ABSTRACT

THE EFFECTS OF FLOOR TIME ON COMMUNICATION INTERACTION BEHAVIORS BETWEEN TYPICALLY DEVELOPING PRESCHOOLERS AND PRESCHOOLERS WITH AUTISM

By Nichole Lynn Cannon

It is important for children with autism to form social relationships among peers to prevent social isolation and to experience the benefits of developing social contacts. The current study trains preschool peers how to interact with their peers with autism through the use of floor time. Floor time is an educational model adopted by Stanley Greenspan.. The purpose of the study was to determine a.) Can typical preschoolers implement the steps of floor time with their peers with autism and b.) Do peers with autism demonstrate an increase in their communication interaction with their typical peers when the steps of floor time are implemented? The current study had four participants, two typical preschoolers and two preschoolers with autism. Results indicated that typical preschoolers can learn to implement the steps of floor time with their peers with autism. The study also showed children with autism exhibit increases in communication behaviors.

THE EFFECTS OF FLOOR TIME ON COMMUNICATION INTERACTION BEHAVIORS

BETWEEN TYPICALLY DEVELOPING PRESCHOOLERS AND PRESCHOOLERS WITH

AUTISM

A Thesis

Submitted to the

Faculty of Miami University

In partial fulfillment of

the requirements for the degree of

Master of Arts

Department of Speech Pathology and Audiology

By

Nichole Lynn Cannon

Miami University

Oxford, OH

2006

Advisor______Kathleen Hutchinson, Ph.D

Reader______Doris Bergen, Ph.D

Reader______Donna Murray, Ph.D

Reader______Ann Glaser M.S. CCC-SLP

Table of Contents

CHAPTER I...... 1 Introduction...... 1 Autism ...... 1 Peer-Mediated Interventions ...... 1 Autism-Related Interventions ...... 2 Significance of the Problem ...... 3 Purpose of the Study ...... 4 CHAPTER II ...... 5 Literature Review...... 5 Autism ...... 5 Language in Autism ...... 6 Communication Deficits in Autism ...... 7 Social Deficits in Autism ...... 8 Play in Autism ...... 9 Peer-Mediated Intervention ...... 11 Interventions ...... 12 Applied Behavioral Analysis (ABA) ...... 13 Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) ...... 14 Floor Time ...... 15 Research Hypothesis ...... 17 CHAPTER III ...... 17 Method and Procedures...... 17 Participants ...... 18 Setting ...... 19 Materials ...... 20 Procedure ...... 20 Measurements ...... 22 Data Collection ...... 25

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CHAPTER IV...... 26 Results ...... 26 Interobserver Agreement ...... 26 Subject A ...... 26 Subject B ...... 31 Participants with Autism -Comparison of Averages ...... 36 Subject C ...... 37 Subject D ...... 45 Typical Peers-Comparison of Averages ...... 52 CHAPTER V ...... 54 Discussion...... 54 Limitations ...... 60 Implications for Future Research ...... 62 Conclusion ...... 62 References ...... 63 APPENDIX A...... 71 APPENDIX B ...... 73 APPENDIX C ...... 75 APPENDIX D...... 77 APPENDIX E ...... 78 APPENDIX F...... 79 APPENDIX G...... 81 APPENDIX H...... 83 APPENDIX I...... 84 APPENDIX J ...... 85 APPENDIX K...... 88

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LIST OF TABLES

1. Definition of Communication Interaction Behaviors…………………………..…23 2. Description of Floor Time Steps……………………………………………….....24 3. Average Frequency of Means of Expression-Subject A……………………….…27 4. Average Frequency of Communication Functions-Subject A.…………………...29 5. Average Frequency of Other Variables-Subject A…………………………….....30 6. Average Frequency of Means of Expression-Subject B………………………….32 7. Average Frequency of Communication Functions-Subject B…………………... 34 8. Average Frequency of Other Variables-Subject B……………………………….35 9. Average Frequency of Floor Time Step One-Subject C………………………….38 10. Average Frequency of Floor Time Step Two-Subject C………………………....40 11. Average Frequency of Floor Time Step Three-Subject C………………………..41 12. Average Frequency of Floor Time Step Four-Subject C………………………....43 13. Average Frequency of Floor Time Step Five- Subject C………………………...44 14. Average Frequency of Floor Time Step One-Subject D……………………….....46 15. Average Frequency of Floor Time Step Two-Subject D…………………………47 16. Average Frequency of Floor Time Step Three-Subject D………………………..49 17. Average Frequency of Floor Time Step Four-Subject D……………………...... 50 18. Average Frequency of Floor Time Step Five-Subject D………………………....52

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LIST OF FIGURES

1. Means of Expression-Subject A………………………………………………..…27 2. Communication Functions-Subject A………………………………………….…28 3. Other Variables-Subject A…………………………………………………….….30 4. Means of Expression-Subject B……………………………………………….….31 5. Communication Functions-Subject B………………………………………….…33 6. Other Variables-Subject B…………………………………………………….….35 7.1 Average Occurrences of Communication Behaviors-Subject A……………..…...36 7.2 Average Occurrences of Communication Behaviors-Subject B……………….…37 8. Floor Time Step One-Subject C……………………………………………….….38 9. Floor Time Step Two-Subject C……………………………………………….…39 10. Floor Time Step Three-Subject C………………………………………………...41 11. Floor Time Step Four-Subject C……………………………………………….…42 12. Floor Time Step Five- Subject C…………………………………………….…...44 13. Floor Time Step One-Subject D……………………………………………….…45 14. Floor Time Step Two-Subject D…………………………………………….…....47 15. Floor Time Step Three-Subject D………………………………………….……..48 16. Floor Time Step Four-Subject D………………………………………….………50 17. Floor Time Step Five-Subject D………………………………………….…..…..51 18.1 Average Occurrences of Floor Time Steps-Subject C………………….…....…53 18.2 Average Occurrences of Floor Time Steps-Subject D…………………………53

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ACKNOWLEDGEMENT

My thesis has been a wonderful learning experience for me. I truly enjoyed developing research in an area that I am strongly passionate about. There were many people who have contributed to the success of my study and I would like to thank everyone for their support and guidance.

I would like to thank Dr. Kathleen Hutchinson for being a wonderful thesis advisor and always being there to guide me every step of the way. Your dedication, wisdom and patience have provided me with much encouragement and motivation to successfully complete this study. I truly appreciate you taking the time to help me with a project that I can be proud of.

I would also like to thank Dr. Doris Bergen for being an outstanding mentor and reader. You have provided me with a lot of support. I would not have been able to develop a strong study on floor time without your guidance. Your time and efforts has been crucial to the success of my study.

I would also like to thank Mrs. Ann Glaser who was also a reader and a strong mentor. Your guidance has allowed me to initiate and execute my study. You have provided me with encouragement and kept my motivations high. Thanks for all your support.

I would also like to thank Dr. Donna Murray for being a reader on my committee. I truly appreciate you taking the time to thoroughly reader over my study and providing me with valuable input. Your knowledge with autism has supplied me with insightful information which has significantly added to the quality of my study.

Lastly, I would like to thank Ann Slone and Sandy Crowell who worked closely during the execution of my study. Your availability and willingness to be apart of my study has been so helpful and beneficial. I appreciate all the time you set aside to help me carry out my study.

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Thanks everyone for working with me and making my study a success. I am truly proud of this accomplishment and will never forget your contributions.

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CHAPTER I

Introduction

Autism According to the American Psychological Association, it is well known that the most outstanding feature of children with autism is forming effective social relationships with their peers (American Psychological Association 2000). Many children with autism do not interact with peers or personal interactions may be limited to adults (Scott, Clark, & Brady, 2000). It is important for children with autism to form social/ play relationships among peers to prevent social isolation and to experience the pleasures and benefits of developing social contacts. According to Schuler and Wolfberg (2000) limited success in teaching play skills for children with autism has negative repercussions in terms of quality of life. Without the benefits of participation in play culture, many children with autism remain isolated. Social interaction skills are the primary developmental goal for young children with autism (Olley & Gutentag, 1999). As typical children enter preschool, they show an increasing desire and ability to coordinate social activity while actively seeking our peers for the purpose of play and companionship (Schuler & Wolfberg, 2000). Recent estimates have shown an increased prevalence in autism with a rate as high as 40 and 60 per 10,000 births (Charman & Baird, 2002). Many children with autism are being integrated into schools with typically developing children. With the higher incidence and integration of autism into schools, communication interaction needs to be addressed in education. Placing typical peers and children with autism together may not be enough to provide the necessary acquisition of social communication skills (Laushey & Heflin, 2000). For this reason it is important that typical peers are taught in the classroom how to interact with their peers with autism.

Peer-Mediated Interventions

Peer-mediated intervention promotes social interaction between children with autism and typical peers in the classroom (Rodgers, 2000). The goal of peer-mediated intervention is to increase social behaviors of children with disabilities by teaching typically developing peers to

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initiate interactions with their peers with disabilities and respond to their social behaviors (Terpstra, Higgins, & Pierce, 2002). Several studies have been done studying the effects of training typical peers to interact with their peers with disabilities. The results of these studies have shown successful outcomes for the child with disabilities and the typical peers. One study investigated the effects of peer-mediated intervention on the social skills of five preschoolers with autism and 10 typical peers (Dawson, et.al, 1992). This experiment addressed questions such as: Can peers without disabilities be taught facilitation strategies that target interactions (i.e. mutual attention to play activity, commenting on ongoing activities, and acknowledge the behavior of their peers with disabilities). The results revealed that a peer-mediated intervention promoted social interaction among typical peers and their classmates with disabilities.

Autism-Related Interventions

There are several interventions used for children with autism. Among them are Lovaas, also known as discrete trial teachings or Applied Behavior Analysis, The Treatment and Education of Autistic and Communication Handicapped Children (TEACCH) and floor time (Greenspan, 1998; Lovaas 1987; Mesibov, 1997). These interventions have been shown to develop communication skills through the use of various strategies such as intensive behavioral therapy (ABA or discrete trail training); visual supports (TEACCH) and following the child’s lead (Floor Time). Applied Behavioral Analysis with a focus on discrete trail teachings, is an intervention for children with autism based on the teachings of Ivar Lovaas in the 1960’s. ABA incorporates the principals of pairing positive behaviors with motivating rewards and unwanted behaviors with negative consequences (Mesibov, Adams & Klinger, 1997). Lovaas’s research on discrete trial teachings which is a form of ABA involves a series of tasks or trials. Each task has a specific command and prompt which helps the child achieve a correct response (Stahmer, Ingersoll, & Carter, 2003). Discrete trail teachings have shown that after the first two years of ABA treatment, participants were able to enter kindergarten with only minimal assists (Lovaas, 1987). The Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) approach was developed by Eric Schopler and Gary Mesibov in the early 1970s. TEACCH is based on structured teachings using visual supports (Panerai, Ferrante & Zingale, 2002). The foundation for TEACCH was established when visual information was

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demonstrated to be more easily processed by people with autism than verbal information (Mesibov, 1997). The use of visual symbols strengthens the child with autism’s understanding of the communication in their environment (Tissot & Evans, 2003). Floor time is an educational model adopted by Stanley Greenspan. It is a philosophy and a technique (Greenspan, 1998). Floor time’s theory focuses on following the target child’s lead (Greenspan, 1990). Floor time increases the circle of interaction between a child and adult. Through the use of floor time parents and educators can help the child move up the developmental ladder by building on what the child does to encourage more interaction (Autism Society of America, 2005). Floor time is traditionally based on adult-child dyads. The adult is approaching the child and following the child’s lead in order to open the doors of communication. Children with autism need interventions that are child focused since children interact with one another (Schuler & Wolfberg, 2000). Peer interaction has not received much attention in education (Greenspan & Weider, 1997). Interventions tend to be highly structured and adult focused when dealing with interaction skill acquisition for children with autism. There needs to be greater attention on peers facilitating interactions with their peers with autism. Peers carry out a distinct role in creating opportunities for socialization that cannot be replicated by adults (Schuler & Wolfberg, 2000).

