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Social Communication Disorders in School-Age Children
Cognition/Language Treatment

Peer-Mediated/Implemented

 


 

External Scientific Evidence

Evidence-Based Practice Guidelines
Ministries of Health and Education (New Zealand)

New Zealand Autism Spectrum Disorder Guideline
Ministries of Health and Education. (2008).
Ministry of Health and Education (New Zealand), 312 pages.
Added: October 2012

Description
This guideline provides recommendations for identification, diagnosis, ongoing assessment, and access to interventions and services for children, adolescents and adults with autism spectrum disorders (ASD) in New Zealand. The target audience of this guideline is primary care practitioners, education professionals, policy makers, funders, parents, carers, specialists and any others who make provisions for individuals with ASD.

  • Level A recommendations are supported by good evidence.

  • Level B recommendations are supported by fair evidence.

  • Level C recommendations are supported by expert opinion.

  • Level I indicates that there was insufficient evidence to make a recommendation.

  • Good practice point recommendations are made by the guideline developers in the absence of evidence.

Recommendations

  • "[Social] interventions using carefully trained and supported typically developing peers should be encouraged" (Grade A Evidence) (p. 102). 

  • "Peers should be provided with information about ASD and given support and encouragement to foster relationships" (Grade C Evidence) (p. 127). 

  • "Support and training should be provided to education professionals to develop peer-mediated strategies for social development" (Good Practice Point) (p. 189).

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National Academies of Science; U.S. Department of Education, Office of Special Education Programs

Interventions to Facilitate Social Interaction for Young Children with Autism: Review of Available Research and Recommendations for Educational Intervention and Future Research
McConnell, S. R. (2002).
Journal of Autism and Developmental Disorders, 32(5), 351-372.
Added: October 2012

Description
This guideline provides recommendations for education interventions for children with autism. The target audience of this guideline includes speech-language pathologists and other professionals involved in the management of children with ASD.

Recommendations
In regards to social interaction, peer-mediated interventions have been shown to produce “powerful and robust treatment effects across a number of children, investigators, and intervention variations” (p. 364). These interventions are challenged, however, by the lack of generalization and maintenance evidence. “The ameliorative effects of these interventions require continuous access to 'trained' peers, and thus likely ongoing training of new peer cohorts” (p. 364).

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National Autism Center

National Standards Report
(2009).
National Autism Center, 1-161.
Added: October 2012

Description
This guideline provides recommendations for treatment of children and adolescents with autism spectrum disorders. The audience for this guideline includes parents, caregivers, educators, and service providers. Treatments have been evaluated and determined to be established, emerging, or unestablished. No treatments were determined to be ineffective or harmful.

Recommendations

  • The guideline authors stress that treatment selection should be made by a team of individuals and that this document should not dictate which treatments can or cannot be used for individuals with autism. However, the following suggestions are made to assist in decision making.

  • “We recommend the decision-making team give serious consideration to [Established Treatments] because these treatments have produced beneficial effects for individuals involved in the research studies published in the scientific literature, b) access to treatments that work can be expected to produce more positive long-term outcomes, and c) there is no evidence of harmful effects” (p. 76).

  • Established interventions that have been shown to increase [social] communication skills include:

    • Antecedent Package

    • Behavioral Package

    • Comprehensive Behavioral Treatment for Young Children

    • Joint Attention Intervention

    • Modeling

    • Naturalistic Teaching

    • Peer Training Package

    • Pivotal Response Treatment

  • “Given the limited research support for Emerging Treatments, we generally do not recommend beginning with these treatments. However, Emerging Treatments should be considered promising and warrant serious consideration if Established Treatments are deemed inappropriate by the decision-making team” (p. 76).

  • Emerging treatments that have been shown to increase [social] communication skills include:

    • Augmentative and Alternative Communication Devices

    • Developmental Relationship-based Treatment

    • Language Training (Production)

    • Language Training (Production and Understanding)

    • Multi-component Package

    • Peer-mediated Instructional Arrangement

    • Picture Exchange Communication System

    • Scripting

    • Sign Instruction

    • Social Communication Intervention

    • Social Skills Package

    • Structured Teaching

    • Technology-based Treatment

    • Theory of Mind Training 

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Evidence-Based Systematic Reviews
Communication Intervention for Children with Autism: A Review of Treatment Efficacy
Goldstein, H. (2002).
Journal of Autism and Developmental Disorders, 32(5), 373-396.
Added: October 2012

Description
This is a review and summary of empirical studies evaluating speech-language interventions involving children with autism.

