The Centers for Disease Control and Prevention estimates that 1 in 68 children in the United States have an autism spectrum disorder (ASD). With the rising cost of educational services for these children and fiscal challenges that school districts face, it is imperative to identify cost-effective autism-related interventions that are easily implemented and sustained in schools. Social impairment represents the most challenging core deficit of ASD and greatly affects children’s school experiences; however, few evidence-based social engagement interventions have been implemented and sustained in school settings. The Autism Intervention Research Network in Behavioral Health (AIR-B) is a multi-site research network that focuses on the deployment of effective and sustainable evidence-based interventions to improve outcomes for children with ASD in community settings. Currently three network partners (i.e., University of California, Los Angeles, University of Pennsylvania, and the University of Rochester) are working in large, urban, under-resourced public school districts to implement a promising social engagement intervention called Remaking Recess.
Remaking Recess was developed to address the significant difficulties that children with ASD encounter on school playgrounds. Children with ASD consistently are less engaged with peers on the playground and are more often on the periphery of the classroom social networks than are their typically developing classmates (Chamberlain, Kasari, & Rotheram-Fuller, 2007; Rotheram-Fuller, Kasari, Chamberlain, & Locke, 2010; Kasari, Locke, Gulsrud, & Rotheram-Fuller, 2011; Kasari, et al., 2012; Locke, Kasari, Rotheram-Fuller, Kretzmann, & Jacobs, 2013).
In two previous studies, Remaking Recess was found to be efficacious in improving children’s peer engagement and social inclusion at school when delivered by study personnel (Kasari, Rotheram-Fuller, Locke, & Gulsrud, 2012; Kretzmann, Shih, & Kasari, 2014). In this study, we are evaluating whether we can obtain similar outcomes when Remaking Recess is delivered by school personnel for children with ASD included in K-5th grade classrooms.
Remaking Recess was designed to transfer skills from the research team to school personnel using consultation and in vivo coaching to change the playground and cafeteria contexts to be more supportive and inclusive of children with ASD (Kretzmann et al., 2014; Locke et al., 2014). The consultation sessions included modules on how to:
- scan and circulate the cafeteria/playground for children who may need additional support
- identify children’s engagement states with peers
- follow children’s leads, strengths, and interests
- provide developmentally and age appropriate activities and games to scaffold children’s engagement with peers
- support children’s social communicative behaviors and conversations with peers
- create opportunities to facilitate reciprocal social interaction
- help children sustain engagement within an activity/game with peers
- coach children through difficult situations should they arise
- provide direct instruction on specific social engagement skills
- individualize the intervention to specific children to ensure the applicability of the intervention to multiple children
- work with typically developing peers to engage children with autism
- fade out of an activity/game to foster children’s independence.
We designed the study with our school partners to minimize: 1) the burden on participating school personnel; and 2) the interruption to regular school activities. The majority of study activities take place with participating children and staff during unstructured times such as recess or lunch periods, usually outside of the classroom. Participating school staff members are receiving 12-16 consultation sessions (approximately 30-45 minutes each session distributed over three months); sessions are tailored to meet the individual needs of the target student and the policies and characteristics of the school. All activities are built around children’s strengths and embedded into children’s daily activities, in the setting where staff are already working. For example, if we are working with a student who enjoys running, we coach school personnel to select age-appropriate activities that involve running (e.g. variations of tag, Red Light/Green Light, relay race, Steal the Bacon, etc.), set boundaries and rules to provide structure, and work with peers to provide encouragement and sustain engagement. If we are working with a student who has a repetitive interest (e.g., Mario, Spongebob, trains, etc.), we coach school personnel to facilitate non-traditional games that involve those interests such as character-themed obstacle courses or fantasy/pretend games. This randomized controlled wait list design study is currently underway and our hypothesized outcomes are based on our previous studies in which study personnel implemented Remaking Recess (Kasari et al., 2012; Kretzmann et al., 2014).