Significance of the Problem

It is important that typical peers are taught socialization skills to use with their peers with autism. Research has shown that typical children are more likely to play with children who do not have disabilities if an intervention is not implemented (Terpstra, Higgins, & Pierce 2002). Floor time provides the child with autism the opportunity to respond to initiations from peers and reinforce their attempted social behavior when a typical peer responds to them (Terpstra, Higgins, & Pierce 2002). Floor time has five steps which are 1. observe the target child (child with autism), 2. approach the target child and open the circle of communication, 3. follow the target child’s lead, 4. extend and expand the target child’s interest, 5. close the circle of communication. The steps of floor time have potential to give typical peers the opportunity to

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respect the child with autism’s individual differences and use those differences to open the doors to communication (Greenspan, 1998). The current study uses a peer-mediated intervention model and incorporates the steps of floor time to increase interactions between typical peers and peers with autism. Studies completed by Goldstein, et.al (1992), Zercher et. al. (2001) and Miller, et. al (2003) have shown the positive effects on peer-mediated interventions. Little research exists on the effectiveness of floor time for children with autism even though it is a popular intervention approach for the autistic population (Autism Society of America, 2005).

Purpose of the Study

The purpose of this research is first to extend floor time literature and teach typical peers the steps of floor time to use on their peers with autism. Second is to increase the communication interactions for the peers with autism when the steps of floor time are used with a typical peer. The following specific research questions will be addressed in this study: (a) Can the steps of floor time be implemented in a peer-mediated intervention model and taught to typical peers in an integrated classroom setting? (b) Do peers with autism demonstrate an increase in their communication interaction with their typical peers when provided with the floor time intervention?

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CHAPTER II

Literature Review

Autism The word “autism” is a compound of two Greek words- ‘aut’, which means ‘self’, and ‘- ism’, which implies ‘orientation or state (Trevarthen, Aitken, Papoudi, & Robarts, 1998). Autism was first reported in the literature in 1943 by psychiatrist Leo Kanner. He described eleven children who exhibited a shared group of remarkable characteristics (Quill, 1995). Kanner pointed out characteristics including: isolated play, remarkable language traits, ritualistic behavior and resistance to change (Olley & Gutentag, 1999). These characteristics continue to be regarded as central traits of autism. Other associated features that have been discovered include hyperactivity, short attention span, impulsiveness, aggressiveness, self-injurious behavior, high threshold for pain, and abnormalities in eating (Olley & Gutentag, 1999). According to the Diagnostic and Statistical Manual of Mental Disorders, 4 th ed. (DSM- IV) autism refers to a disorder in which persons manifest the following characteristics: social interaction impairments, communication problems; and repetitive stereotypic and restricted interests and activities (Whitman, 2004 ). Troubles within the domains of communication and language are so prevalent in individuals with autism that they have been used as the central descriptors of the syndrome (Quill, 1995). Recent estimates on the incidences of autism suggest that the disorder may be on an increase. Early estimates indicated that autism occurred in about four to ten children per 10,000 (American Psychological Association, 1994). In contrast, recent studies indicate a rising prevalence of autism. In a review of current studies, Charman and Baird (2002) suggest the rate may be as high as 40 and 60 per 10,000 births. Most studies indicate that autism is more prevalent among males, with a male to female ratio somewhere between 3:1 and 4:1 (Volkman, Szatmari, & Sparrow, 1993). Symptoms of autism have to be present by 36 months of life. Once diagnosed most individuals retain the diagnosis over their life time, thus it is a chronic disorder (Whitman, 2004). Early intervention in combination with a coordinated education program helps increases the likelihood for positive long-term outlooks for children with autism (Koegel & Koegel, 1995). Early intervention increases their chances of becoming independent individuals in society with

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only a few showing minimal signs of the essential characteristics of autism. However, the social difficulties associated with autism tend to persist (Simpson & Myles, 1998). Autism is one of five disorders falling under the umbrella of Pervasive Developmental Disorders (PDD), a category of neurological disorders characterized by "severe and pervasive impairment in several areas of development," including social interaction and communications skills (DSM-IV-TR). The five disorders under PDD are Autistic Disorder, Asperger's Disorder, Childhood Disintegrative Disorder (CDD), Rett's Disorder, and PDD-Not Otherwise Specified (PDD-NOS). Each of these disorders has specific diagnostic criteria as outlined by the (DSM-IV- TR) (Autism Society of America, 2005).

Language in Autism Language is a fundamental component of all known human societies; in fact it has been argued to be the tool by which intellectual, social, and cultural achievements are organized in adults and passed along to children (Wilkinson, 1998). Language entails four interconnected systems of linguistic communication: pragmatics (social language), semantics (word meanings and concepts), phonology (speech sound rules), and syntax (rules governing word order) (Wilkinson, 1998). In typical development, all four systems emerge in synchrony. For children with autism there may be uneven development across all four domains. Some remarkable behaviors observed in children with autism in the area of pragmatics or social language is eye gaze patterns and gestures. Children with autism have difficulty using gestures and eye contact during joint attention or when their attention must be coordinated between environmental events and another person (Wilkinson, 1998). Children with autism also have challenges conversing with others. They tend to limit communication functions to requesting. Children with autism rarely convey communicative acts such as acknowledging others, commenting on something or expressing social etiquette and sharing thoughts and feelings (Scott, Clark, & Brady, 2000). In the area of semantics or word meanings, children with autism show atypical word- related behaviors. Some common behaviors include echolalia or repetition of words or phrases either immediately or delayed. Echolalia results from a gestalt processing style. Gestalt processing is a processing style in which unanalyzed chunks of auditory or visual information is memorized (Schuler, 1995). The child with autism is learning language units as a whole rather

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than breaking it down into smaller units of individual meaning. An example of gestalt processing style would be a child with autism saying “put it on.” The child processed this phrase as a whole and would not analyze each word as a separate unit. Another common behavior is “metaphorical” and idiosyncratic language which includes the use of unusual but meaningful words or phrases or made-up words (neologisms) that are not appropriate to the context (Wikinson, 1998). The child with autism has associated a word or phrase to a particular event that is unusual to the listener. An example of idiosyncratic language is a child with autism may hear his or her mother make a comment such as “going to grandmas” while riding in the car. Each time the child rides in the car regardless of the destination the phrase “going to grandmas” is repeated by the child with autism. It has meaning to the child but is considered unusual to the listener. Children with autism tend to be concrete and inflexible with their use of language. Abstraction, idioms, and inferencing are difficult concepts both expressively and receptively (Scott, Clark, & Brady, 2000). For example if a child with autism is given a picture of a baby lying in a crib crying and is asked “why is the baby crying?” The child is likely to give a concrete answer and say “because the baby is lying in his/her crib” rather than “the baby is hungry” or “the baby wants their mommy”. As with pragmatics and semantics, children with autism demonstrate remarkable phonological (speech sound rules) and syntactic (rules governing word order) features. One aspect in the area of phonology that is clearly unique is their use of prosody or intonation and stress patterns while speaking (Wilkinson, 1998). Some children with autism have been described as monotonous while others are extraordinarily loud or a singsong vocal quality. For example a child with autism may echo or repeat the phrase “Do you want a cookie?” with the same question-intonation, but for the purpose of requesting a cookie for him or herself. Syntax or word order does not typically appear to be delayed relative to other language domains in children with autism. The reversals of pronouns “you” for “me” are common syntactic errors observed for children with autism (Scott, Clark, & Brady, 2000; Wilkinson, 1998).

Communication Deficits in Autism Communication refers to the process of sharing information and ideas from one person to another. It involves encoding, transmitting and decoding the intended message (Shames &

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Wigg, 1990). Communication is more than being able to speak or being able to put words in the proper order . It is the ability to let someone else know that you want something, to tell someone about an event, to describe an action and to acknowledge another persons presence (Quill, 1995). Communication also implies a social interaction between two or more people. According to Wetherby and Prizant (1999) communication may be an initiation, a response, or an imitation. It may serve to express emotion, make a request or voice a protest. In autism all aspects of communication are usually impaired. Scott, Clark and Brady (2000) suggest autism can affect components of communication such as speech, language, non-verbal communication (i.e. body language, eye gaze and touch). Communication in individuals with autism can range from totally nonverbal to superior reading and vocabulary skills. It has been estimated one third of children with autism never develop functional speech (Prizant & Whetherby, 2000). Many children with autism who do develop speech are reported as echolalic or repeating the speech of others either immediately or delayed (Schuler, 1995). When compared to typically developing children, children with autism communicate more often in attempts to regulate adult behavior to accomplish an environmental need. They seldom attempt to direct attention to themselves or objects. Children with autism were also found to use more primitive motoric gestures such as contact gesture of leading (pulling or manipulating another’s hand) and fewer vocalizations to express intentions in the early stages of language development (Shulman, Bukai & Tidhar, 2001). These children lack the use of many gestures such as showing, waving, pointing and symbolic gestures, such as nodding head and depicting actions (Wetherby & Prizant, 1999).

Social Deficits in Autism Wetherby and Prizant (1999) believe that social interaction skills are the primary goal development of young typical children. Development of these skills should be an important focus of early childhood. Social interaction is an important part of children’s development and community living. People engage in reciprocal social interactions at home, school, at work and during leisure activities (Scott, Clark, & Brady, 2000). Interactions with others within the environment provide a basis from which the child with autism learns to view the world. Therefore, the importance of social interaction should not be overlooked. Grubbs and Niemeyer

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(1999) stated that if children do not possess a repertoire of interaction strategies, environmental exploration and schema development may be affected. While most typical children seek out others for play and social reinforcement, children with autism do not interact with other children and seem unaware of other peers in their environment (Scott, Clark, & Brady, 2000). Personal interactions may be limited to adults and are usually for self motivating purposes. Osterling and Dawson (1994) also studied social interaction in autism. They investigated video tapes of first birthday parties of 11 one year old toddlers who would later be diagnosed with autism to videotapes of 11 typical one-year-old toddlers with 10 boys and one girl in each group. They found that the one year olds later diagnosed with autism, attended less to people and failed to orient when their names were called. Dawson, Meltzoff, Osterling, Rinaldi and Brown (1998) compared 20 children with autism to 19 developmentally matched children with Down syndrome and 20 typical peers. The study investigated the participants ability to visually orient two social stimuli (name called, hands clapping) and two nonsocial stimuli (rattle, musical jack-in-the-box), and ability to share attention (follow another’s gaze or point). It was found that compared to children with Down Syndrome and typically developing children, the children with autism took longer to orient to social stimuli and also exhibited impairments in shared attention. Rodgers (2000) reported that early efforts in the field of socialization were aimed at adults teaching social interaction to children with autism. Currently research has moved to more careful attention to children’s interactions in natural settings, with a greater focus on social interaction with peers instead of adults. Greenspan (1998) believes that children need to interact with their peers because they will need to engage with peers throughout their lives. Scott, Clark and Brady (2000) also support that difficulties with social communication can also be manifested in play and other circumstances where interaction with others is expected.

