at the end of the study for 
John may have been due to a high frequency of inappropriate social skills observed in the 
classroom, as reported by the teacher. These inappropriate social behaviors generally consisted 
of facial grimaces directed to peers, yelling out in class to gain attention, and repeating scripts 
from movies and videos out loud. 

The findings of this investigation contribute to the treatment efficacy literature for 
improving communication of young children with social impairments in several ways. First, this 
research documents the potential benefits of using visually-cued instruction to improve social 
communication for children in the early elementary grades. Although it is difficult to identify 
which components of the treatment package were beneficial, a number of strategies capitalized 
on the visual modality to ameliorate social impairments. For example, written visual stimuli were 
left on the table during the activities to allow constant access to appropriate social utterances. 
These written cues also were used by the typical peers, which resulted in increased modeling of 
targeted social skills. This investigation also used soda! stories (Gray & Garand, 1993) written 
to increase the focus children’s understanding and awareness of specific social skills. The social 
stories included descriptions of situations where it would be appropriate to use the social skill, 
possible reactions of others in that social situation, and directive statements of appropriate or 
desired social responses. Finally, videotaped feedback was used in conjunction with static visual 
stimuli as a component of the treatment program. Generally, only the three oldest participants 
demonstrated consistent self-evaluation skills. Thus, this component of treatment may be more 



22 



beneficial for older, higher-functioning children who have better developed metapragmatic 
awareness. Furthermore, because there was a 2 to 5 day lapse between sessions, caution is 
warranted in stating the relative contribution of videotape feedback to changes in specific 
conversational skills. Additional research is necessary to evaluate the relative contributions of 
videotape modeling and feedback, self or peer models, and opportunities to practice skills to 
treatment outcomes. 

Thus far, the majority of intervention literature on improving social interactions of 
children with FDD has focused on preschoolers (English, et al., 1997; Goldstein & Cisar, 1992), 
adolescents (Haring & Breen, 1992; Schnorr, 1997), or elementary school children with low IQs 
and moderate to severe developmental delays (Kamps, Locke, Delquadri, & Hall, 1989; 
Mundschenk & Sasso, 1995). In contrast, all participants in this study were partially or fully 
included in regular education classes, had emergent or acquired reading skills, and were verbal 
communicators. The findings of this study augment other research efforts that seek to guide 
procedural decisions and program planning for effective social intervention for children with 
FDD and autism. 

In summary, this study examined the effects of a visually-mediated intervention on the 
social communication of five elementary students with social impairments associated with FDD. 
The visual strategies were effective in improving specific social communication skills of the 
focus children as they interacted with peers without disabilities. Capitalizing on the visual 
modality resulted in higher rates of socially desirable behaviors, with generalized treatment 
effects observed across untrained behaviors. General education teachers and graduate students 
unfamiliar with the study socially validated improved reciprocal social interactions. Improved 
relationships with other classmates not involved in the intervention were noted based on positive 



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23 



changes in sociometric status. These findings support recommendations for using visually-cued 
instruction to guide the social development of children with social impairments (Quill, 1997; 
Schuler, 1995), and add to the scant literature available for effective social intervention supports 
and strategies for elementary students with more developed language and reading skills. 



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Appendix A 

Social Conversational Skills Checklist 

(Thiemann, 1997; adapted from Prutting & Kirchner, 1987) 

Name; Date:_ Age; 

Observer; Setting; 

Relationship of Social Partner;. 



Social Skills; 


Consistently 


Occasionally 


Inappropriate 


Not observed 


Comments (examples or note lack of 
opportunity to observe) 


1. Nonverbal Discourse Skills: 

a) Communicative gestures (points, waves) 

b) Eye gaze (e.g., eye contact, to signal attention) 

c) Proximity (e.g., appropriate distance to partner) 

d) Physical contacts (uses approp. touch to gain atten) 

e) Facial expression (e g,, uses positive, negative, or 
neutral expressions as appropriate) 




Pp^ 


w 
























































2. Paralanguage Skills: 

a) Vplume/intensity (varies with setting) 

b) Intonation (prosody and stress patterns) 

c) Fluency/rate (smoothness/speed) 

d) Pitch/quality (appropriate for age and setting) 




'A 




Wm 












































3. Verbal Discourse Skills: 

a) Initiates topics, games, activities with others using 
different speech acts (e g., requests, comments) 

b) Introduces new topics within social interactions 

c) Takes other’s perspective (e.g., comments on peer’s 
topic) 

d) Maintains topics with more than 5 verbal turns 

e) Asks different questions (e.g., what, where, why) 

0 Contributes relevant comments to the conversation 

g) Gives verbal/nonverbal feedback to the listener (e.g., 
nods head, ‘‘mhmm”) 

h) Recognizes pauses or eye gaze as turn signals (i.e., 
knows not to interrupt speaker) 

i) Recognizes and repairs breakdowns (e.g.. requests 
clarification, responds to peers requests) 

j) Adjusts message based on listener’s knowledge of 
the event (i.e., provides background information) 

k) Uses socially polite words (e.g., please, thank-you) 








wMM. 




















































































































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Appendix B 
Social Story Stimuli 



25 



Example Social Story: 

“Getting Friends to Look” 

Friends like playing with different toys and games. 