Thus, our two main outcome measures are peer playground engagement and social network inclusion. Based on these previous studies, we will examine whether children with ASD spend less time alone and more time engaged in a joint activity or game with a peer following intervention, and whether children with ASD will be increasingly included in social networks. We will examine social networks using maps as seen in Figures 1 and 2. Anecdotal reports from our research team suggest that, with consultation, school personnel can improve peer engagement by facilitating opportunities for children with ASD to join activities such as games and subsequently removing themselves from those activities. In addition, our research team reports that involving peers to engage children with ASD in an activity is more effective and meaningful than having the adult engage the child. Although we do not yet know the results of our current study, one thing is clear: schools need novel and easy-to-implement intervention strategies to give children with autism the opportunity to have rich social experiences – experiences that are frequent and natural for typically developing children and necessary for an enriching and positive school experience.
Figure 1. Below is a depiction of a classroom social network administered prior to intervention, at Time 1. All of the names have been changed to protect our participants’ confidentiality. Each line represents a connection between children. Joe is the target student with ASD. He was nominated by his classmates zero times during the pre-intervention survey. Therefore, he was classified as an “isolate” (he was not included in a group).
Figure 2. After the intervention, at Time 2, Joe was nominated to a group six times by classmates, belonged to a group with a status of eight (the number among the web) suggesting he improved his social network inclusion over time. He was classified as “secondary” indicating he was well connected and salient in the classroom.
Jill Locke, PhD, is an assistant professor at the Center for Mental Health Policy and Services Research and the Center for Autism Research at the University of Pennsylvania. Mark Kretzmann, PhD, is a post-doctoral scholar at UCLA’s Semel Institute for Neuroscience and Human Behavior. Tristram Smith, PhD, is an associate professor of pediatrics at the University of Rochester Medical Center. David Mandell, ScD, an associate professor of psychiatry and pediatrics at the University of Pennsylvania. Dr. Mandell also directs the Center for Mental Health Policy and Services Research, and is Associate Director of the Center for Autism Research at The Children’s Hospital of Philadelphia. Connie Kasari, PhD, is Professor of Psychological Studies in Education and Psychiatry at UCLA.
Correspondence should be addressed to: Jill Locke PhD, Center for Mental Health Policy & Services Research, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104. firstname.lastname@example.org. http://www.airbnetwork.org.
Chamberlain, B., Kasari, C., & Rotheram-Fuller, E. (2006). Involvement or isolation? The social networks of children with autism in regular classrooms. Journal of Autism and Developmental Disorders, 37, 230-242.
Kasari, C., Locke, J., Gulsrud, A., & Rotheram-Fuller, E. (2011). Social networks and friendships at school: Comparing children with and without autism. Journal of Autism and Developmental Disorders, 41, 533-544.
Kasari, C., Rotheram-Fuller, E., Locke, J., & Gulsrud, A. (2012). Making the connection: Randomized controlled trial of social skills at school for children with autism spectrum disorders. Journal of Child Psychology and Psychiatry, 53, 431-439.
Kretzmann, M., Shih, W., & Kasari, C. (2014). Improving peer engagement of children with autism on the school playground: A randomized controlled trial. Behavior Therapy. http://www.sciencedirect.com/science/article/pii/S0005789414000550
Locke, J., Kasari, C., Rotheram-Fuller, E., Kretzmann, M., & Jacobs, J. (2013). Social network changes over the school year among elementary school-aged children with and without an autism spectrum disorder. School Mental Health, 5, 38-47.
Locke, J., Olsen, A., Wideman, R., Downey, M.M., Kretzmann, M., Kasari, C., & Mandell, D.S. (2014). A tangled web: The challenges of implementing an evidence-based social engagement intervention for children with autism in urban public school settings. Behavior Therapy. http://www.sciencedirect.com/science/article/pii/S000578941400074
Rotheram-Fuller, E., Kasari, C., Chamberlain, B., & Locke, J. (2010). Grade related changes in the social inclusion of children with autism in general education classrooms. Journal of Child Psychology and Psychiatry, 51, 1227-1234.