Play in Autism Play is an integral part of child development. Through play, children learn social skills such as sharing, cooperation and turn-taking. Social language is learned, self-esteem is built, and friendships are formed during recreational activities with peers (Indiana Resource Center for Autism, 2005). Through play, children learn many aspects of language, including non-verbal

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cues, turn-taking, joint attention, and regulation of behavior through requesting and other social interactions (Terpstra, Higgins, & Pierce, 2002). Restal and Magill-Evans (1994) studied children with autism and play behavior. They found play provided a medium through which typical children develop skills, experiment with roles, and interact with others. Children with autism were disadvantaged in their use of play for these purposes. Children with autism lack the predisposition to play spontaneously with peers (Wolfberg, 1999). Scott, Clark and Brady (2000) suggest that children with autism tend not to exhibit social reciprocity during play without specific instruction. The lack of structure and explicit “rules” to follow as well as the speed with which auditory and nonverbal social signals need to be processed, make play a difficult time for these children. It is difficult for children with autism to attend to all the social, language and communication skills that are involved with play. These skills usually work together and become overwhelming for the child (Scott, Clark, & Brady, 2000). Children with autism play in stereotypic ways with objects and they typically remain isolated from peers (Wolfberg, 1995). During free-play situations, children with autism frequently avoid their peers or resist social overtures, passively enter play with little or no self- initiation, or approach peers in a vague and one sided-fashion (Wolfberg, 1999). Terpstra, Higgins, and Pierce (2002) stated that a child with autism may play near another peer with the same toys but not interact with the other child. Schuler and Wolfberg (2000) warn that without specific support and guidance, children with autism gravitate to repetitive play activity ranging from manipulating objects, enacting elaborate routines to engaging in obsessive and narrowly focused interest. Play is important for children with autism because play is the norm in early childhood and a lack of play skills can aggravate children’s social isolation and underline their difference from other children (Boucher, 1999). Peer play has not received much attention in the education and intervention for children with autism (Greenspan & Weider, 1997). Interventions tend to be highly structured and adult focused when dealing with play skill acquisition for children with autism (Schuler & Wolfberg, 2000). Children with autism need interventions that are child focused since children engage with

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one another. Peers carry out a distinct role in creating opportunities for socialization that cannot be replicated by adults (Schuler & Wolfberg, 2000).

Peer-Mediated Intervention Physical integration in the classroom will not ensure that children with disabilities will interact with others in the environment (Grubbs & Neimeyer, 1999). Interacting with peers may be particularly challenging for students with autism and needs to be addressed in education (Wetherby & Prizant, 1998). Goals need to be targeted to teach peers to interact more effectively with their peers with autism. Peer-mediated interventions help promote social interactions between children with autism and typical peers in the classroom. Peer-mediated techniques have been influenced by the work of Goldstein et. al (1992) who have worked to develop successful peer-mediated strategies for the past twenty years (Rodgers, 2000). The goal of peer-mediated intervention is to increase social behaviors of children with autism by teaching the typically developing peers to initiate interactions with other children with autism and respond to their social behaviors (Terpstra, Higgins, & Pierce, 2002). Rodgers (2000) believes peers make the best partners at facilitating social interactions. The use of adult partners for children with autism does not easily generalize to peer partners. Pierce and Schreibman (1995) add that peers can be taught to interact, initiate, reinforce, and prompt their peers with autism so that they engage in positive social interactions and appropriate play. Several studies have been done studying the effects of training typical peers to interact with their peers with autism. Goldstein, Kaczmarek, Pennington and Shafer (1992) investigated the effects of peer-mediated intervention on the social interaction of five preschoolers with autism and 10 typical peers. The setting took place in a play area in an empty classroom. Peers were taught to attend to, comment on, and acknowledge the behavior of their classmate with autism. Results showed that a peer-mediated intervention promoted social interaction among typical peers and their classmates with autism. Laushey and Heflin (2000) tested the effects of enhancing social skills of kindergarten children with autism through the training of multiple peer tutors. The participants of the study included two male students with autism and their typical peer’s ages 5-6 years. The setting took

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place in the classroom. A buddy approach was used to facilitate interaction between the two groups of participants in the classroom as compared to just being in close proximity to classmates with no intervention. The typical peers had to stay with, play with and talk to their buddy with autism. The results revealed a higher percentage of positive social interactions in comparison to just being in close proximity to typical peers. Zercher, Hint, Schuler and Webster (2001) studied increasing joint attention, play and language through peer supported play. In this study, two 6-year old twin brothers with autism, along with three typically developing girls, ages 5, 9, and 11 years participated. The study took place on a weekly basis during Sunday school. The three typically developing peers were trained to 1) use attention directing behaviors and language to establish joint attention episodes, 2) model symbolic play behavior and 3) embed the behaviors of the children with autism in the context of the chosen play theme. The results indicated increased in shared attention to objects, symbolic play acts and verbal utterances for the participants with autism. Miller, Cooke, Test, and White (2003) explored the effects of friendship circles on the social interactions of elementary age students with mild disabilities. There were three participants with a mild disability and typical classroom peers. The setting took place in the school cafeteria. Friendship circles, comprised of typical peers, were created for each of the three participants with a mild disability. Each time they met, they engaged in various activities with one another such as, icebreaker games, discussions on friendship responsibilities and role play appropriate social situations. The results revealed that the “friendship circles” produced a higher percentage of social interactions for the students with mild disabilities. Peer-mediated intervention strategies are a successful way to increase social interaction between children with and without disabilities in integrated classroom settings (Dawson, et. al, 1992).

Interventions Treatments developed for children with autism evolved from different philosophies. These include applied behavioral analysis-discrete trail teachings (Lovaas, 1987), Treatment and Education of Autistic and Related Communication Handicapped Children-TEACCH (Schopler and Mesibov, 1997) and floor time (Greenspan, 1990).

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Applied Behavioral Analysis (ABA) and Discrete Trail Teachings Applied behavioral analysis (ABA), often used interchangeably with the term behavioral modification is the science of human behavior. One of the earliest pioneers for ABA is based on the teachings of Ivar Lovaas in the 1960’s (Mesibov, Adams, & Klinger, 1997). ABA is based upon the principals of learning theory and operant teachings to improve socially significant behaviors in a meaningful manner (Autism Society of America, 2005). Operant teachings are straightforward applications of the basic principals of learning theory. Principals involve pairing positive behaviors with motivating rewards and unwanted behaviors with negative consequences (Mesibov, Adams, & Klinger, 1997). The principals of positive reinforcement have been widely used with children with autism. Discrete trial teachings are also used within an ABA approach and include the principals of positive reinforcement. Discrete trial training is accomplished by working one-on-one, the adult acting as the instructor and the child with autism acting as the learner. The child is presented with a series of tasks or trials. Each task has a specific command and prompt which helps the child achieve a correct response (Stahmer, Ingersoll, & Carter, 2003). A reinforcing stimulus, usually a motivational reward, is given to the child with autism if a correct response is given. The expectation is that positive rewards will increase desired behavior (Green, 2005). Many parents and professionals have looked very highly on ABA approaches as a successful intervention for their children with autism (Corsello, 2005). Parents and professionals have been influenced greatly by outcomes (Lovaas, 1987). Research on discrete trail teachings, between an experimental and control group, showed that after the first two years of ABA treatment some of the children in the treatment group were able to enter kindergarten with only minimal assistance, and scored average or above on IQ tests (Lovaas, 1987). Discrete trail teachings may allow the child with autism to gain cognitive skills which are comparable to typical peers however little communication and social interaction exists during discrete trail teachings (Layton & Watson, 1995). The child is learning skills in a highly controlled teaching environment in which the adult chooses the stimuli to be used in training and the nature of the interactions (Schreibman, Kaneko, & Koegel, 1991). Prizant, Wetherby and Rydell (2000) state the nature of play as a self-imposed activity is violated when adults serve as authoritative control Figure. Layton and Watson (1995) believes one of the behaviors necessary to be a successful communicator is to have something to communication about. Watson, Lord,

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Schaffer, and Schopler (1989) recommend the child be leader and decide what to communicate about. Behaviors and language taught in highly controlled ABA environments such as discrete trail teaching fail to generalize to other environments (Prizant, Wetherby, & Rydell, 2000). Isolation from peers and being taught in a highly controlled environment for the purposes of training causes more aggravation to social deficits. Schuler and Wolfberg (2000) support that being drilled in an adult controlled environment will never prepare children with autism for more social forms of learning and interaction.

Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) The TEACCH approach was developed by Eric Schopler and Gary Mesibov in the early 1970s. The TEACCH approach, also known as “structured teaching”, was designed to serve children with autism and related communication handicaps (Whitman, 2004). “Structured Teaching” is based on the understanding of and respect for the “Culture of Autism” (Mesibov, Shea & Schopler, 2005). TEACCH is different from an ABA approach in that it focuses more on generalization, functional learning and natural environmental teachings (Mesibov, 1997). TEACCH takes into account the features of autism and tries to minimize the child’s difficulties using structured and visually supported interventions (Panerai, Ferrante, & Zingale, 2002 Mesibov (1997) sampled 72-parents and professionals in an evaluation of TEACCH in Northern Ireland. Parents and professionals were interviewed and specific evaluations were conducted with 26 students in five different TEACCH Programs. Over 86% of parents and professionals described TEACCH as effective, mentioning improvements in self-help, communication, and social skills (Mesibov, 1997). Structured teaching has five major components: 1) Organize and simplify the environment to be more consistent with the ways that people with autism process information; 2) Develop meaningful schedules to makes each day more predictable; 3) Develop individual work systems for independent functioning; 4) Use visually clear and organized materials and learn to identify and use visual cues in order to facilitate generalization; 5) Establishing a positively productive routine (Mesibov, Adams, & Klinger, 1997). In structured teaching, the environment and learning activities are designed to help people with autism understand that the world is an

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organized place where they can succeed; rather than random events that inevitably overwhelm or confuse them. The foundation for structured teaching was established when visual information was demonstrated to be more easily processed by people with autism than verbal information (Mesibov, 1997). Spoken directions and instructions that occur in traditionally taught classrooms are not always clearly understood. These instructions are “lost” and the child with autism can miss the learning opportunity. The use of visual systems can strengthen the child’s understanding of the communication in their environment (Tissot & Evans, 2003). It builds on their strengths rather than placing demands on their greatest area of difficulty (Whitman, 2004). The TEACCH approach uses the student’s strengths in visual skills to teach social-linguistic rules and expectations that may be too subtle for them to infer independently (Mesibov, Shea, & Schopler, 2005). According to the Autism Society of America (2005) some people feel that TEACCH is too structured. Children with autism become too focused on the structured environment which discourages ordinary spontaneous experiences. TEACCH also focuses on teaching independence through individual work systems which may isolate children with autism from experiencing the social interaction among peers and developing social skills ( Yarnall, 2000).

