Stereotypy and social engagement : A Research Review

A research review by Jennifer Morrison (CUNY Queens College).

Lee, S., Odom, S. L., & Loftin, R. (2007). Social engagement with peers and stereotypic behavior of children with autism. Journal of Positive Behavior Interventions, 9, 67 – 79.

Purpose of the study: The relationship of social engagement and stereotypic behavior for children with autism, which looked particularly at if increased social engagement lead to decreases in stereotypic behavior, and finally if these decreases in stereotypic behavior generalized to other settings as well.

Participants: Three children diagnosed with autism who engaged in frequent stereotypic behavior. One child was 8 yrs old with moderate to severe mental retardation with severe delays in language. Another child was 7 hrs old and engaged in a variety of oral/vocal stereotypy and also would sometimes engage in self-injurious behavior to himself and also others. The other boy was 9 years old and had profound mental retardation; he could follow simple verbal commands from adults but also engaged in high rates of vocal and motor stereotypy. In addition to the three children diagnosed with autism, 12 (6 pairs) of children without disabilities also participated that were all in third grade classes that the three children that were part of the study were in.

Setting: The study was done in a 5 m x 4 play area in a special education classroom. The area was full of several different types of toys and objects that they could play with.

Target Behaviors: The behaviors that were mainly investigated in this study were initiations with a peer or stereotypic behavior. Initiations were defined as: any vocal/verbal or gestural behavior that a participant/peer directed to another peer and that was not preceded by a socially oriented behavior from that peer. Stereotypic behavior was defined as topographically similar behaviors that were performed repetitively. These could include vocal which was when children used their mouths or made vocalizations or sounds. Motor stereotypy was defined as when children used any of their body parts except vocal with or without manipulating objects (eg finger flipping, wiggling fingers, banging head, etc.)

Procedure: The experimenters used a multiple baseline across participants and settings. After the first participant had a stable baseline they then introduced the intervention. Once the first participant reached stable responding at intervention, the intervention was introduced for the next participant…so on. During the baseline phase, each child with autism was observed during structured free-play sessions with two peer buddies. No instructions were given to the children and lasted approximately 5 minutes. During training, the trainer taught the peers four social skills concepts (sharing, suggesting play ideas, assisting and being affectionate). Each training session began with a verbal discussion of the importance of playing with friends and/or a review of the previous day’s play. After this the teacher then modeled appropriate and inappropriate responses. In the using skills intervention the teacher reminded the peer to use the skills they had learned to get their friend to play, and the peer then got the child to play in a structured activity with them.

Results: During baseline, all three children did not engage with peers at all in any type of play situation. After training with peers, the mean percentage of social engagement increased to, 69%, 79%, and 56% for all three children. More importantly, this behavior continued through the reimplementation period and also for generalization probe trials with children that were not trained. At the same time, the participants’ engagement was more variable during the generalization phase which took place at snack time. In addition, during baseline each of these three children engaged in high rates of stereotypy (87%, 47%, and 89% respectively). When the peer initiation intervention was introduced not only was social engagement increased but stereotypic behavior decreased in all three children.

Implications: This study had several important findings. First of all, this study showed the importance of training peers to initiate social interactions with children diagnosed with autism. This study also showed how effective training with a peer model can be in increasing social engagement in a child on the autism spectrum. More importantly it was shown that the percent of self-stimulatory behavior also decreased with all three children. This shows the importance of the relationship of a set of social skills in comparison to stereotypy. If a child is engaging in a conversation with another child, this gives them less of a chance to engage in vocal stereotypy especially. The other really nice thing about this study is that it was naturally done with peers of the children that were their age. This study ultimately shows the importance of peer modeling and peer assistance to children diagnosed on the autism spectrum. One thing I thought was a strong point of this study was that they also used children that were not on the high functioning side of the autism spectrum. When reading studies similar to this, there are a lot of studies done with children with Asperger’s or related symptomology, but very little with children with more severe deficits and higher rates of self-stimulatory behavior.