Friends like to show each other what they are doing. 

Sometimes a friend calls my name and says “look.” 

This means they want to show me something, and they like it if I look. 

I can try to call my friend’s name or say “look” to show them what I am doing. 

Comprehension Questions for Social Story “Getting Friends to Look”: 

1 . What can friends show each other? 

2. Do friends say your name to get you to look at them? 

, 3 . If a friend calls your name, what should you do? 

4. Do they like it if you don’t look at them? 

5. What can you say to get your friends to look at you? 




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TABLES 



Table 1 

Particioants’ Test Performance 


Participants 


Test performance 


Casey (6:6) 


Greg (7:6) 


John (8:2) 


Ivan (12:2) 


Dan (11:6) 


CARS 


36 


39.5 


35 


30 


25 




Mild to Mod 


Severe 


Mild to Mod 


Mild to Mod 


Non-Autistic 


PPVT-R 


<40 


<41 


<40 


64 


67 


TOLD-2 Primary: 












Oral Vocabulary 


2P 


IP 


IP 






Grammatic Understanding 


<1P 


<1P 


IP 






Grammatic Completion 


2P 


IP 


IP 






CELF-3: 












Sentence Assembly 








IP 


2P 


Formulated Sentences 








IP 


IP 


Recalling Sentences 








IP 


IP 


TONI-2 


37P 


19P 


9P 


3P 


3P 


SSRS: 












Parent Report: 












Social Skills 


60 


71 


84 


68 


84 


Problem Behaviors^ 


100 


131 


110 


118 


100 


Teacher Report: 


Pre- Post- 


Pre- Post- 


Pre- Post- 


Pre- Post- 


Pre- Post- 


Social Skills 


82 84 


59 91 


106 103 


59 91 


82 87 


Problem Behaviors 


120 113 


135 115 


135 120 


135 115 


106 112 


WRMT-R: WI Subtest 


120 


65 


77 


65 


87 



Note. All scores reported are Standard Scores with the exception of Raw Scores reported for the CARS 
and percentiles reported for TOLD-2 Primary, CELF-3, and TONI-2. 

“Problem Behaviors scale on the SSRS assesses negative behaviors, therefore higher scores = more 
problem behaviors than the average student in the standardization comparison group. 

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hiaifiiifftaiTi-Taaa 



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Table 2 

Definitions for Appropriate and Inappropriate Social Language Measures 



Appropriate Social Skills 



Description 



Contingent Response 
(CR) 



Securing Attention (SA) 



Initiating Comments 
(1C) 



Initiating Requests (IR) 



Coded if the target child’s utterance is contingent upon a peer ’s immediate 
prior utterance, within a 2-second interval following the peer’s utterance, 
through (a) acknowledging (e g,, “hmm”) and direct or partial repetition of 
the utterance, (b) agreeing (e g., head nod, "y^ah”), (c) answering peer’s 
question(s), (d) responding with a related comment about observable objects 
or events within the ongoing activity, (e) confirming/clarifying a question or 
comment from the peer (e g:, ‘‘What did you say?”). 

Coded if the target child (a) requests attention or acknowledgement from 
peers (e.g., “Hey!” “See this?” or “Look.”), (b) calls the peer’s name to gain 
attention, or (c) uses gestures or vocalizations to establish joint attention 
with the peer (e g., taps on shoulder, hold an object up to show peers). 
Descriptive comments that are related to the ongoing topic/event, but not 
contingent upon a peer’s prior utterance and not used to request information, 
and the target child (a) provides a comment following a 3-second interval 
after a peer’s last utterance, (b) initiates a new idea or topic that relates to the 
ongoing joint activity/topic, but is not a request, (c) compliments the peer 
(e.g., “You did it!”) or himself, (d) reinforces the peer for winning, (e) 
expresses enjoyment to the peer regarding their interaction together (e.g., 
“This is fun!”). Note: Child’s utterances coded as IC if it met the criteria of 
(b) to (e) and if within the 3-second interval. 

Coded if target child’s utterance is related to the ongoing topic/event, but not 
contingent upon a peer’s prior utterance and not used to clarify something 
the peer said (would be CR), and the target child requests information or 
actions following a 3-second interval after a peer’s last utterance.. 