Floor Time Floor time is an educational model adopted by child psychiatrist Stanley Greenspan (Greenspan, 1990). It is a technique that can be done anywhere, any place or any time (Greenspan, 1990). There are five steps involved during floor time: 1) observe what the child is doing; 2) approach or open the circle of communication: take interest in the child’s interest; 3) follow the child’s lead: let the child be the director and you be the assistant; 4) extend and expand: tune into the child and extend their interest one step further; 5) close the circle of communication: The circle is closed once the child responds to your interaction (gesture, verbalization, etc.) (Greenspan, 1990). Greenspan (1998) states “Floor time is similar to ordinary interaction and play in that it is spontaneous and fun. Floor time is unlike ordinary play in that one must follow the child with autism’s lead.” One must follow whatever captures the child’s interest and encourage the child

15

to interact. For example if a child with autism is rolling cars, you roll cars with them but offer a faster car to the child with autism. According to the Autism Society of America (2005) floor time builds an increasing larger circle of interaction between a child and adult. Through the use of floor time parents and educators can help the child move up the developmental ladder by following the child’s lead and building on what the child does to encourage more interaction (Autism Society of America, 2005). Following the child with autism’s lead encourages the child with autism to interact, verbalize and take initiative (Greenspan, 1998). Floor time helps build interactions in a way that serves the child’s individual challenges (Greenspan, 1998). Stanley Greenspan hopes the behaviors controlled by the steps of floor time can be generalized. Greenspan postulates that emotional bonds are being formed as a result of placing yourself in the world of the child. Emotions can generalize from place to place. So if there is an emotional connection during interaction, then there is potential for generalization. Previous studies based on the features of floor time include a chart review of 200 cases of children with autism spectrum disorder (Greenspan & Wieder, 1997). All children had severe problems with relating and communicating and were diagnosed, between 22 months and 4 years of age, as having autistic spectrum disorders. After a minimum of 2 years of a comprehensive, relationship/developmentally based floor time intervention program, 58% of the children presented with positive outcomes. The experimental group became trusting and intimately related to parents, showed joyful and pleasurable affect and most remarkably, had the ability to learn abstract thinking and interactive, spontaneous communication at a preverbal and verbal level (The Floor Time Foundation, 2005). Lewy and Dawson (1992) examined the effects of social stimulation on the joint attention behavior of 20 children with autism less than 6 years of age. Children’s social and non-social engagement states were measured during two experimental play sessions and during free play with parents. The results concluded that joint attention was increased when adult play behavior closely followed the child’s lead (Lewy & Dawson, 1992). Baker et. al (1998) demonstrated the effects of incorporating a child’s interests into playground games. Three children with autism were participants in this study. Playground games were developed for children with autism that incorporated themes which were highly

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motivating. Results showed that when games were developed around the child’s favorite themes and topics their social participation increased. The Floor Time Foundation (2005) reported that there have been no peer-reviewed published studies for Greenspan’s floor time effectiveness for children with autism. The report noted that floor time can be included during a preschool/kindergarten program with typically developing peers. Greenspan (1998) mentioned children need to interact with their peers because they will need to engage with peers throughout their lives. Greenspan also mentioned that children are naturally very interactive. They intuitively make good floor time partners (Greenspan, 1998). Floor time has potential to give typical peers the opportunity to respect the child with autism’s individual differences and use those differences to open the doors to communication (Greenspan, 1998).

Research Hypothesis 1. Can the steps of floor time be implemented in a peer-mediated intervention model and taught to typical preschoolers in an integrated classroom setting? 2. Do peers with autism demonstrate an increase in their communication interaction with their typical peers when provided with the floor time intervention?

CHAPTER III

Method and Procedures

This section describes the research methods used to answer the following research questions a) Can the steps of floor time be implemented in a peer-mediated intervention model and taught to typical peers in an integrated classroom setting? b) Do peers with autism demonstrate an increase in their communication interaction with their typical peers when provided with the floor time intervention? Descriptions of the study participants, the setting, materials used, procedure and measurements are included.

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Participants Participants for this study were four children enrolled in two different preschools. Two of the participants, A and B, were five year old males with autism and two participants, C and D, were typical peers. Participant C, is a five year old female and participant D, is a five year old male. The typical peers were selected by the classroom teacher to carry out the steps of floor time. Contact with an early childhood supervisor and student service supervisor allowed identification of schools containing children with autism. Direct observations of students were made in the classrooms and interviews with instructional staff were obtained in order to answer questions pertaining to the level of communication, language social, and play functioning of the participants with autism. Questions can be found in Appendix F. Selection criteria required the children with autism to have verbal abilities. Typical peers where chosen based on the following: compliancy with teacher and classroom rules demonstrates social maturity toward other members of the class and attended class on a regular basis. Letters to the preschool supervisors, teacher and parents were presented to inform the purpose of the study. Letters can be found in Appendix A and B. Permission slips were given to all participants and signed by parents prior to the study. Permission slips can be found in Appendix C and D. Subject A Subject A is a five year old male with autism. He is verbal and speaks in sentences. He presents with superior reading abilities but comprehension is questionable. Subject A communicates primarily with adults and is beginning to engage in pretend play skills. He imitates the play of others when prompted by an adult. Areas of interest include numbers and writing. No significant behavior issues were reported. Subject B Subject B is a five year old male with autism. He is verbal and is able to speak in sentences. Subject B interacts with peers with adult guidance and needs direct facilitation to engage in pretend play activities. It was reported that he is able to imitate the play of others. Areas of interest include blocks, toy trucks, trains and activities with movement. No significant behavior issues were reported. Subjects C

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Subject C is a typically developing five year old female. She attends the same preschool as participant A (peer with autism). Subject C was recommended by the classroom teacher to be the typical peer participant. It was reported that subject C had a good relationship with the children in her class. It was also reported that she is outgoing and would be the best candidate for the study. Subject D Subject D (typical peer) attends the same preschool class as participant B (peer with autism). Subject D was recommended by the classroom teacher as the typical peer candidate for the study. It was reported that subject D is socially mature and is able to relate well to others in his class.

Setting The present study was conducted at each set of participant’s preschools. These schools are licensed by the state to provide educational services to children from preschool through sixth grade. Subject A and C’s school had approximately 11 children enrolled in the preschool program, including one child with autism. Subject B and D’s school had approximately 11 children enrolled in the preschool program, including one child with autism. The main preschool classroom was used as the setting. The interaction took place around classroom activities and toys that caught the child with autism’s interest. Research was conducted during free play which typically occurred at 1:15 p.m for subjects A and C and 9:30 a.m. for subjects B and D. Each male with autism was paired with a selected typical peer. Participant A was paired with participant C (A=peer with autism, C= typical peer). Participant B was matched with participant D (B=peer with autism, D=typical peer). The participants were paired for sessions that lasted approximately ten minutes. Each pair (one participant with autism and one typical peer) were kept constant throughout the study. The children were monitored by the investigator and preschool staff. Prior to the beginning of each session, the investigator reminded the typical peer of the floor time steps and helped transition the typical peer into the activity with the child with autism. The investigator stayed near the play areas but did not enter unless providing physical prompts or other assistance

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during the training and coaching phase. The investigator used verbal praise during training, coaching and intervention phases.

Materials A questionnaire found in Appendix F was used to obtain the participants with autism’s current level of communication, language, social and play functioning. A checklist for the steps of floor time and a checklist for communication interactions were devised based on 10 second spans of time to obtain a baseline and to collect data during the training phase and intervention phase of the study. Checklists can be found in Appendix J and K. A poster board consisting of simplified floor time steps with visual symbols was used to assist the typical peer in providing the intervention during training, coaching and intervention phases. Simplified floor time steps can be found in Appendix H. A visual schedule was used to inform participants with autism and typical peers of the videotaping procedure. The visual consent schedule can be found in Appendix E. A training video (developed by the investigator) on the steps of floor time- preschool version was used during the training phase. A digital timer was used for participant D (typical peer) and a sand timer was used for participant C (typical peer). The timer was for time keeping purposes. A Sony 330x digital zoom video camera was used during the study for data collection purposes for a period of 10 minutes per session. Poster boards with stickers for each session were used as motivation for both typical peers and peers with autism. After each session the typical peer was given a sticker for carrying out the steps of floor time. The child with autism was also given a sticker for participating in the study.

Procedure Baseline: 2 sessions A baseline was collected for the children with autism to determine current level of communication using the checklist found in Appendix K. A video camera was used to tape the interactions for the child with autism in the classroom. A baseline was also obtained from the typical peers to determine if steps of floor time are currently used in daily interactions using the checklist found in Appendix J. The baseline lasted 10 minutes over a period of the first two sessions. No prompts for initiating or maintaining interaction were provided. Peers from both schools were taped during regular free play hours. Peer Training: 4 sessions

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Following baseline data collection, training was implemented with the typical peers over 4 sessions. Peers were trained one on one with the investigator. The peers were informed on their role as a participant. An overview of the steps of floor time was given (1. Observe the child, 2. Approach the child, 3. Follow the child’s lead, 4. Extend and expand on the child’s interest, 5. Close the circle of communication). The steps were written and simplified into a preschool version and specific strategies were given using the visuals from Appendix H. The clarified steps and strategies included: (a) watch your friend (b) go to your friend (c) say their name or tap them on the shoulder (d) play with your friend (e) ask them questions, make comments or give them toys to play with. In addition to being taught the steps of floor time, the typical peers were shown a training video developed by the investigator. The video footage showed how to implement the simplified steps of floor time. Adult-child demonstration was also provided and typical peers were given verbal praise each time they exhibited a floor time behavior with the investigator. Posters with visual symbols and words were used to illustrate the steps and strategies during training and adult-child demonstrations. A sticker was provided at the end of the training session to the typical peers for listening and following directions. The training session was video taped for data collection purposes. Coaching Phase: 7-8 sessions Following the training phase, typical peers were them instructed to implement the simplified steps of floor time with their peer with autism over the next 7-8 sessions. The investigator provided ongoing verbal guidance along with presenting the visual symbols for each floor time step. The steps prompted were: watch your friend, go to your friend, say their name and tap them on the shoulder, play with your friend, ask them questions, make comments and give them toys to play with. The investigator would continuously give verbal suggestions and provide physical guidance on how to implement the steps with subjects C and D (typical participants). The typical peer was instructed to follow their peer with autism’s lead and play with them until the timer goes off. The coaching phase lasted 10 minutes each session over a period of 8 sessions for subjects A and C and 7 sessions for subjects B and D. Intervention Phase: 7 sessions Following the coaching phase, typical peers were then instructed to independently perform the trained steps and strategies of floor time with their peers with autism. The

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investigator no longer provided prompts or coaching. All interactions were initiated and carried out by the typical peer subjects C and D. The visual steps of floor time were posted in the play area as a reminder. These steps can be found in Appendix I. The children were video taped for 10 minutes over a duration of 7 sessions.

Measurements

Dependent Variables Nine sets of behaviors were assessed across baseline, coaching and intervention phases for subjects A and B (participants with autism). These behaviors were coded in terms of means of expression, communication function and other behaviors (see Table 1). Nine sets of behaviors associated with the five steps of floor time were also assessed across baseline, coaching and intervention phases for subjects C and D (typical peer participants). Table 2 lists the components of the five steps.

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Table 1 Definition of Communication Interaction Behaviors Means of Expression

Verbalizations Behaviors that serve to express a communicative intent through the use of words.

Gestures Using hand motions such as waving or pointing to serve a communication function i.e. requesting or refusal.

Imitative Response Verbally repeats the words or nonverbally repeats the actions of the typical peer.

Communication Function

Requesting Use of words or actions to fulfill a self-serving need.

Refusing Verbally or nonverbally expresses an objection against an activity, comment, question or interaction (i.e. saying “no”)

Comment Verbally uses words to express a personal belief or opinion.

