Exploring the Social Inclusion of High Functioning Children with Autism in Regular Education Classes: Current Interventi

1. Exploring the Social Inclusion of High Functioning Children with Autism in Regular Education Classes: Current Interventions and Future Needs Erin Rotheram-Fuller, Ph.D. Temple University

2. Goals Explore current methods of assessing socialization among children with autism. Learn about the �Friendship Survey� as an assessment tool and intervention guide. Examine differences in the level of social inclusion of high functioning children with autism across the elementary school years using the Friendship Survey. Review the preliminary results of a new intervention trial to improve social inclusion.

3. Social Lives of Children at School School is about academics�. Unless you ask children�.. More about connecting to friends, and having fun Extensive data on connection between social ability and academic success

4. Social Lives of Children with Autism Social impairment--huge disadvantage for children entering school Consistent across age, ability Families invest great amounts of money to tutor children with ASD on �social skills�

5. What does high-functioning autism look like? http://www.youtube.com/watch?v=m5x0aJ3xIrw&feature=related

6. Adapted from Wing, L. (1995). The relationship between Asperger's syndrome and Kanner's autism. In U. Firth (Ed.), Autism and Asperger Syndrome (pp. 93-121). Cambridge, MA: Cambridge University Press.

8. What we know about children with autism�s desire for socialization. Report a desire for social connectedness (Bauminger & Kasari, 2000; Chamberlain et al., 2007)

9. Loneliness at School Replicates previous workReplicates previous work

10. Loneliness at School Replicates previous workReplicates previous work

11. Loneliness at School Replicates previous workReplicates previous work

12. Inclusion ? Intervention? Push for inclusion (Fuchs & Fuchs, 1994) Inclusion vs. Specialized Services Debate Exposure to: Typical models Standard curriculum Activities But is inclusion enough to be considered THE intervention?

13. Inclusion ? Intervention Inclusion is insufficient to socially engage children with autism with their typical peers. (Burack et al., 1997; Chamberlain et al, 2007) More often neglected & rejected (Church et al., 2000; Ochs et al., 2001) More isolated, & less responsive to others on playground (Sigman & Ruskin, 1999) Teachers less willing to accept children in regular classrooms (McGregor & Campbell, 2001)

14. Reciprocated Best FriendsChamberlain, Kasari, & Rotheram-Fuller, 2007

15. How do we measure the success of inclusion?

16. Current Methods to Evaluate Inclusion Academic success Grades (keeping up with peers) Standardized testing Social success Measure specifically targeted social skills Initiations, responses, number of interactions Does the child interact with peers socially? Anecdotal reports from teachers and TSS Does the child feel socially successful? Self-report of friendships by the child with autism Self-report of loneliness Do other peers in the class feel the child is an important part of the class? Social networks from correlated student reports.

17. Social Networks Ecological structure within which friendships develop Focus on reciprocity of classroom social relationships & peer acceptance Simple nomination procedure that has been previously validated, and effective with as few as 50% of the class (Cairns & Cairns, 1994)

18. Friendship survey Are there any kids in your class that you like to hang out with? Circle the top 3, & star the best friend. Do you see that best friend just at school? Are there any kids in your class that you don�t like to hang out with? Are there kids in your class who like to hang out together? Draw a circle around each group. Prompt: be sure to think of both boys and girls.

19. 1. Are there any kids in your class that you like to hang out with? Indegrees: number of classmates that nominate a child as one of their friends. Acceptance: z-score within the class of the number of indegrees received by each student. Outdegrees: number of classmates that a child nominates as a friend. Reciprocal Top 3: Number of times a child nominated a classmate as in their top 3 closest friends in the class, in which that classmate also nominated them (if the classmate did not complete the measure, the result is missing data, not counted as a non-reciprocal friendship). Reciprocal Best Friend: Same as Top 3, but with top 1.

20. 2. Are there any kids in your class that you don�t like to hang out with?  Rejection: Number of times a child was nominated as being not liked by classmates.

21. 3. Are there kids in your class who like to hang out together? Class of: Chris Jane John Lisa Mark Rebecca

22. Drawing the social network map

23. 3. Are there kids in your class who like to hang out together? Number of Social Connections Male and Female connections Social Network Centrality 0 = Isolated 1 = Peripheral 2 = Secondary 3 = Nuclear

24. Social Network Map

25. Study Design

26. In Los Angeles Unified School District, there are about 750,000 children. LAUSD spans a distance of 30 miles East to West, and 55 miles North to South. Containing 219 year-round and 429 traditional schools.