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(Table 2 Continued) 

Inappropriate Social Skills Description 



Topic Change (TC) 



Unintelligible (UN) 
Other (OT) 

No Response (NR) 



Coded with or without a change in materials/games if the target child: (a) 
interrupts (definite overlap of words) a peer to introduce a new topic that 
has not been discussed previously, or to reintroduce a previous topic, (b) 
changes the topic to something unrelated to and noncontingent upon the 
peer’s prior utterance, (c) comments tangential to some aspect of the peer’s 
previous utterance, but there is an ambiguous semantic referent not 
immediately recognizable, (d) verbal turns that follow a TC are coded as 
CR, IC, IR, SA if the conversation follows the changed or shifted topic. 
Utterances that are not interpretable or are unintelligible to the coder on- 
line and after listening to the audiotape a maximum of three times. 

Code as “Other” any (a) animal noises or other vocalizations, (b) 
stereotypic or perseverative utterances (considered perseverative on the 
THIRD utterance - code as OT; if another child speaks or the child 
continues the perseveration at a later time, start over and code the first two 
utterances as they are defined), (c) delayed echolalia that is non-interactive 
or perseverative 

Child does not respond verbally or nonverbally within 3 -seconds to a 
peer’s requests for: (a) information, requests for actions, or protests, (b) if 
the child is performing an action requested by the peer that takes longer 
than 3 -seconds, wait to see if he completes the task and give him credit if 
he does, or (c) if the peer asks the same question again within the 3-second 
interval, the utterance is not coded, and the time frame starts at 0 after the 
peers second question; if the child does not respond after the peer repeats 
themselves 2 or more times, code as “NR”. 




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29 



Table 3 

Average Number of Target Children's Utterances per Conversational Episode 
Based on Last Five Baseline and Last Five Treatment Sessions 



Session Type 



Participant 


Baseline 


Treatment 


Casey 


0.6 


2.9 


Greg 


3.8 


5.1 


Jolm 


2.4 


4.1 


Ivan 


2.4 


4.9 


Dan 


1.9 


3.4 



Table 4 



Summary^ of Teacher and Graduate Student Social Validity Ratings Pre- and Post-Intervention 



Child 






Teacher Ratings 




Graduate Student Ratings 






Pre-Tx 


Post-Tx 


Pre-Tx 


Post-Tx 




M 




M 




M 




M 




Casey 


Tc» 


1.7 


1.7 


3.2 


2.2 


1.4 


0.8 


2.7 


2.8 




ph 


2.8 


4.0 


4.1 


1.0 


1.6 


2.6 


3.4 


3.0 


Greg 


TC 


2.2 


3.3 


3.7 


2.7 


2.2 


1.5 


4.2 


0.8 




P 


3.6 


4.2 


4.3 


1.5 


2.9 


3.1 


4.1 


0.4 


John 


TC 


1.4 


1.3 


3.3 


1.6 


1.9 


1.2 


3.5 


1.0 




P 


1.8 


3.2 


3.6 


1.1 


1.8 


1.6 


4.0 


1.7 


Ivan 


TC 


2.0 


2.3 


4.3 


1.3 


2.1 


1.2 


4.1 


1.6 




P 


1.5 


2.3 


4.1 


0.4 


1.2 


1.2 


3.9 


2.2 


Dan 


TC 


2.7 


1.8 


4.0 


1.7 


2.3 


2.7 


3.0 


2.0 




P 


3.0 


3.3 


4.7 


1.2 


2.0 


3.5 


4.0 


1.7 



Note. 1 = No active involvement in activity, verbal initiations, or responses to peer's comments, 5 = 
Better than average engagement in these 3 behaviors. 

"^TC = Target child's social behavior ratings. = Peer's social behavior ratings. 



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Table 5 

Summary of Sociometric Status Before and After Visually-Mediated Treatment 

Before Tx After Tx Pre-Post Class-Wide 



Participant M SD M SD Change M Change 



Casey 


.2.19 


.83 


2.38 


.38 


.19 


.06 


Greg 


2.31 


.87 


2.69 


-.19 


OO 


.06 


Jolin 


1.94 


.93 


1.75 


.21 


-.19 


.06 


Ivan 


2.00 


.75 


2.21 


.30 


.21 


.17 


Dan 


1.83 


.72 


2.13 


.69 


.30 


.19 


Note. Based 


on class-wide ratings 


; on a 


scale of 1 to 3 


with 1 == 


Doesn’t like to play 



3 = Likes to play with. 



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Number of Behaviors per 10-Minute Session 



Figure 1. Frequency of Appropriate Social Language Skills During Baseline, Treatment, 
and Maintenance Social Activities. 



31 





Number of Behaviors per 10-Minute Session 




Figure 2. Frequency of Coded Social Language Skills During Baseline, Treatment, 
Maintenance, and Classroom Social Activities. 




Number of Sessions 



30 



35 



40 



Number of Behaviors per 10-Minute Session 



Figure 3. Frequency of Coded Social Language Skills During Baseline, Treatment, 
Maintenance, and Classroom Social Interactions. 