Questions Verbally uses words i.e. what, who, when, where, how and why to obtain information from typical peer.

Other Behaviors

Joint Attention Follows the gaze shift to an object, person or event. Responding verbally or nonverbally when attention directing imperatives are used (i.e. “look”)

Eye Contact Directs visual contact with typical peer’s eyes.

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Table 2 Description of Floor Time Steps

Step 1- Observe Peer

Observe -The typical peer watches the child with autism play for 0-30 seconds.

Step 2-Approach Peer

Words-The typical peer approaches the child with autism using words (i.e. “Do you want to play?” or “hi”) Gestures-The typical peer taps the peer with autism to get their attention, points to objects, or waves.

Step 3- Follow the Peer’s Lead

Join an object -The typical peer touches the same object as the peer with autism during interaction. Join an action-The typical peer performs the same action as the peer with autism (i.e. running, jumping, rolling cars, etc).

Step 4- Extend and Expand on the Peer’s Actions

Questions -The typical peer verbally obtains information from the peer with autism using what, who, where, why and how. Comments -The typical peer verbally gives suggestions, offers personal beliefs or opinions. Physical Involvement -The typical peer hands the child with autism toys, touches the child or touches the child with autism’s toy.

Step 5- Close Circles of Communication

Close the Circle of Communication - The typical peer uses all the above steps of floor time resulting in the child with autism verbally or nonverbally responding.

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Data Collection A multiple baseline design across subjects was used to assess the steps of floor time executed by typical peers during baseline, coaching and intervention phases. The design was also used to assess the communication interaction behaviors of the peer with autism during baseline, coaching phase and intervention phase. The Wilcoxon matched-pairs signed-ranks test was used to incorporate information about the magnitude of the difference between the coaching phase and intervention phases (George & Mallery, 2005). Data was taken for 10 second intervals over a 10 minute period for a total 17 sessions for subjects A and C and 16 sessions for subjects B and D. The floor time steps implemented by the typical peer were recorded during baseline, coaching and intervention phases. The first step of floor time (observe peer with autism) was coded for the first 20 seconds. The second step of floor time (approach the peer with autism) was coded after the first 20 seconds over a period of 30 seconds. The manner in which the typical peer approached the child with autism was also coded (i.e. words, gestures). The third step (follow the peer with autism’s lead) was coded throughout the 10 minute duration in 10 second intervals. The method in which the typical peer followed their peer with autism’s lead was also coded (joined an action with the peer with autism or joined them while playing with an object). The fourth step (extend and expand on activity) was also coded during the 10 minute duration in 10 second intervals. The method in which the typical peer expanded on the child with autism’s interest was also coded (questions, comments, or physical involvement-providing objects/toys). The fifth step (close the circle of communication) was coded during the 10 minute duration in 10 second intervals each time the child with autism responded verbally or nonverbally to the typical peers interaction. The communication interaction behaviors exhibited from the peer with autism was recorded during baseline for sessions one and two and while the typical peer was implementing floor time steps throughout the coaching and intervention phases. The type of communication interaction behaviors coded was: Means of Expression (vocalization, gesture and imitative response (repeating words or actions); Communication Functions (requesting, refusing, commenting and questions); Joint Attention (directed to peer) and Eye Contact (peer). These behaviors were recorded in 10 second intervals for a period of 10 minutes. The behaviors were coded on a graph based on the number of occurrences for each individual session.

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CHAPTER IV

Results This section describes the outcomes of the three experimental phases mentioned in chapter three (baseline phase, coaching phase and intervention phase). The results are broken down and discussed for each participant (subject A, B, C, and D). The participants with autism, subjects A and B have 9 communication interaction behaviors that are described in Table 1. The typical peers (C and D), have 9 behaviors associated with the 5 steps of floor time that are described in Table 2.

Interobserver Agreement One observer rated four out of 14 (29 percent) of the intervention sessions for subjects A and B, the peers with autism. Mean interobserver agreement was 95 percent for the occurrence of two dependent variables, verbalizations and joint attention with a range of 90-100 percent. Mean interobserver agreement was 95 percent for subject A for the occurrence of verbalizations and joint attention. Mean interobserver agreement was 100 percent for subject B for the occurrence of verbalizations and joint attention.

Subject A Means of Expression (Verbalizations, Gestures and Imitative Response) During the baseline phase the means of expression behaviors were low or nonexistent. Gestures and imitative response had an average of 0.00 and verbalizations had an average of 0.50. Once the steps of floor time were implemented during the coaching and intervention phases, verbalizations had the most dramatic increase. Verbalizations increased to an average of 23.50 for coaching and 12.14 for the intervention phase (p=.034, p>.01). Gestures did not show any significant change from baseline after the coaching and intervention phases. Imitative response only showed slight increases during the coaching phase with an average of 1.38 and stayed stable with baseline during intervention phase (p=1.09). Further analysis of data using the Wilcoxon Matched-Pairs Signed-Ranks Test (Geroge & Mallery, 2005) revealed no significance between coaching and intervention phases for verbalizations, gestures and imitative response (p >.01). Figure 1 shows the pattern of expressive behaviors and Table 3 presents the descriptive measurements for each means of expression.

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Figure 1. Means of Expression

Means of Expression S ubje ct A 4 0

3 0

2 0

1 0

Occurrences 0 12123456781234567 Se ssio n Verbalization G estu re Imitaitve Response

Table 3 Average Frequency of Mean of Expression and Probability of Significance Phase Verbalization Gesture Imitative Response Baseline Average 0.50 0.00 0.00 SD 0.71 0.00 0.00 Coaching Average 23.50 0.50 1.38 SD 9.12 0.53 2.07 Intervention Average 12.14 0.00 0.00 SD 6.20 0.00 0.00 Probability for Coaching and Intervention Phase Differences Probability 0.034 0.046 0.109 (p >.01)

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Communication Function (Requesting, Refusing, Commenting, Questioning) The communication functions of requesting, refusing and questioning were non-existent during the baseline phase with an average of 0.00 occurrences. The communication function of commenting was slightly higher with an average of 0.50 occurrences. Once the steps of floor time were implemented during the coaching and intervention phases, commenting appeared to show the most dramatic increase with an average of 20.50 during the coaching phase and 7.00 during intervention phase but showed no significance (p=0.02). Results were variable for requesting, refusing and questioning. During the coaching phase questions had an average of 1.88 and then increased slightly to an average of 2.00 during the intervention phase but showed no significance (p=0.833). Requesting also increased from 0.75 during the coaching phase to 2.29 during the intervention phase. Refusing decreased slightly from coaching to intervention phase with an average of 1.25 in the coaching to 0.86 in the intervention phase with no significant difference (p=0.317). All of the data across all phases was greater than baseline performance. Further analysis of the data using the Wilcoxon Matched-Pairs Signed-Ranks Test showed no significant difference between the coaching and intervention phase for requesting, refusing, commenting and questions (p >.01). Figure 2 shows the pattern of communication functions and Table 4 presents descriptive measurements for communication behaviors.

Figure 2. Communication Function

Com m unication Function S ubje ct A 4 0

3 0

2 0

1 0

Occurrences 0 12123456781234567 Se ssio n

Requesting Refusing Commenting Questions

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Table 4 Average Frequency of Communication Function and Probability of Significance

Phase Requesting Refusing Commenting Questioning Baseline

Average 0.00 0.00 0.50 0.00

SD 0.00 0.00 0.71 0.00

Coaching

Phase 0.75 1.25 20.50 1.88

Average 1.04 2.55 9.52 1.89

SD

Intervention

Phase 2.29 0.86 7.00 2.00

Average 1.80 1.46 5.29 2.31

SD

Probability for Coaching and Intervention Phases

Probability 0.083 0.317 0.02 0.833

(p >.01)

Other Variables (Joint Attention and Eye Contact) Subject A did not exhibit joint attention or eye contact during the baseline phase. The average for joint attention and eye contact was 0.00 occurrences. During the coaching phase, joint attention and eye contact increased to an average of 1.38. Joint attention and eye contact decreased during intervention phase to an average of 0.14. The Wilcoxon Matched-Pairs Signed-Ranks Test revealed a significant difference for joint attention between coaching and intervention phases (p=0.01) but no difference for eye contact (p=0.059). Figure 3 shows the pattern of other behaviors and Table 5 presents the descriptive measurements for joint attention and eye contact.

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Figure 3. Other Variables

Othe r Variables Sub je ct A 4 3

2 1

O ccurrences0 12123456781234567 Se s s ion

Joint A ttention Eye Contact

Table 5 Average Frequency of Other Variables and Probability of Significance Phase Joint Attention Eye Contact Baseline Average 0.00 0.00 SD 0.00 0.00 Coaching Phase Average 1.38 1.38 SD 0.92 1.06 Intervention Phase Average 0.14 0.14 SD 0.38 0.38 Probability for Coaching and Intervention Phases Probability 0.015 0.059 (p >.01)

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Subject B Means of Expression (Verbalizations, Gestures and Imitative Response) Subject B presented with an average of 2.00 verbalizations during baseline phase. This average was higher than Subject A. Gestures and imitative responses were nonexistent with an average of 0.00. Once the steps of floor time were implemented during the coaching and intervention phases, verbalizations appeared to have the most dramatic increases. This finding is consistent with Subject A. Verbalizations had an average of 28.43 for coaching and 10.71 for the intervention phase. There was no significance difference between the coaching and intervention phase for verbalization (p=0.018). Gestures also followed the same pattern as Subject A. There was a slight increase during coaching 0.43 but then gestures disappeared during the intervention phase with an average of 0.00. There was no significant difference between the two phases (p=0.083) Imitative responses increased to an average of 4.57 which appears to be higher than subject A during the coaching phase but this behavior decreased to 0.71 during the intervention phase. The Wilcoxon Matched-Pairs Signed-Ranks Test revealed no significant difference between phases for verbalizations, gestures and imitative response (p >.01). Figure 4 shows the pattern of expressive behavior and Table 6 presents descriptive measurements of means of expression behaviors

Figure 4. Means of Expression

Means of Expression S u bje ct B 50 40 30 20 10 O ccurrences 0 1212345671234567 S e ssion Verbalization Ges ture Im itaitve Response

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Table 6 Average Frequency of Means of Expression and Probability of Significance Phase Verbalization Gesture Imitative Response Baseline Average 2.00 0.00 0.00 SD 1.41 0.00 0.00 Coaching Average 28.43 0.43 4.57 SD 9.41 0.53 4.08 Intervention Average 10.71 0.00 0.71 SD 7.70 0.00 0.76 Probability for Coaching and Intervention Phases

Probability 0.018 0.083 0.058 (p >.01)

Communication Function (Requesting, Refusing, Commenting, and Questioning) Subject B had an average of 0.00 during baseline for requesting and questioning. This finding is consistent with Subject A. Commenting had the highest average of 1.50 followed by refusing with an average of 0.50 during baseline. Once coaching and intervention phases took place, all communication functions increased. The communication function of commenting increased the highest to an average of 23.14 during the coaching phase and an average of 8.00 for the intervention phase. There was no statistical difference between the coaching and intervention phases for commenting (p=.028). Requesting was also higher than baseline during coaching with an average of 3.86 but decreased to and average of 1.00 during the intervention phase. There was no difference between the phases (p=0.061). Refusing remained fairly consistent between coaching and intervention phase with an average of 1.00 in coaching and a slight increase of 1.29 during intervention phase. There was no significant difference between the two phases for refusing (p=0.414). Subject B did have significant increases with questioning

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with an average of 0.29 which remained consistent during the coaching and intervention phases (p=1.00). The Wilcoxon Matched-Pairs Signed-Ranks Test showed no significant differences between the coaching and intervention phases (p >.01). Figure 5 shows the pattern of communication functions and Table 7 presents the descriptive measurements for communication functions.