Conclusions
The author presented evidence on peer facilitation, scripted interactions, and an intervention involving modeling, rehearsal, and token reinforcement and concluded: “Given that a problem relating to others is a core social deficit associated with autism, the effectiveness of these interventions in increasing social interaction with peers in particular is quite striking” (p. 390).

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Social Skills Intervention for Adolescents with Autism Spectrum Disorders: A Review of the Experimental Evidence
Burgess, S., & Turkstra, L. (2007).
EBP Briefs, 1, 41-58.
Added: October 2012

Description
This is a review of quantitative studies investigating social skills intervention for adolescents with autism spectrum disorders (ASD).

Conclusions
"The studies reviewed suggest that typically developing adolescents can enhance the social skills of peers with ASD in naturalistic environments" (p. 44).

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Increasing Social Interaction among Adolescents with Intellectual Disabilities and Their General Education Peers: Effective Interventions
Carter, E. W., & Hughes, C. (2005).
Research and Practice for Persons with Severe Disabilities, 30(4), 179-193.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: October 2012

Description
This is a review of empirical investigations on the “the efficacy of interventions directed at increasing social interaction among adolescents with intellectual disabilities and their general education peers in secondary schools” (p. 180). Studies in which the majority of participants were identified as having autism or other disabilities without intellectual disability were excluded.

Conclusions
Skill-based and support-based interventions were effective in increasing peer interactions across participants with a range of intellectual disabilities; however, differential effects were noted for several types of interventions by severity. Communication book instruction, social interaction skill instruction, and peer support arrangements were most effective for participants with severe intellectual disabilities, whereas general education participation and the assignment of roles to general education peers was most effective for participants with moderate disabilities (p. 186).

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A Meta-Analysis of School-Based Social Skills Interventions for Children with Autism Spectrum Disorders
Bellini, S., Peters, J. K., et al. (2007).
Remedial and Special Education, 28(3), 153-162.
Added: October 2012

Description
This is a meta-analysis of single-subject designs investigating school-based social skills interventions for children and adolescents with autism spectrum disorders (ASD).

Conclusions

  • This meta-analysis found school-based social skills interventions to be"minimally effective for children with ASD" (p. 159). These interventions yielded “low treatment effects and low generalization effects across participants, settings, and play stimuli. Moderate maintenance effects were observed suggesting that gains made via social skills interventions are maintained after the intervention is withdrawn” (p. 159).

  • "Similar treatment, maintenance, and generalization effects were observed across collateral skills, peer-mediated, child-specific, and comprehensive interventions. Furthermore, there were no significant differences between the intervention and maintenance effects of studies that implemented group interventions and studies that implemented individual interventions" (p. 160).

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Evidence-Based Comprehensive Treatments for Early Autism
Rogers, S. J., & Vismara, L. A. (2008).
Journal of Clinical Child & Adolescent Psychology, 37(1), 8-38.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: October 2012

Description
This is a review of comparative studies assessing the efficacy of early comprehensive interventions (those that addressed the core deficits of autism including language, social, cognition, and play) for children with autism.

Conclusions
"Peer interactions are a crucial part of intervention programs for children with autism; children with autism of all ages and all levels of disability have been shown to gain from these approaches.  Many such approaches use typically developing peers to foster social growth in children with autism.  National reviews recommend that children with autism have frequent access to typical peers" (p. 33).

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Social Skills Development in Children with Autism Spectrum Disorders: A Review of the Intervention Research
Williams White, S., Keonig, K., et al. (2007).
Journal of Autism and Developmental Disorders, 37(10), 1858-1868.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: October 2012

Description
This is a review of published studies and unpublished dissertations exploring the state of the evidence for social skills training interventions for school-age children with autism spectrum disorders (ASD) in order to determine future research directions.

Conclusions
Although empirical support for this approach is incomplete, group-based social skills training may be a useful intervention for children with ASD. Promising teaching strategies for social skills training include teaching social scripts, modeling and role-play, differential reinforcement, peer involvement, multiple trainers, parent involvement, practice in natural environments, fostering self-awareness, errorless teaching, and defining concrete social rules.