27. LAUSD Demographics

28. Demographics of Children with Autism

29. Reciprocal Top Friendships by Grade Group

30. Acceptance by Grade Group

31. Rejection Nominations from Peers by Grade Group

32. Social Outcomes by Grade

33. Social Network Centrality

34. Grade Related Differences in Social Inclusion Social inclusion of children with autism shows a different pattern to typical peers. Social difficulties are especially apparent for children with autism in the older grades. Some possible explanations: Delayed cognitive skills Decreased school resources Shared Activities

35. Shifts in School Activities

36. So what do we do once we have identified the problem?

37. Current Interventions ABA Floortime Gluten Free, Casein Free Diet (GFCF) Occupational Therapy PECS Relationship Development Intervention SCERTS Sensory Integration Therapy Speech Therapy TEACCH STAR Verbal Behavior Intervention

38. Current Interventions In practice�.most standardized programs are done off campus, and by private clinicians. Video-self-modeling (Bellini et al, 2007) Friendship training (Frankel, 2008) Emotion knowledge/regulation training (Bauminger, 2002; Solomon, et al., 2004) On-school campus programs include: Lunch bunch approach 1:1 aide (TSS)

39. Common Targets of Social Interventions Communication skills Initiations, responses, joint attention, conversations, pragmatics, prosody, etc. Play skills Symbolic play, interactive play, collaborative play, competitive play Challenging/Disruptive Behaviors

40. Evaluation of Current Interventions Several recent reviews: Conclusion-- �not very effective� (Bellini, 2007; Rao, et al, 2008; White et al, 2008). Why? Treatments mostly limited: In focus�.child alone In time�.little follow up In generalization�. to new contexts In transfer�. to more global skills Not connected to individual needs of children. So 2 of our treatment studies focus on children�s peer interactions and friendships. We think this is a particularly important area because of what we currently know of children�s peer relationshipsSo 2 of our treatment studies focus on children�s peer interactions and friendships. We think this is a particularly important area because of what we currently know of children�s peer relationships

41. How are interventions selected in daily practice?

42. How are interventions selected in daily practice? Familiarity Ease of implementation Available resources

43. How can we improve the use of validated interventions in practice? Know what to target: Good assessment of skill deficits or social problems. Make interventions adaptive to multiple environments. Compare interventions to identify which is most effective with which children, in which settings.

44. Recently Completed Randomized Control Trial 60 Children with autism 6-week intervention 2x/week for 20 min, in school 4 groups: Child with Autism 3 Typical Peers Combination: separate but concurrent Control 3 month follow-up evaluation

45. Baseline Social Network Results Unique part of this research is that each child is seen within their own classrooms. As you can imagine, classrooms differ greatly, and it is important to obtain accurate information at a particular time in the child�s lifeUnique part of this research is that each child is seen within their own classrooms. As you can imagine, classrooms differ greatly, and it is important to obtain accurate information at a particular time in the child�s life

46. Picking typical peers for intervention Teacher nomination � suggesting report of likelihood to participate and interact with the child with autism. High salience within the class network Other students likely to follow the model peer�s behavior.

47. Primary Intervention Components Interactive play with the children in natural environment. Concrete description of desired behavior. Modeling of desired behavior. Opportunities to practice.

49. Preliminary Treatment Changes Combination Tx: Effect size large (1.0) Peer Tx: Effect size medium (.60) Unique part of this research is that each child is seen within their own classrooms. As you can imagine, classrooms differ greatly, and it is important to obtain accurate information at a particular time in the child�s lifeUnique part of this research is that each child is seen within their own classrooms. As you can imagine, classrooms differ greatly, and it is important to obtain accurate information at a particular time in the child�s life

50. How do the children with autism see their Friendship Quality? Feelings of �Closeness� with peers before to after the intervention.

51. How do the children with autism rate their loneliness? Change in Dyadic Loneliness from before to after treatment.

52. Change in the number of Social Connections before to after treatment. Unique part of this research is that each child is seen within their own classrooms. As you can imagine, classrooms differ greatly, and it is important to obtain accurate information at a particular time in the child�s lifeUnique part of this research is that each child is seen within their own classrooms. As you can imagine, classrooms differ greatly, and it is important to obtain accurate information at a particular time in the child�s life

53. Key Findings Can make changes with brief intervention (6 weeks, 12 sessions) Peer and combination treatments most effective Suggests that typical peers should be involved in treatments at school for children in inclusive settings To truly change situation for children at school we must try to improve the school environment With peers and teachers

54. Next Steps Identify the specific resources needed to implement the interventions in school settings. Use class-wide interventions to improve classroom cohesion for all students. Develop more studies to directly compare interventions in the same settings.

55. Acknowledgements Connie Kasari, Ph.D. Tracy Guiou Steve Johnson Jill Locke Amanda Gulsrud Brandt Chamberlain Nirit Bauminger Lisa Lee Nancy Huynh Eric Ishijima Mark Kretzmann