Figure 5. Communication Function

Comm unication Function S ubje ct B 4 0

3 0

2 0

1 0 Occurrences 0 1212345671234567 Se ssion

Requesting Refusing Commenting Q uestions

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Table 7 Average Frequency of Communication Function and Probability of Significance Phase Requesting Refusing Commenting Questioning Baseline Average 0.00 0.50 1.50 0.00 SD 0.00 0.71 0.71 0.00 Coaching Average 3.86 1.00 23.14 0.29 SD 3.46 1.15 8.75 0.76 Intervention Average 1.00 1.29 8.00 0.29 SD 1.53 1.11 6.00 0.49 Probability for Coaching and Intervention Phases Probability 0.061 0.414 0.028 1.00 (p >.01)

Other Variables Subject B showed no joint attention behaviors during baseline. The average was 0.00 for joint attention. Eye contact was slightly higher with an average of 0.50 during baseline. Joint attention increased to an average of 0.29 during the coaching phase and increased slightly higher during the intervention phase with an average of 0.43. There was no significant difference between the coaching and intervention phase for joint attention (p=0.078). Eye contact had the most significant increases during the coaching phase with an average of 3.57 and then dropped to an average of 0.53 during the intervention phase. There as no statistic difference between coaching and intervention phase for eye contact (p=0.26). Joint attention and eye contact overall remained slightly higher than baseline when coaching and intervention took place. Further analysis of the data using the Wilcoxon Matched-Pairs Signed-Ranks Test showed no significant increases between the coaching phase and intervention phase for joint attention and eye contact. (p >.01). Figure 6 shows the pattern of joint attention and eye contact and Table 8 presents the descriptive measurements for these behaviors.

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Figure 6. Other Variables

Other Variables S ubje ct B 6 5 4 3 2 1 O ccurrences 0 1212345671234567 S e ssio n

Joint Attention Eye Contact

Table 8 Average Frequency of Other Variables and Probability of Significance Phase Joint Attention Eye Contact

Baseline Average 0.00 0.50 SD 0.00 0.71 Coaching Phase Average 0.29 3.57 SD 0.76 1.62 Intervention Phase Average 0.43 0.57 SD 0.79 0.53 Probability for Coaching and Intervention Phases Probability 0.078 0.26 (p >.01)

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Participants with Autism -Comparison of Averages Subjects A and B Figures 7.1 show the total average of occurrences for all dependent variables across all phases for subject A. Figure 7.2 shows the total average of occurrences for all dependent variables across all phases for subject B. Both Figures 7.1 and 7.2 show that during baseline, both subjects A and B exhibited low to nonexistent behaviors for means of expression (verbalization, gesture, imitative response), communication function (requesting, refusing, commenting, questioning) and other variables (joint attention and eye contact). Subject A showed greater increases in refusing, questioning and joint attention acts than subject B during the coaching phase. Subject B showed greater increases during the coaching phase in verbalizations, imitative responses, requesting, commenting and eye contact. Once the intervention phase took place, subject A showed greater increases in verbalizations, requesting and questioning than subject B. Subject B showed greater increases for imitative response, refusing, commenting, joint attention and eye contact. Figure 7.1. Average Occurrences of Communication Behaviors- Subject A

Average Occurrences Com munication Behaviors S ubje ct A 2 5 .0 0

2 0 .0 0

1 5 .0 0

1 0 .0 0

5 .0 0

0 .0 0 Average Occurrences

g tu re in g n ta ct tio n s i n a e n t stion s n tion o G e C R efusing esp o nse eq u est Qu e ye R E V e rba liz R e C om m e Jo in t A tt itv a it m I Communication Types

Baseline C oaching Intervention

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Figure 7.2. Average Occurrences of Communication Behaviors-Subject B

Average Occurrences Communication Behaviors S ubje ct B 3 0 .0 0 2 5 .0 0 2 0 .0 0

1 5 .0 0 1 0 .0 0 5 .0 0 0 .0 0 Average Occurrences e r g s in g on a ct tio n stu se i za e on t i G u est ef usin g e st te n tion C R m e n tin rba l sp o n eq Q u t A t e R om E ye V R e C Jo in tve ta i Im i Communication Types

Bas eline Coaching Intervention

Subject C Step 1-Observe the Peer with Autism Step one involves the typical peer watching the child with autism play during a span of 0-30 seconds. Subject C displayed no observing behaviors the baseline phase with an average of 0.00. When the coaching phase took place, observing increased to an average of 2.00. This average decreased to 1.43 during the intervention phase. Further analysis using the Wilcoxon Matched- Pairs Signed-Ranks Test showed no significant difference between coaching and intervention phase for observing (p >.01). Figure 8 shows the pattern of behaviors for step one of floor time and Table 9 presents the descriptive measurements for step one.

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Figure 8. Floor Time Step One

Floor Time Ste p 1 Observe the Child Su b je ct C 2 .5 2 1 .5 1 0 .5

Occurrences 0 12123456781234567 Ses sion

Obs erve

Table 9 Average Frequency of Floor Time Step One and Probability of Significance Phase Observe

Baseline Average 0.00 SD 0.00 Coaching Phase Average 2.00 SD 0.00 Intervention Phase Average 1.43 SD 0.98 Probability for Coaching and Intervention Phases Probability 0.157 (p >.01)

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Step 2-Approach the Child with Autism Step two involves the typical peer approaching the child with autism using words or gestures. Subject C did not approach other children with words or gestures during the baseline phase. The average for words and gestures was 0.00 occurrences. During the coaching phase words and gestures slightly increased to an average of 1.88 for words and 1.00 for gestures. Words and gestures decreased during the intervention phase. Word use had an average of 1.29 which is still greater than baseline and gestures had an average of 0.00 which matched the baseline total. The Wilcoxon Matched-Pairs Signed-Ranks Test showed no significant difference between coaching and intervention phases for words and gestures (p >.01). Figure 9 shows the pattern of behaviors for step two of floor time and Table 10 presents descriptive measurements for each behavior.

Figure 9. Floor Time Step Two

Floor Tim e Step 2 Approach the Child Subject C 2.5 2 1.5 1 0.5 Occurrences 0 12123456781234567 Ses sion W ords Ges tures

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Table 10 Average Frequency of Floor Time Step Two and Probability of Significance Phase Words Gestures

Baseline Average 0.00 0.00 SD 0.00 0.00 Coaching Phase Average 1.88 1.00 SD 0.35 0.93 Intervention Phase Average 1.29 0.00 SD 0.76 0.00 Probability for Coaching and Intervention Phases Probability 0.157 0.038 (p >.01)

Step 3-Follow the Peer with Autism’s Lead Step three involves following the child with autism’s through joining and action or object. Subject C during the baseline phase was able to join objects with her peers for an average of 2.00 occurrences. Subject C was unable to join an action with peers. Her average for baseline was 0.00. Joining objects increased to an average of 10.63 during the coaching phase and decreased to 1.71 during the intervention phase. Subject C appeared to make dramatic improvements with joining an action during the coaching phase with an average of 7.63 but this behavior decreased to an average of 2.00 in the intervention phase. The Wilcoxon Matched-Pairs Signed-Ranks Test showed there was no significant difference between the coaching and intervention phases for join an object and join an action (p >.01). Figure 10 shows the pattern of behaviors for step three and Table 11 presents the descriptive measurements for step three.

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Figure 10. Floor Time Step Three

Floor Time Step 3 Follow the Child's Lead Su b je ct C 2 5 2 0 1 5 1 0 5 Occurrences 0 12123456781234567 S es s ion Joined with object Joined with action

Table 11 Average Frequency of Floor Time Step Three and Probability of Significance Phase Join an Object Join an Action

Baseline Average 2.00 0.00 SD 1.41 0.00 Coaching Phase Average 10.63 7.63 SD 5.90 5.10 Intervention Phase Average 1.71 2.00 SD 1.38 1.83 Probability-Coaching and Intervention Phases Probability 0.028 0.051 (p >.01)

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Step 4-Extend and Expand of the Peer with Autism’s Actions During step four the typical peer extends and expands of the peer with autism’s actions through commenting, asking questions or using physical involvement. Subject C displayed the highest average of commenting behaviors during baseline with an average of 5.50 followed by questions with an average of 0.50. She was unable to display the physical involvement behavior. During the coaching phase commenting increased the highest to an average of 30.00 occurrences followed by questions with an average of 17.25. Physical involvement made the least amount of gain with an average of 6.38. When the intervention phase took place, commenting decreased to an average of 6.00 but still remained higher than questions and physical involvement. Questions had an average of 2.00 occurrences and physical involvement had an average of 3.00 occurrences. All of these behaviors remained higher than baseline performance. The Wilcoxon Matched-Pairs Signed-Ranks Test showed no statistical significant difference between the coaching and intervention phase for questions, commenting and physical involvement (p >.01). Figure 11 shows the patterns of behaviors for floor time step four and Table 12 provides descriptive measurements for the step four behaviors.

Figure 11. Floor Time Step Four

Floor Time Step 4 Extend and Expand on Interest S ubje ct C 50

40

30

20

10 Occurrences 0 12123456781234567 Se s s ion Ques tions Comments Physical Involvement

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Table 12 Average Frequency of Floor Time Step Four and Probability of Significance Phase Questions Comments Physical Involvement Baseline Average 0.50 5.50 0.00 SD 0.71 2.12 0.00 Coaching Average 17.25 30.00 6.38 SD 10.04 10.00 5.97 Intervention Average 3.57 6.00 3.00 SD 1.99 3.37 4.40 Probability for Coaching and Intervention Phase Probability 0.018 0.018 0.024 (p >.01)

Step 5- Close Circles of Communication During step five, the typical peer closes the circles of communication. This step occurs when the peer with autism responds either verbally or nonverbally to the previous floor time steps (steps one-four). Subject C did not close circles of communication with peers during the baseline phase. During the coaching phase this behavior increased to an average of 10.63 but then decreased to 2.14 during the intervention phase. The Wilcoxon Matched-Pairs Signed-Ranks Test showed no significant difference between coaching and the intervention phase for closing the circles of communication (p >.01). Figure 12 shows the pattern of closing circles of communication for step five and Table 13 presents the descriptive measurements for the step five behaviors.

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Figure 12. Floor Time Step Five

Floor Time Step 5 Close the Circle of Communication Su bje ct C 35 30 25 20 15 10

O ccurrences 5 0 12123456781234567 Se s s ion Closed Circles of Communication

Table 13 Average Frequency of Floor Time Step Five and Probability of Significance Phase Close Circles of Communication

Baseline Average 0.00 SD 0.00 Coaching Phase Average 10.63 SD 9.84 Intervention Phase Average 2.14 SD 2.19 Probability for Coaching and Intervention Phases Probability 0.043 (p >.01)

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Subject D Step 1-Observe the Peer with Autism Step one involves the typical peer watching the child with autism play during a span of 0-30 seconds. Subject D displayed no observing behaviors during the baseline phase. Observing behaviors increased the most during the coaching phase with an average of 2.00 and decreased during the intervention phase with an average of 1.71. The Wilcoxon Matched-Pairs Signed- Ranks Test showed no significant difference between coaching and intervention phases for observing behaviors (p >.01). Figure 13 shows the patterns of behaviors for step one and Table 14 presents the descriptive measurements for step one.