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Evidence-Based Review of Moderate to Severe Acquired Brain Injury
Teasell, R., Marshall, S., et al. (2008).
Retrieved from http://www.abiebr.com.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: October 2012

Description
This is a review of prospective and retrospective experimental and non-experimental studies that investigated the effectiveness of rehabilitation for adults and children with moderate to severe acquired brain injury (ABI), including stroke and traumatic brain injury (TBI). This review includes the assessment and management of several aspects of rehabilitation including speech and language treatments. The levels of evidence used to summarize the findings are based on the modified Sackett criteria:

  • Level 1 was applied to randomized controlled trials (RCTs) with a PEDro score greater than 5.  

  • Level 2 was applied to RCTs with a PEDro score less than 6, non-RCTs, and cohort studies.

  • Level 3 was applied to case control studies.  

  • Level 4 was applied to pre-post studies, post-studies, case series, and single intervention group studies.

  • Level 5 was applied to observational studies, case studies, and consensus statements.

Conclusions
“There is Level 4 evidence that peer-group training of pragmatic language skills may benefit children with communication deficits following brain injury” (p. 38).

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Including Children with Special Educational Needs in Mainstream Classrooms: Implications for Pedagogy from a Systematic Review
Nind, M., & Wearmouth, J. (2006).
Journal of Research in Special Educational Needs, 6(3), 116-124.
Added: October 2012

Description
This is a  review of reports that investigated the outcomes of inclusion of children with special needs in mainstream classrooms who were instructed using a variety of teaching approaches.

Conclusions
Peer group interactive approaches […] are effective in academic terms [and] are also often effective in terms of social participation and children’s attitudes [towards] their learning" (pp. 121-122).

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Evaluation of the Efficacy of Communication-Based Treatments for Autism Spectrum Disorders
Brunner, D. L., & Seung, H. (2009).
Communication Disorders Quarterly, 31(1), 15-41.
Added: October 2012

Description
This is a review of the best available evidence investigating communication-based treatments for children with autism spectrum disorders (ASD).

Conclusions
Peer-mediated interventions, which are supported by more than 20 years of research, have been described as emerging and effective in regard to their impact on social development in children with ASD. Although, more research is warranted as findings are largely based on single-subject studies (p. 25).

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The Interaction Between Behavior and Speech and Language Difficulties: Does Intervention for One Affect Outcomes in the Other? Technical Report
Law, J., & Plunkett, C. (2009).
Research Evidence in Education Library. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: October 2012

Description
This is a review of studies that investigated "the relationship between speech, language, and communication difficulties and emotional and behavioral difficulties in children of primary school age" (p. 3).

Conclusions
Within the group of studies of didactic techniques (e.g., pivotal response training, peer intervention, functional communication), it was found "that children described as normally developing have been successfully instructed to teach social communicative skills and social interactive behaviours to children with autism" (pp. 43-44).

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Autism Spectrum Disorders (ASDs) Services: Final Report on Environmental Scan
Young, J., Corea, C., et al. (2010).
Baltimore, MD: IMPAQ International, 112 pages.
Added: October 2012

Description
This is an “environmental scan” of the empirical evidence regarding the efficacy, effectiveness, safety, and availability of behavioral and psychosocial interventions for individuals with autism spectrum disorders (ASD). The evidence, separated by children, transitioning youth, and adults and interventions, is rated as evidence-based, emerging evidence-based, or unestablished within each population.

  • Evidence-based: Interventions were considered evidence-based if they were supported with multiple high quality randomized, quasi-experimental or single-subject design studies with no critical design flaws to create confounders to the studies.

  • Emerging evidence-based: Emerging evidence-based interventions were those supported with evidence of mixed quality and mixed effects.

  • Unestablished: An intervention was considered unestablished based on the poor quality of the studies or the lack of studies showing a positive result.

Conclusions
Evidence-based interventions included joint attention intervention, naturalistic teaching strategies, peer training package, social communication intervention, and social skills package (pp. 25-26). "Overall, the studies reviewed for the interventions included in this group had positive outcomes" (p. 24).

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A Meta-Analysis of Peer-Mediated Interventions for Young Children with Autism Spectrum Disorders
Zhang, J., & Wheeler, J. J. (2011).
Education and Training in Autism and Developmental Disabilities, 46(1), 62-77.
Added: October 2012

Description
This is a meta-analysis of single-subject design studies that investigated peer-mediated interventions for promoting social interactions in young children with autism spectrum disorder (ASD).

Conclusions

  • "The overall effect sizes suggest that peer-mediated interventions were highly effective among children under eight years of age diagnosed with ASD for promoting social interactions" (p. 71).

