Jill Locke

Making the Connection: Randomized Controlled Trial of Social Skills at School for Children with Autism Spectrum Disorders

BACKGROUND   This study compared two interventions for improving the social skills of high functioning children with autism spectrum disorders in general education classrooms. One intervention involved a peer-mediated approach (PEER) and the other involved a child-assisted approach (CHILD). METHOD   The two interventions were crossed in a 2 × 2 factorial design yielding control, PEER, CHILD, and both PEER and CHILD conditions. Sixty children participated from 56 classrooms in 30 schools. Interventions involved 12 sessions over 6 weeks, with a 3-month follow-up. Outcome measures included self, peer and teacher reports of social skills and independent weekly observations of children on their school playground over the course of the intervention. RESULTS   Significant improvements were found in social network salience, number of friendship nominations, teacher report of social skills in the classroom, and decreased isolation on the playground for children who received PEER interventions. Changes obtained at the end of the treatment persisted to the 3-month follow-up. CONCLUSIONS   These data suggest that significant improvements can be made in peer social connections for children with autism spectrum disorders in general education classrooms with a brief intervention, and that these gains persist over time.

Exploring the Social Impact of Being a Typical Peer Model for Included Children with Autism Spectrum Disorder

This study examined the social impact of being a typical peer model as part of a social skills intervention for children with autism spectrum disorder (ASD). Participants were drawn from a randomized-controlled-treatment trial that examined the effects of targeted interventions on the social networks of 60 elementary-aged children with ASD. Results demonstrated that typical peer models had higher social network centrality, received friendships, friendship quality, and less loneliness than non-peer models. Peer models were also more likely to be connected with children with ASD than non-peer models at baseline and exit. These results suggest that typical peers can be socially connected to children with ASD, as well as other classmates, and maintain a strong and positive role within the classroom.

A Tangled Web: The Challenges of Implementing an Evidence-Based Social Engagement Intervention for Children With Autism in Urban Public School Settings

There is growing evidence that efficacious autism-related interventions rarely are adopted or successfully implemented in public schools, in part because of the lack of fit between the intervention and the needs and capacities of the school setting. There is little systematic information available regarding the barriers to implementation of complex interventions such as those addressing social engagement for children with autism.The present study used fieldnotes from an implementation trial to explore barriers that emerged during the training of school personnel and subsequent implementation of a social engagement intervention. A number of barriers at the individual (training) and school levels (policies surrounding recess, staffing, prioritization of competing demands, level of respect and support, and availability of resources) interfered with the continued use and sustainment of the intervention. We offer potential strategies to overcome these barriers and provide directions for future research in this critical area.

Services for children with autism spectrum disorder in three, large urban school districts: Perspectives of parents and educators:

This study used qualitative methods to evaluate the perceptions of parents, educators, and school administrators in three large, urban school districts (Los Angeles, Philadelphia, and Rochester) regarding services for children with autism spectrum disorder within the context of limited district resources. Facilitators followed a standard discussion guide that contained open-ended questions regarding participants’ views on strengths and limitations of existing services and contextual factors that would facilitate or inhibit the process of introducing new interventions. Three primary themes were identified: (1) tension between participant groups (teachers and paraprofessionals, staff and administration, teachers and parents, special education and general education teachers), (2) necessity of autism spectrum disorder–specific and behavioral training for school personnel, and (3) desire for a school culture of accepting difference. These themes highlight the importance of developing trainings that are feasible to deliver on a large scale, that focus on practical interventions, and that enhance communication and relationships of school personnel with one another and with families.

Social network analysis of children with autism spectrum disorder: Predictors of fragmentation and connectivity in elementary school classrooms

Although children with autism spectrum disorder are frequently included in mainstream classrooms, it is not known how their social networks change compared to typically developing children and whether the factors predictive of this change may be unique. This study identified and compared predictors of social connectivity of children with and without autism spectrum disorder using a social network analysis. Participants included 182 children with autism spectrum disorder and 152 children without autism spectrum disorder, aged 5–12 years in 152 general education K-5 classrooms. General linear models were used to compare how age, classroom size, gender, baseline connectivity, diagnosis, and intelligence quotient predicted changes in social connectivity (closeness). Gender and classroom size had a unique interaction in predicting final social connectivity and the change in connectivity for children with autism spectrum disorder; boys who were placed in larger classrooms showed increased social network fragmentation. This increased fragmentation for boys when placed in larger classrooms was not seen in typically developing boys. These results have implications regarding placement, intervention objectives, and ongoing school support that aimed to increase the social success of children with autism spectrum disorder in public schools.

Assessing Social Skills in Early Elementary-Aged Children With Autism Spectrum Disorders: The Social Skills Q-Sort

This study employed a newly developed measure, the Social Skills Q-Sort (SSQ), to assess paraprofessionals’ and teachers’ reports of social skills for children with and without ASD. Paraprofessionals and teachers showed good rater-agreement on the SSQ. ROC curve analyses yielded an excellent profile of sensitivity and specificity for discriminating between children with ASD and typically developing children. The paraprofessional SSQ converged with objective ratings of playground social behavior; however, there was little evidence of convergence between SSQ scores and parent and teacher ratings on questionnaire measures. The SSQ may be effective in screening for ASD and the severity of ASD-related social communication challenges.