Figure 13. Floor Time Step One

Floor Time Step 1 Observe the Child Su bje ct D 2 .5 2 1 .5 1 0 .5 Occurrences 0 1212345671234567 S e s s ion Obs erve

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Table 14 Average Frequency of Floor Time Step One and Probability of Significance Phase Observe

Baseline Average 0.00 SD 0.00 Coaching Phase Average 2.00 SD 0.00 Intervention Phase Average 1.71 SD 0.76 Probability for Coaching and Intervention Phase Probability 0.317 (p >.01)

Step 2-Approach the Child with Autism Step two involves the typical peer approaching the child with autism using words or gestures. Subject D was unable to approach peers with words or gestures during the baseline phase. Words and gestures increased during the coaching phase. Words had an average of 1.57 and gestures averaged at 0.86. During the intervention phase words decreased slightly to an average of 1.14 and gestures decreased to 0.00 which matched the baseline total. The Wilcoxon Matched-Pairs Signed-Ranks Test showed no significance between coaching and intervention phases for words and gestures (p >.01). Figure 14 shows the patterns of behaviors for step two and Table 15 presents the descriptive measurements for step two.

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Figure 14. Floor Time Step Two

Floor Tim e Step 2 Approach the Child Subject D 2.5 2

1.5

1 0.5 Occurrences 0 1212345671234567 Se ss ion W ords Gestures

Table 15 Average Frequency of Floor Time Step Two and Probability of Significance Phase Words Gestures

Baseline Average 0.00 0.00 SD 0.00 0.00 Coaching Phase Average 1.57 0.86 SD 0.53 0.69 Intervention Phase Average 1.14 0.00 SD 0.69 0.00 Probability for Coaching and Intervention Phase Probability 0.083 0.034 (p >.01)

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Step 3-Follow the Peer with Autism’s Lead Step three involves following the child with autism’s through joining and action or object. Subject D was unable to approach peers with words or gestures during the baseline phase Subject D during the baseline phase joined an object with peers and average of 1.00 occurrences. He did not join actions with peers during the baseline. The average was 0.00 for joining actions. During the intervention phase the behavior of joining an object increased to an average of 15.71 and then decreased to 6.71 for the intervention phase. The behaviors of joining an action also increased during the coaching phase with an average of 11.71 and also decreased in the intervention phase to 6.57. Although these behaviors decreased during the intervention phase, they still remained higher than baseline. The Wilcoxon Matched-Pairs Signed-Ranks Test showed there was no significant difference between coaching and intervention phases for join an object and join an action (p >.01). Figure 15 shows the patterns of behavior for step three and Table 16 presents the descriptive measurements for the behaviors.

Figure 15. Floor Time Step Three

Floor Time Step 3 Follow the Child's Lead Subje ct D 3 5 3 0 2 5 2 0 1 5 1 0 5 Occurrences 0 1212345671234567 Se ssion Joined with object Joined with action

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Table 16 Average Frequency of Floor Time Step Three and Probability of Significance Phase Join an object Join an Action

Baseline Average 1.00 0.00 SD 1.41 0.00 Coaching Phase Average 15.71 11.71 SD 9.39 7.54 Intervention Phase Average 6.71 6.57 SD 3.64 4.96 Probability for Coaching and Intervention Phase Probability 0.034 0.023 (p >.01)

Step 4-Extend and Expand of the Peer with Autism’s Actions During step four the typical peer extends and expands on the peer with autism’s actions through commenting, asking questions or using physical involvement. Subject D had the highest average for commenting with peers during baseline. Commenting had an average of 2.00 followed by physical involvement with an average of 1.00 during baseline. The behavior of asking questions had the lowest average of 0.50. During the coaching phase commenting increased the highest with an average of 26.43 occurrences followed by questions with an average of 13.57. Physical involvement had the lowest average during baseline of 10.86. During the intervention phase, all behaviors decreased. Physical involvement decreased the most with an average of 5.57 followed by questions with an average of 6.57. Commenting declined to 10.00 occurrences. All these behaviors remained higher than baseline performance. The Wilcoxon Matched-Pairs Signed- Ranks Test showed there was no significant difference between the coaching and intervention phases for questions, comments and physical involvement (p >.01). Figure 16 shows the pattern of behaviors of step four and Table 17 presents the descriptive measurements for the behaviors of step four.

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Figure 16. Floor Time Step Four

Floor Tim e Step 4 Extend and Expand on Interest Subje ct D 5 0 4 0

3 0 2 0

1 0 Occurrences 0 1212345671234567 Ses sion

Questions Comments Physical Involvement

Table 17 Average Frequency of Floor Time Step Four and Probability of Significance Phase Questions Comments Physical Involvement Baseline Average 0.50 2.00 1.00 SD 0.71 0.00 1.41 Coaching Average 13.57 26.43 10.86 SD 3.82 11.40 6.39 Intervention Average 6.43 10.00 5.57 SD 5.09 6.86 3.95 Probability for Coaching and Intervention Phases Probability 0.034 0.028 0.092 (p >.01)

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Step 5- Close Circles of Communication During step five, the typical peer closes the circles of communication. This step occurs when the peer with autism responds either verbally or nonverbally to the previous floor time steps (steps one-four). Subject D during baseline was unable to close circles of communication with her peers. Once the coaching phase took place, this behavior increased to 11.43 but then dropped to 4.43 during the intervention phase. Although the behavior dropped during the intervention phase it still remained higher than baseline. The Wilcoxon Matched-Pairs Signed-Ranks Test showed no significant difference between the coaching and intervention phase for closing circles of communication (p >.01). Figure 17 shows the patterns of behavior for step five and Table 18 presents the descriptive measurements for step five.

Figure 17. Floor Time Step Five

Floor Tim e Step 5 Close the Circle of Comm unication S ubje ct D 20

15

10

5 Occurrences

0 1212345671234567 Se ss ion Closed Circles of Communication

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Table 18 Average Frequency of Floor Time Step Five and Probability of Significance Phase Close Circles of Communication

Baseline Average 0.00 SD 0.00 Coaching Phase Average 11.43 SD 4.61 Intervention Phase Average 4.43 SD 2.88 Probability for Coaching and Intervention Probability 0.028 (p >.01)

Typical Peers-Comparison of Averages

Subjects C and D Figure 18.1 shows the total average of occurrences for all the dependent variables for subject C. Figure 18.2 shows the total average of occurrences for all the dependent variables for subject D. During the baseline phase, subject C was commenting more than subject D. Subject D was using more physical involvement during baseline than subject C. Once the coaching phase took place, Subject C continued to display more commenting behaviors and questioning behaviors were also higher than subject D. Subject D was able to join with an object, join an action, continue to use physical involvement at a higher frequency and close more circles of communication than subject C during the coaching phase.

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Figure 18.1. Average Occurrences of Floor Time Steps-Subject C

Average Occurrences Steps of Floor Tim e Su bje ct C 35.00 30.00 25.00 20.00

15.00 10.00 5.00

Average Occurrences 0.00 of ac tion O bserve G estures Comments J oined with Closed Circles Steps of Floor Tim e Communication

Bas eline Coaching Interv ention

Figure 18.2. Average Occurrences of Floor Time Steps-Subject D

Average Occurrences Steps of Floor Time S u b ject D 30.00

25.00

20.00

15.00

10.00

5.00

Average Occurrences Average 0.00

s s rve e ct ns t nt e e ion o e ords j t on W stur m i Obs e e G h ob h ac lv it it Questi w w Commen vo d d In e e n n al oi oi ic J J ys Ph s of Communicat e

Circl Ste ps of Floor Time Closed B as eline Coaching Intervention

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CHAPTER V

Discussion The most salient feature of children with autism is forming effective social relationship with peers (American Psychological Association, 2000). It is important for children with autism to form social/play relationships among peers to prevent social isolation and to experience the pleasures and benefits of developing social contacts (Olley & Guttentag, 1999). Research has shown that typical children are more likely to play with children who do not have disabilities if an intervention is not implemented (Terpstra, Higgins & Pierce, 2002). Early efforts to improve socialization focused on adult interactions with children with autism (Rodgers, 2000). It is important for typical peers to interact with their peers with autism so peers with autism will get the opportunity to build social and play relationships to build on important social skills. The primary motivation for this study was to increase the communication behaviors of children with autism by teaching typical peers how to interact with them. The current study trained two typical preschoolers the five steps of floor time to facilitate social interaction with their two peers with autism. Floor time is an educational model adopted by child psychiatrist Stanley Greenspan (Scholastic, 1990). This model is commonly used by adults for children with autism. According to Schuler and Wolfberg (2000), children with autism need interventions that are child focused since children engage with one another. The current study trained preschoolers how to implement the five steps of floor time. Greenspan (1998) mentions children are naturally very interactive. They intuitively make good floor time partners. Schuler and Wolfberg (2000) mention that peers carry out a distinct role in creating opportunities for socialization that cannot be replicated by adults. Floor time has potential to give typical peers the opportunity to respect the child with autism’s individual differences and use those differences to open the doors to communication (Greenspan, 1998). The current study hypothesized that typical preschoolers would be able to implement the steps of floor time with their peers with autism. This investigation also hypothesized that when the steps of floor time are implemented by typical peers, communication behaviors will increase for children with autism. Little peer-reviewed research exists investigating Greenspan’s floor time effectiveness for children with autism (Floor Time Foundation, 2005). The results of this investigation indicated that floor time is effective for increasing communication behaviors for children with autism and can be successfully implemented by preschoolers with adult support and facilitation.

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Data was taken over three phases: baseline, coaching and intervention. During the baseline phase, the peers with autism (subjects A and B) were directing low to nonexistent occurrences of communication behaviors towards their typical peers. Verbalization and commenting behavior was practically nonexistent for the peers with autism during baseline. Subject A had an average of 0.50 occurrences for verbalizations and commenting and subject B had an average of 2.00 occurrences of verbalizations and 1.50 occurrences for commenting over a period of ten minutes for two sessions. During baseline, subject A used many communication behaviors with adults but low communication behaviors were directed towards peers. Scott, Clark and Brady (2000) also discovered that while most typical peers seek out others for play and social reinforcement, children with autism seem unaware of others in their environment. Personal interactions may be limited to adults for caretaking purposes such as requesting a motivational need. Children with autism may also feel more comfortable with adults since many autism- related interventions are implemented by adults. Rodgers (2000) reported that many interventions for children with autism are geared towards adults teaching social interaction to the children with autism. This makes it difficult for children with autism to learn how to socially interact with peers when they are only exposed to learning social skills with adults. After baseline data was taken for subject A and B, baseline data was also taken for the two typically developing preschoolers (subjects C and D) to determine if they were using any steps of floor time during their play; results showed that the only floor time steps subject C and D were more capable of implementing independently was step two, join an object with an average of 2.00 occurrences for subject C and 1.00 occurrence for subject D. They were also able to implement step four, making comments to a peer, with an average of 5.50 occurrences for subject C and 2.00 for subject D. After a baseline was taken on all participants, the typical peers were trained on the steps of floor time. The steps of floor time were simplified into a preschool version. Visuals were used to illustrate and to teach each step and to clarify expectations. Subject C and D were able to clearly label each visual step with 90% accuracy. Training also consisted of watching a video of the floor time steps, talking about the pictures and role-playing the steps. During the coaching phase, the typical peers were able to successfully implement each step when provided with verbal reinforcement and presentation of floor time visuals. During the coaching phase, it was observed that subject A had a special interest in numbers. Whenever he

