Research 1 Autism

Journal of Autism and Developmental Disorders, Vol. 30, No.
5, 2000
Interventions That Facilitate Socialization in Children

with Autism
Sally J. Rogers1
Social dysfunction is perhaps the most defining and handicapping feature of autism. Improved
social functioning has long been considered one of the most important intervention outcomes.
A variety of social interventions have been designed, empirically examined, and published in
the autism literature. Children with autism have been found to be responsive to a wide varie-
ty of interventions aimed at increasing their social engagement with others, both adults and
peers. Successful strategies employing peer-mediated approaches and peer tutoring have in-
volved typically developing peers. Furthermore, several studies have demonstrated that social
engagement directly affects other important behaviors like language, even when these be-
haviors are not specifically targeted by the teaching program. Thus, while an area of severe
involvement, social behavior is also responsive to intervention.
KEY WORDS: Social dysfunction; autism; social interventions.
INTRODUCTION of the acquisition of the behavior, maintenance of

the behavior under more natural reinforcement condi-
Social dysfunction is the single most defining fea- tions, and generalization to other settings, persons, and
ture of autism (Kanner, 1943) and arguably its most behaviors.
handicapping as well. From the beginning, improved While earlier efforts in the field involved adult-
social functioning has been considered one of the most directed teaching, with demonstrated effectiveness, the
important intervention outcomes. A variety of social field has moved to more careful attention to the ecol-
interventions have been designed, empirically exam- ogy of children’s social interactions in natural settings,
ined, and published in the autism literature. These in- with a concurrent shift to a greater focus on social
terventions differ in a variety of ways: the age group interactions with peers. As Simpson, Myles, Sasso, and
of the people with autism involved, the target behav- Kamps (1997) have pointed out, adult-directed instruc-
ior of the intervention (initiation, response, mainte- tion in social skills has not been grounded in natural
nance), the kind of social partner involved: peer or contexts and use of typical stimuli and reinforcers.
adult, the intervention strategy used, and the charac- Many current approaches, such as incidental teaching
teristics of the intervenor: adult or peer. Almost all of and various peer-mediated strategies, are built upon
the published interventions represent a behavioral careful prompting and shaping of child behaviors by
methodology, involving careful definition of the target typical peers embedded in child-initiated interactions
behaviors to be acquired, increased, or diminished, de- within natural contexts. Peer interactions may take sev-
finition of the antecedents and consequences of the eral forms. Peers may be taught to initiate the interac-
behavior, the use of task analysis, and measurement tion, or they may be taught to respond to the child with
autism whose initiation is prompted by another person.
1
University of Colorado Health Sciences Center, JFK Partners, 4200 Finally, peers may be taught to be tutors for both school-
East 9th Avenue, Campus Box C–234, Denver, Colorado 80262. work and recreational activities.
399
0162/3257/00/1000-0399$18.00/0 © 2000 Plenum Publishing Corporation
400 Rogers
This paper reviews some of the social interven- ners, adding convergent validity to the impact of this
tions with demonstrated empirical support that have model on social development of young children with
been described in peer-reviewed journals in order to autism.
identify additional research needs and future directions.
This is not meant as an exhaustive review; rather, the
Interventions That Enhance Preschoolers’
papers are representative of the peer-reviewed publi-
Interactions with Other Adults
cations available in the literature, most of which in-
volve single-subject designs. The paper is organized Two approaches for increasing interactions with
both by age group and by type of intervention used, be- teachers or other therapists have been demonstrated
ginning with interventions to improve preschoolers’ so- using multiple baseline approaches. One approach,
cial interactions with parents, other adults, and peers, coming from the work of Schreibman using pivotal re-
then moving to school-age children’s interactions with sponse training (PRT), was described in several publi-
adults and peers, and closing with three different in- cations by Stahmer, Schreibman, and colleagues. In
terventions to build adolescent interactions with peers. pivotal response training, certain behaviors are seen as
central to wide areas of functioning. Changing pivotal
behaviors is thought to affect change in other associ-
INTERVENTIONS FOR FACILITATING
ated behaviors without specifically targeting them.
SOCIAL INTERACTIONS IN PRESCHOOLERS
Stahmer (1995) compared two interventions—symbolic
play training and language training—using pivotal re-
Interventions That Enhance Parent–Preschooler
sponse techniques, including child choice and rein-
Interactions
forcing attempts, among others, with seven preschool-
Two published papers have focused on increasing aged children with autism who had some verbal skills.
interactions of very young children with their parents. In addition to demonstrating increases in the targeted
Both of these studies involve noncontrolled group de- symbolic play skills, the children demonstrated in-
signs without reversals or other methods that unequiv- creased positive responses to adult initiations and
ocally demonstrate a causal relationship. Dawson and smaller increases in initiations to adults in the play
Galpert (1990) described a pre–post study of 14 chil- training, but not the language training, intervention.
dren, ages 20 to 66 months, and their mothers. The in- These results were maintained for 3 months after the end
tervention involved teaching the parent to imitate the of treatment and generalized over settings and other
child in play with toys for 20 minutes each day for adults, but not peers.
2 weeks. Follow-up after 2 weeks demonstrated sig- Krantz and McClannahan (1998) used a visual
nificant increases over baseline in increased gaze to cuing system involving a script-fading procedure to in-
mother’s face, increased number of toys played with, crease social initiations to a teacher. The technique, pre-
and increased number of play schemas used, as well as viously found to be effective with older children, in-
generalization to novel toys. Rogers, Herbison, Lewis, volved using a one-word stimulus embedded in a child’s
Pantone, and Reis (1986) used a similar pre–post de- independent play schedule. The stimulus prompted the
sign to assess changes in child behavior of 13 preschool- child to approach an adult and initiate a joint attention
ers following 6 or more months of intensive inter- request (look, watch me, etc.), to which the adult res-
vention in a daily preschool program that heavily ponded with various comments about the child’s be-
emphasized positive adult–child interactions, play, and havior, but without any other reinforcing consequence.
communication. Several markers of significantly im- Over time the script was faded. Three preschoolers with
proved social functioning were found, including im- some language learned the procedure, maintained and
provements in the social-communicative play levels increased initiations even after the stimuli were faded,
with a familiar adult and increases in child positive af- and demonstrated generalization by using unscripted
fect and social initiations and decreased negative re- and elaborated initiations and by generalizing across
sponses to mother’s initiations during mother–child new adults and new activities. One important aspect of
play. Maternal behavior was stable across the two sam- this technique for eliciting social initiations deserves
ples; thus changes in child behavior did not appear due highlighting. By using a visual cue, potential difficul-
to changes in maternal behaviors, but rather represented ties seen in adult prompting paradigms (disruptions in
generalization of effects from the day program. Im- ongoing social interactions, constant presence of cuing
provement in social interactions was demonstrated adult, difficulties with fading adult prompts; Oke &
across three separate measures and with various part- Schreibman, 1990) were avoided.

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Journal of Autism and Developmental Disorders, Vol. 30, No.

Interventions That Facilitate Socialization in Children

KEY WORDS: Social dysfunction; autism; social interventions.

INTRODUCTION of the acquisition of the behavior, maintenance of

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