etadd_47(3) - Division on Autism and Developmental Disabilities

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modeling may be both cost and time effective, since the same video models can be reused with one child as well as with multiple children. Video modeling has also been shown in numerous studies to be an effective instructional methodology for developing play, but a number of factors still remain unexplored. Charlop and Milstein (1989) used video modeling to increase use of scripted conversation about toys and found generalization across novel conversations, toys and partners, but neither scripted nor novel motor play was studied. Taylor, Levin, and Jasper (1999) taught two children with autism to engage in play-related statements with siblings, using a forward chaining procedure to teach a longer series of comments, but focused only on playrelated statements and not motor play skills themselves. D’Ateno, Mangiapanello, and Taylor (2003) were able to increase a child’s use of complex play sequences, including both verbal and motor play; but no data was presented on generalization of the learned sequences to different toys or settings. Nikopoulus and Keenan (2003, 2004), were able to successfully decrease latency in initiating social play and increase appropriate play using video modeling instruction in the majority of their subjects, but generalization tended to be limited only to toys depicted in the video models. MacDonald, Clark, Garrigan, and Vangala (2005) used video modeling to teach thematic pretend play skills to two preschool children with autism but only scripted, rather than unscripted play, increased significantly. Reagon, Higbee, and Endicott (2006) extended the use of video modeling to teach pretend play skills to one participant using a sibling as a video model but findings were limited by a quasi-experimental, A-B research design. Hine and Wolery (2006) extended the findings of Charlop and Milstein (1989) to show that point-of-view modeling could also be used to teach play skills without experimenter-implemented reinforcement, but both subjects in the study were highly verbal, and readily imitated in vivo actions of adults with materials prior to intervention. Furthermore, the play taught was limited to two scenarios (gardening and cooking), and did not address the developmental sequence of play by teaching skills in a progression from more concrete to more abstract and imaginary acts. Paterson and Arco (2007) showed that video modeling led to increased frequency of independent motor and verbal play actions in two boys with autism using both related toys and unrelated toys, but both subjects showed prior proficiency with the toys, and the study did not address the developmental sequence of play. The primary aims of this investigation were threefold. The first aim was to extend the work of Kasari et al. (2006) who have shown that adhering to a developmental sequence is effective when teaching play skills to children with autism which in turn relates to language improvements. The second aim was to integrate the work of D’Ateno et al. (2003), Mac- Donald et al. (2005), and Paterson and Arco (2007), who have demonstrated that video modeling is an effective methodology to teach play skills to children with autism, including symbolic and imaginative play. The final aim was to integrate a language-based approach that incorporates specific language instruction and outcome into the methodology. We attempted to achieve these aims by using a multiple-baseline single-subject design on four children, teaching language and play skills through video modeling using a hierarchal developmental sequence and a language model that incorporated play-connected, developmentally–appropriate language. Play outcomes included immediate and generalized performance of the learned play skills across other environments and toys than those presented in the video models. Language outcomes focused on increased complexity of language used during the children’s unstructured play as well as standardized language assessments. Specifically, we sought to (a) teach play skills to children with autism through video modeling using a developmental sequence, (b) to assess generalization of play skills learned through this video modeling instruction across environments and materials, and (c) to assess whether and to what extent incorporating language in the video modeling could teach language skills to those children which would generalize across environments and materials. 304 / Education and Training in Autism and Developmental Disabilities-September 2012
Method Participants Four male children participated in this investigation. The investigation was conducted at a day treatment program for children with autism. The program features an integrative and cross-disciplinary team approach to treatment. All four children were enrolled five days a week for six hours per day throughout the investigation. Each child received approximately the same treatment during the course of investigation, which was based on applied behavior analysis principles utilizing a staff ratio of nearly 1:1 and incorporating behavior, speech, recreational, and occupational therapy (individualized). Thus, “treatment” as a confounding variable was held constant. Most importantly, none of the children received separate instruction on play skills during the investigation. The program staff was blind to the hypotheses of the investigation. Participants were randomly selected from the program; two were selected from a classroom comprised of 2–3 year olds recently diagnosed with autism, and two were selected from a classroom comprised of children with increased cognitive challenges and poor language skills. We stratified the selection to get a wider range of play skills, cognitive skills and language skills. Informed consent was obtained from each of the child’s parents or guardians prior to admission to the investigation. See Table 1 for diagnosis, demographic, and initial developmental characteristics. The Preschool Language Scale, 4th Edition (PLS-4) was also carried out at the end of the intervention. Instructional Video A video model was created for each of the developmental levels of play on the Kasari et al. (2006) scale (Table 2), except levels 3 and 4 were combined into one level and model, levels 7 and 9 were combined into one level and model, and levels 15 and 16 were combined into one level and model. These levels were combined due to difficulties in accurately and consistently assigning play acts between levels. Each video model depicted three play acts or sequences at that level of play, each using a different toy or set of toys, accompanied by scripted language which not only related to the modeled play act or sequence (e.g., “put in” when inserting a puzzle piece) but also consisted of a length of utterance, syntax and morphology appropriate for a typically–developing child who had achieved the level of play being modeled. All of the video models were developed based on the authors’ experience and were validated by observing the play and accompanying language of typically–developing children of various developmental levels who were provided with the selected toys and prompted to “play.” The primary author is a licensed clinical speech therapist with over 10 years experience with program development and speech therapy with children with autism. The video models were acted by the second author seated in a child–sized chair at the child-sized table in a speech therapy room. The acting author has over 10 years of experience engaging in play intervention with children with autism. The camcorder was focused primarily on the toys modeled rather than the adult actor (e.g., tight shots in which the toys were the primary focus and only the adult actor’s hands and arms were shown), except for the level 6 (Pretend Self) play video models, in which toys are extended towards self, and the combined levels 15 (Sociodramatic) and 16 (Fantasy) play, where the entire body of the adult actor was included in the model. Experimental Design and Procedural Overview We used a single subject multiple baseline design across the four children. Baseline. A 15 minute free play session was observed to assess the child’s mastery and emergence level of play in a generalized setting (their classroom in the program) with a standard set of toys, including a peg board, puzzles, shape sorters, ring stackers, baskets, building blocks, a doctor kit, dress–up clothes, doll house with furniture and figures, play kitchen with food, plates and utensils, play farm with animals and assorted vehicles. The third baseline session (regardless of the number of baseline sessions) was in the speech therapy room for every child to ensure that their play was not specific to the environment. The observer used the developmental Video Modeling for Appropriate Play and Connected Speech / 305
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Education and Training in Autism an
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serve both cognitive (e.g., self in
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and quasi-experimental designs for
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& Cobb, 2002). Generalization, the
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academic activities in the classroo
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Procedure Baseline. In this multipl
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condition for each student. With th
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Boning, R. A. (1997). SRA Specific
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TABLE 1 Student demographic informa
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Figure 6. Student data across math
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