  • "Further categorical comparisons suggest that these interventions were more effective in enhancing social responses in younger boys, when older male siblings served as interventionists, when the interventions took place in the home, when peer modeling was used, and when consideration was given to maintenance and generalization across participants, behaviors and activities, and in involving collaboration among all researchers, peers/siblings, school staff, and parents/families" (p. 71).

  • Several limitations, such as the impact of publication bias and the use of Cohen's d with single-subject design data, were reported (p. 71).

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Examining the Effectiveness of Peer-Mediated and Video-Modeling Social Skills Interventions for Children with Autism Spectrum Disorders: A Meta-Analysis in Single-Case Research Using HLM
Wang, S.-Y., Cui, Y., et al. (2011).
Research in Autism Spectrum Disorders, 5(1), 562-569.
Added: October 2012

Description
This is a meta-analysis of single-case research studies of the effectiveness of peer-mediated and video-modeling social skills interventions for children with autism spectrum disorder (ASD).

Conclusions

  • "The results of the current study indicate that peer-mediated and video-modeling interventions are both effective in improving social behavior of children with ASD and there is no significant difference between the effectiveness of these two intervention approaches.... Our results suggest tentatively that younger [children] may [benefit] more from the interventions than older children.  Additionally, participant's age may interact with intervention approaches and impact intervention effectiveness" (p. 567).

  • Limitations such as the use of Cohen's d for single-case research data were reported (p. 567).

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Video Modeling for Individuals with Autism: A Review of Model Types and Effects
McCoy, K., & Hermansen, E. (2007).
Education and Treatment of Children, 30(4), 183-213.
Added: October 2012

Description
This is a review of research studies in peer-reviewed journals that provided data on video modeling for individuals with autism implemented from a variety of perspectives (i.e., adults, peers, self, point-of-view, and mixed).  Social skills outcomes were reported.

Conclusions
"Studies utilizing peers as models demonstrated effectiveness in enhancing and generalizing language skills for successful social situations including play and independent living skills."

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A Review of Treatments for Deficits in Social Skills and Self-Help Skills in Autism Spectrum Disorder
Flynn, L., & Healy, O. (2012).
Research in Autism Spectrum Disorders, 6(1), 431-441.
Added: October 2012

Description
This is a review of intervention studies that investigated treatments for deficits in social skills and self-help skills in autism spectrum disorder (ASD).

Conclusions

  • Increases in social skills were noted subsequent to treatments in the following categories:  peer-mediated intervention, social skills group, pivotal response training, script fading treatments, and video modeling.

  • Limitations, such as the lack of research on generalization and maintenance of peer-mediated intervention findings, was reported.

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Evidence-Based Social Skills Interventions for Children with Autism: A Meta-Analysis
Wang, P., & Spillane, A. (2009).
Education and Training in Developmental Disabilities, 44(3), 318-342.
Added: October 2012

Description
This is a meta-analysis of group experimental or quasi-experimental and single subject studies that investigated the effect of interventions used to increase social skills for children and adolescents with autism spectrum disorder (ASD).

Conclusions
"The effectiveness of peer mediated strategies to improve social skills in children with autism remains to be questionable due to the low [percentage of non-overlapping data points] PND scores" (p. 337).

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Social Skills Interventions for Children with High-Functioning Autism Spectrum Disorders
Schreiber, C. (2011).
Journal of Positive Behavior Interventions, 13(1), 49-62.
Added: October 2012

Description
This is a review of studies that investigated social skills interventions used with children with high-functioning autism spectrum disorders (HFASD).

Conclusions

  • "Parent, family, and peer training may be the essential component in ensuring a holistic skill application" (p. 59).

  • "In light of the reviewed studies, the use of Social Stories, both alone and in conjunction with technological and peer-mediated interventions, appears to be an effective intervention for children with HFASD" (p. 59).

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Social Skills Interventions for Children with Autism: A Meta-Analytic Application of Percentage of All Non-Overlapping Data (PAND)
Schneider, N., Goldstein, H., et al. (2008).
Evidence-Based Communication Assessment & Intervention, 2(3), 152-162.
Added: October 2012

Description
This is a meta-analysis of single-subject experimental design (SSED) studies that investigated peer-mediated social-skills interventions for preschool-age children with autism.

Conclusions

  • "On the basis of [percentage of all non-overlapping data points] PAND analyses of the literature on peer-mediated interventions to improve the social skills of children with autism, effect sizes for this body of literature seem large" (p. 159).