Clearing Hurdles: The Challenges of Implementation of Mental Health Evidence-Based Practices in Under-Resourced Schools.

Schools have become the main provider of services to children with mental health needs. Although there is substantial literature on barriers to implementation of evidence-based practices (EBPs) in under-resourced school districts, less has been written on how to overcome those barriers. Providing mental health services in the school setting presents a tremendous opportunity to increase access to quality mental health care for underserved youth. This review provides a brief overview of the barriers to successful implementation and sustainment of EBPs in under-resourced public schools and provides recommendations for overcoming them. The discussion is organized around an established conceptual framework adapted for the delivery of services in under-resourced schools that focuses on interdependent factors that exist at the individual-, team-, school-, and macro-levels. This manuscript explores some recommendations and strategies for effectively addressing challenges related to implementation of EBPs. Research ideas are offered to bridge the research-to-practice gap that impacts many under-resourced public school districts.

Examining playground engagement between elementary school children with and without autism spectrum disorder

Little is known about the social behavior of children with and without autism spectrum disorder during recess. This study documented the naturally occurring recess engagement and peer interaction behaviors of children with and without autism spectrum disorder in inclusive school settings. Participants included 51 children with autism spectrum disorder and 51 classmates without autism spectrum disorder who served as peer models matched on gender, classroom, grade, age, and ethnicity. Using a timed-interval behavior-coding system, children with autism spectrum disorder spent approximately 30% of their recess time engaged in solitary activities, whereas their classmates only spent approximately 9% of recess unengaged. In addition, children with autism spectrum disorder spent about 40% of the recess period jointly engaged with peers in a reciprocal activity, conversation, or game as compared to 70% for matched classmates. These findings provide a context for which to interpret intervention outcomes and gains for children with autism spectrum disorder in inclusive settings.

Characteristics of socially successful elementary school‐aged children with autism

BACKGROUND The extant literature demonstrates that children with autism spectrum disorder (ASD) often have difficulty interacting and socially connecting with typically developing classmates. However, some children with ASD have social outcomes that are consistent with their typically developing counterparts. Little is known about this subgroup of children with ASD. This study examined the stable (unlikely to change) and malleable (changeable) characteristics of socially successful children with ASD. METHODS This study used baseline data from three intervention studies performed in public schools in the Southwestern United States. A total of 148 elementary-aged children with ASD in 130 classrooms in 47 public schools participated. Measures of playground peer engagement and social network salience (inclusion in informal peer groups) were obtained. RESULTS The results demonstrated that a number of malleable factors significantly predicted playground peer engagement (class size, autism symptom severity, peer connections) and social network salience (autism symptom severity, peer connections, received friendships). In addition, age was the only stable factor that significantly predicted social network salience. Interestingly, two malleable (i.e., peer connections and received friendships) and no stable factors (i.e., age, IQ, sex) predicted overall social success (e.g., high playground peer engagement and social network salience) in children with ASD. CONCLUSIONS School-based interventions should address malleable factors such as the number of peer connections and received friendships that predict the best social outcomes for children with ASD.

School-Based Behavioral Health Service Use and Expenditures for Children With Autism and Children With Other Disorders

OBJECTIVE This study compared use of and associated expenditures for Medicaid-reimbursed school-based and out-of-school services for children with autism spectrum disorder (ASD) and those with other psychiatric disorders. METHODS Philadelphia County Medicaid claims were used to identify children ages five to 17 who received behavioral health services through Medicaid any time between October 2008 and September 2009 (N=24,271). Children were categorized into four diagnostic groups: autism spectrum disorder (ASD), conduct disorder or oppositional defiant disorder (conduct-ODD), attention-deficit hyperactivity disorder (ADHD), and other psychiatric disorders. Logistic regression analysis compared use of in-school and out-of-school behavioral health services between children with ASD and children with other psychiatric disorders. Generalized linear models with gamma distribution were used to estimate differences in Medicaid expenditures for in-school and out-of-school services and total Medicaid expenditures for both service types by disorder, with adjustments for age, sex, and race-ethnicity. RESULTS The most common diagnosis was ADHD (40%); 35% had other psychiatric disorders, 21% had conduct-ODD, and 4% had ASD. A significantly greater proportion of children with ASD (52%) received in-school behavioral health services (conduct-ODD, 5%; ADHD, 8%; and other psychiatric disorders, 1.7%) Per-child expenditures for both school-based and out-of-school behavioral health services were significantly higher for children with ASD than for children in the other groups. CONCLUSIONS Medicaid represents an important source of in-school and out-of-school care for children with ASD and their families. States that expand Medicaid under the Affordable Care Act should give careful consideration to covering school-based mental health services for children with ASD.