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Number of Sessions 



f-r 



40 ■ 

30 - 

20 - 

10 - 

0 ■ 

40 ■ 

30 - 

20 - 

10 ' 

0 

40 

30 

20 

10 

0 

40 ' 

30 

20 

10 

0 



3H 

Frequency of Coded Social Language Skills During Baseline, 
it, Maintenance, and Classroom Social Interactions. 

Initiates Comments and Requests 





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Number of Behaviors per 10-MinuteSession 



3 ^ 

Figure 5. Frequency of Appropriate Social Language Skills During Baseline, Treatment, 
and Maintenance Social Activities. 




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PROJECT IMPACT 



Implications of Findings. 

(1) The outcomes of this research generate new knowledge on the effectiveness of an 
intervention that capitalizes on the visual modality to remediate social deficiencies. The 
results may directly influence early intervention efforts for improving reciprocal social 
interactions between young children with PDD and their peers in inclusive classrooms. 

(2) Implementing this intervention in the early elementary grades may have a significant 
impact on later emotional, cognitive and language development, and possibly prevent 
continued social difficulties in adulthood. 

(3) The results add to the scant literature available on effective intervention strategies for 
young children with PDD who exhibit basic expressive language and reading skills. 

(4) The results extend research investigating the role of typical peers as mediators of social 
interventions for elementary students with social impairments. Although only limited 
peer training was provided, it was evident that involving peers as conversational partners 
contributed to the focus children’s success. Interacting with peers during typical social 
activities created multiple opportunities for the focus children to respond to and use a 
variety of functional social communication skills. Involving typical peers as 
conversational partners contributed to the children’s acceptance among classmates not 
involved in the intervention. 

Dissemination Activities: 

(1) Thiemann, K. S. & Goldstein, H. (July, 1999). Effects of Visually-Mediated Intervention 
on the Social Communication of Children with Pervasive Developmental Disorders. 
Poster presented at the annual OSEP Leadership Project Director’s Conference, 
Washington, DC. 

(2) Thiemann, K. S. & Goldstein, H. (November, 1999). Effects of Visually-Mediated 
Intervention on the Social Communication of Children with Pervasive Developmental 
Disorders. Poster presented at the Annual Convention of the American Speech-Language 
and Hearing Association, San Francisco, CA. 

(3) Thiemann, K. S. (July, 1999). Guiding Social Development Through Visual- and Peer- 
Mediated Approaches. In-service presented to the Center for Autism and Related 
Disabilities, Florida State University, Tallahassee, FL. 

(4) Thiemann, K. S. (February, 2000). Enhancing Friendships Between Children with 
Autism Spectrum Disorders and Their Peers. In-service presented to Valparaiso 
Elementary School, Okaloosa County, FL. 

(5) Thiemann, K. S. (June, 2000). Enhancing Social Competence and Friendships of High- 
Functioning Elementary Students with Autism Spectrum Disorders. Presentation at the 
Institute on Autism at Florida State University, Tallahassee, FL. 

(6) Thiemann, K. S. (February, 1999). Picture My Words; Visual Strategies for Improving 
Social Skills of Elementary School-Age Children. Social intervention manual provided to 
the Florida State University Center for Autism and Related Disabilities, Tallahassee, FL. 



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PLANNED FUTURE ACTIVITIES 

(1) Research findings will be submitted for presentation at regional and national conferences 
on early intervention/education for children with disabilities in the upcoming year. 

(2) Continued in-service training for local and/or regional educators and speech-language 
pathologists as invited. 

(3) Investigators will be submitting manuscript for publication to appropriate journals. 



We assure that copies of the full final report has been sent to: 

(1) Ms. Rose Sayer, Office of Special Education 
US. Department of Education 

400 Maryland Avenue SW 
Switzer Building Room 33 1 7 
Washington, D.C. 20202-2626 

(2) ERIC/OSEP Special Project 

ERIC Clearinghouse on Handicapped and Gifted Children 
Council for Exceptional Children 
1920 Association Drive 
Reston, Virginia 22091 

We assure that the copies of the title page and abstract have been sent to: 
Peggy Hensley 

NECTAS Coordinating Office 
137 East Franklin Street, Suite 500 
Chapel Hill,NC 27514-3628 



ASSURANCE STATEMENT 





Kathy Thiemann, MA 
Student Investigator 



Howard Goldstein, Ph D. 
Principal Investigator 





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REFERENCES 

Brinton, B. , & Fujiki, M. (1984). Development of topic manipulation skills in discourse. 
Journal of Speech and Hearing Research, 27, 350-358. 

Bristol, M„ Cohen, D., Costello, E., Denckla, M., Eckberg, T., Kallen, R., Kraemer, H., 
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