  • "The fact that one can calculate effect sizes from PAND does not ensure that they should be interpreted in the same way as effect sizes from group-design experiments.... Also, in comparison to large-group social science research, effect sizes in SSEDs are large" (p. 160).

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Peer Interactions of Students with Intellectual Disabilities and/or Autism: A Map of the Intervention Literature
Carter, E. W., Sisco, L. G., et al. (2010).
Research & Practice for Persons with Severe Disabilities, 35(3/4), 63-79.
Added: October 2012

Description
This is a review of intervention-based investigations using group (i.e., experimental or quasi-experimental) and single-case design studies that provide "a comprehensive map of interventions focused on promoting social interaction among students with [intellectual disability] ID and/or [autism spectrum disorder] ASD and their peers without disabilities" (p. 64).  Student-focused (e.g., AAC use, cognitive-behavioral-ecological social skills training), peer-focused practices (e.g., assigning roles, peer awareness training), and support-focused practices (e.g., direct adult facilitation) were addressed.

Conclusions
"Some support-based practices (e.g., inclusive practices) may be requisite to implementing peer- and student-focused interventions" (p. 73).

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Clinical Expertise/Expert Opinion

Consensus Guidelines
American Academy of Pediatrics; Council on Children with Disabilities

Management of Children With Autism Spectrum Disorders
Myers, S. M., & Johnson, C. P. (2007).
Pediatrics, 120(5), 1162-1182.
Added: October 2012

Description
This guideline provides recommendations for the management of children with autism spectrum disorder (ASD). The target audience of this guideline is pediatricians. In place of formal recommendations, conclusive statements regarding the level of evidence supporting a specific treatment are included.

Recommendations
There is descriptive and anecdotal support for the use of social skills groups, social stories, peer-mediation, play, and leisure curricula (p. 1166).

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Ohio Developmental Disabilities Council; Ohio Department of Health; Monarch Services

Service Guidelines for Individuals with Autism Spectrum Disorder/ Pervasive Developmental Disorder (ASD/PDD): Birth through Twenty-One
Autism Task Force. [2003].
(OH): Ohio Developmental Disabilities Council, 105 pages.
Added: October 2012

Description
This guideline is intended to help families and professionals in assessing, treating, and developing educational and community transition programs for people with autism spectrum disorder (ASD) from birth to 21. The target audience of this guideline includes families, educators, medical professionals, and other service providers.

Recommendations
Strategies to consider to increase social understanding include: scripting, modeling, role play, social curriculums, social skills manuals, visual supports, and peer supports (p. 44).

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Client/Patient/Caregiver Perspectives

Effects of Peer Training and Written Text Cueing on Social Communication of School-Age Children with Pervasive Developmental Disorder
Thiemann, K. S., & Goldstein, H. (2004).
Journal of Speech, Language & Hearing Research, 47(1), 126-144.
Added: October 2012

Description
This is a multiple-baseline design study of five school-age children with pervasive developmental disorder.  This study examined the "effects of peer training on the [five] children's overall rates of social interaction and the effects of systematic instruction using written text cues on specific social-communication skills" (p. 130).

Conclusions
“For all [five] children [with pervasive developmental disorder], peer training did not influence their use of specific social initiation strategies. Once implemented, the [written text treatment] WTT improved their repertoires and rates of three targeted social-communication skills. By the end of the study, these changes resulted in perceived improvements in the quality of interactions for all five triads” (p. 140).

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Using the Picture Exchange Communication System to Increase the Social Communication of Two Individuals with Severe Developmental Disabilities
Cannella-Malone, H. I., Fant, J. L., et al. (2010).
Journal of Developmental and Physical Disabilities, 22(2), 149-163.
Added: October 2012

Description
This is a study of two children with communication delays and developmental disability using a multiple baseline across behaviors design. One of the participants, Tulla, was diagnosed with pervasive development disorder not otherwise specified (PDD-NOS) and mood disorder not otherwise specified (Mood-NOS) and the other participant, London, was diagnosed with severe autism. This study examined the effect of using Picture Exchange Communication System (PECS) with Peers to increase  participants' social communication.

Conclusions

  • In regard to Tulla, teachers commented that they noted differences after the intervention, including noticing that she and her peer trainer interacted more than they had prior to the training, their communication was clearer, and they made more complete sentences (p. 159). 

  • "London's mother completed the social validity questionnaire and indicated that she thought social communication was an appropriate and important goal, she had a positive view of the intervention, her daughter benefited from-and showed improvement with-the intervention, and she would recommend the intervention to other parents" (p. 159).

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