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played during free time, he would always talk about numbers. During the coaching phase, subject C was prompted to talk more about numbers or give subject A an object with a number. For example, subject A was interested in a calendar, during coaching session 8. Subject C was prompted to talk about subject A’s favorite year, birthdays and how many days are in a month. Expanding on his interest in numbers increased subject A’s communication significantly. He had 37 verbalizations towards subject C in one session versus his average of 0.50 verbalizations over 2 sessions during baseline. Subject C was able to close 33 circles of communication in that one session about numbers because she expanded on subject A’s area of high interest. Baker, Koegel and Koegel (1998) also found that obsessive themes of children with autism can be transferred into positive social play interactions. In the present study, subject A’s communication functions increased significantly during session 8 when areas of high interest were discussed. Subject A sustained an overall increase in communication behaviors when subject C performed the steps of floor time throughout the whole coaching session. The communication behaviors that increased highly were verbalizations and commenting. Verbalizations increased to an average of 23.50, and commenting increased to an average of 20.50 occurrences during the coaching phase. Other communication behaviors increased to an average range of (0.50-1.88 occurrences) which resulted in higher averages than baseline. Subject C was able to successfully implement the steps of floor time with specific instruction (verbal guidance) and supportive structure (visual chart) during the coaching phase. A sticker chart was also used for subject C to keep her motivated throughout the session. Likewise, subject D was also able to implement the steps of floor time with high frequencies during the coaching phase. It was observed that subject D had difficulty staying motivated to follow- through with the steps of floor time during the coaching phase. A sticker chart was also used as a reinforcement system. Once subject D obtained a certain number of stickers, he earned a prize at the end for implementing the steps. This type of reward system worked out well in this study. Subject D was able to stay motivated the whole session and worked diligently while implementing the steps. Subject B, the peer with autism, responded well to the steps of floor time with subject D. Subject B seemed to enjoy physical interaction with subject D i.e. being chased and rolling on the ground. Subject D was coached to follow that behavior by pretending to be chased and this created a dramatic increase in interaction between the two participants. During the sessions when physical interaction was involved communication behaviors increased.

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Subject B had 42 verbalizations, 31 comments, 11 requests, and 3 occurrences of eye contact in one session. This average is higher when compared to baseline averages. During baseline, zero occurrences for all behaviors were observed during one session. Overall, subject B had an increase in the same type communication behaviors as Subject A. His overall verbalizations increased to an average of 28.43 occurrences and commenting behavior increased with an average of 23.14 occurrences. The other communication behaviors increased to an average range of (0.29-4.57) which still resulted in higher averages than baseline. During the intervention phase the typical peers (subjects C and D) were no longer provided with verbal prompts. The pictures of the floor time steps remained in the play area but no adult facilitation was given. Some different findings occurred during this part of the experiment. Subject C was able to perform the majority of the floor time steps but in lower frequencies than the coaching phase. The main breakdown occurred during extending and expanding on an activity. Subject C had difficulty expanding on subject A’s interest without coaching. For example when subject A started talking about playing a number game subject C replied, “but I don’t like numbers”. Subject C was trying to get subject A to follow her interest instead of following subject A’s interest. Nguyen and Frye (1999) studied the development of play behavior through a perspective on the theory of mind to understand preschooler's interaction patterns. They found that in order for children to engage in cooperative play, children need to understand each others desires, beliefs and emotions. Play depends on two people wanting to share the same activity. Results revealed that when there was a conflict in beliefs, emotions and desires, there was less cooperative play acts being performed. Their study also investigated the thoughts of five years olds concerning theory of mind. The study found that many five year olds do not expect two people to play together if they have a conflict in desires. This finding agrees with subject C’s behavior towards subject A. When a conflict in interests occurred, subject C had difficulty implementing the steps of floor time and engaging in cooperative play with subject A. They were unable to have cooperative play secondary to that conflict in desire. Many sessions occurred where subject C would play in close proximity to subject A, but subject C would play with a separate toy and refuse to interact because she was not interested. Although subject C had difficulty with step four (extending and expanding), the results during intervention phase were still higher than the baseline phase.

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During the intervention phase, subject A demonstrated a decrease but not significant (p >.01) in communication behaviors with the exception of requesting and imitative response when compared to the coaching phase. The communication behavior of requesting increased to an average of 1.04 occurrences compared to 0.75 during coaching. Imitative response also increased to 2.07 compared to 1.38 during the coaching phase. This behavior could be attributed to a present conflict in interests and subject A had to request more in order to get subject C to follow his lead. A previous study based on the features of floor time included a chart review of 200 cases of children with autism (Greenspan & Weider, 1997). All children with autism ranged in age between 2-4 years. After a minimum of two years of floor time provided by the children’s parents, 58% of the children presented with positive outcomes. The children with autism became trusting, intimately related to their parents, and showed spontaneous verbal and nonverbal communication. Adults from the chart review study were able to successfully implement the steps of floor time to increase behaviors from their children with autism. Subject C (typical peer) was unable to successfully implement the floor time step four (extend and expand) which may have contributed to a decrease in communication behaviors for subject A. In contrast to subject C, subject D was able to implement all steps of floor time without adult coaching during the intervention phase. The steps were implemented but in lower frequencies compared to the coaching phase. Sessions occurred when subject D would occasionally get distracted and there were periods of silence. There was also one significant incidence that occurred over a period of 2 sessions (sessions 4 and 5). The classroom displayed a new train set and subject B was highly fascinated by the set and wanted to spend the whole session playing with the train. Subject D would also play with the trains and implement the steps of floor time independently by giving subject B more trains to play with and putting objects in subject B’s trains. Subject B responded aggressively towards subject D’s interaction. As a result, subject D stopped interacting and using the steps of floor time. This resulted in a decrease in floor time steps and communication behaviors from the peer with autism. When the classroom teacher took the train away the next day, subject B was able to interact positively towards the floor time interaction. It was also interesting that subject D remembered subject B’s enjoyment with physical play from the coaching phase and started initiating that type of play over the next few sessions. This type of behavior was not observed in subject C.

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In the intervention phase, subject C was unable to expand on subject A’s interest and did not want to play activities that were of interest to her peer with autism. Subject D behaved differently and was still able to extend and expand and also understood subject B’s interest for physical interaction. Subject D turned that perceived desire into interaction, which allowed him to be more successful overall during the intervention phase. Subject D was also able to perform more steps of floor time during the intervention phase in higher frequencies that subject C. He had an average of 6.57 joining with an object and 6.43 joining with an action compared to subject C who had an average of 1.71 joining an object and 2.00 joining an action during one session. Subject D also used questions, comments and physical involvement in higher occurrences than subject C. Subject D’s success implementing the steps of floor time could also be related to the fact that he is a male and is interacting with subject B who is also a male. Subject C is a female and was interacting with subject A who is a male. Research has been done on social interaction and gender. McElwain and Volling (2002) studied gender and interaction. Their study showed that girl-girl dyads engage in the highest levels of coordinated play followed by boy-boy dyads and then mixed gender play. This finding could support the discovery that subject B and D were able to have the more successful interactions by both being the same gender. During the intervention phase the peers with autism had variable results with improvements in communication behaviors. Subject A was exposed to less floor time activity secondary to conflict of desire but had a higher average of verbalizations, requesting and questions than subject B. Subject B had a higher level of imitative responses, refusing, commenting, joint attention and eye contact compared to subject A. This study has shown that a peer mediated intervention program that focuses on teaching typical peers the steps of floor time can be used to increase communication behaviors for children with autism. Children with autism were involved in the social world with typical peers. Typical peers learned how to socially interact with their peers with autism. Benefits to all participants occurred because the steps of floor time allowed preschool age children to model appropriate play and interaction behaviors. This study demonstrated that the steps of floor time can be learned and implemented by children for any type of interaction between any groups of children disabled or non-disabled. Typical peers are learning social skills that they can carry with them throughout their lives. Children with autism are also benefiting because they are

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getting the support and guidance they need in order to be active play partners in the classroom. Schuler and Wolfberg (2000) warn that without specific support and guidance, children with autism engage in repetitive play acts and avoid peers. The results of this current study are consistent with the findings from other studies on peer mediated interventions. Goldstein, Kaczmarek, Pennington and Shafer (1992) found that teaching typical peers to attend to, comment on and acknowledge the behavior of their peer with autism promotes and increase in social interaction between typical peers and peers with autism. Laushey and Heflin (2000) also tested the affects of peer mediated interventions and found that using a buddy approach and training a typical peer to stay with, play with and talk to their peer with autism resulted in higher percentages of positive social interactions. Teaching typical peers how to use the five steps of floor time creates an increase in communication behaviors resulting in higher occurrences of communication interaction.

Limitations The current investigation had certain limitations. The lack of available participants was a disadvantage; testing more children with autism and involving more typical peers would have helped generalize the results. Second, the classroom rules occasionally interfered with the nature of floor time. There were incidences when the classroom teacher would intervene if the child with autism was not following classroom rules. This interference affected the social interaction as the child with autism had to find a different toy or activity to play with. Environmental limits may lead the child to depend on routine and structure thus developing possible behavior issues. Lack of diagnostic information available from the parents of the children with autism prevented full knowledge of prior level of functioning. Information on their level of functioning and language capabilities had to be obtained through the classroom teachers who are only exposed to the children with autism during school hours. Studies done by Mccabe and Meller (2004) show that language plays a fundamental role in social interaction. Children with language impairments may be perceived as less socially competent. Mccabe and Meller (2004) studied 36 language impaired children and 36 typically developing children ages three-five years. The language impaired children evidenced delays in self-control, assertiveness and sociability, emotional knowledge understanding and semantic processing of contextually meaningful information. A greater understanding of the participants with autism’s language

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capabilities prior to the experiment would have helped further explain sessions when the child with autism did not fully participate in socialization acts. Joint attention in the current study was narrowly defined. Joint attention was only accepted if the peer with autism followed the typical peer’s eye gaze and also if the peer with autism responded visually to “look”. A more general view of joint attention would have led to greater increases in behavior. Zercher, Hunt, Schuler and Webster (2001) studied increasing joint attention, play and language through peer supported play. Joint attention was widely defined as the sharing of objects or cognition between two or more individuals. The object may be physical, topic or idea presented verbally, or an event in the environment. Results of the study showed an immediate and dramatic increase in joint attention acts across all phases of the experiment. Joint attention acts increased from two acts during baseline to 13 acts during the intervention phase for one participant with autism. This finding is different from the present floor time study. Joint attention was narrowly defined so performance across all phases stayed fairly consistent. For example, joint attention for subject A, during baseline had an average of 0.00 then increased to 1.38 during coaching but decreased to 0.14 during the intervention phase. The age of the participants may have impacted the success of the study. Participants who are more socially mature and have higher language capabilities may have executed the floor time steps more successfully without coaching. Zercher, Hunt, Schuler and Webster (2001) did a similar study in which they trained typical children between the ages of 6-11 years to implement a peer mediated intervention for children with autism. The typical peer participants were taught how to use an integrated play group model through the use of showing, giving, pointing to objects and asking questions to children with autism. Results showed that the integrated play group model could be utilized effectively with kindergarten and elementary age children. The typical peer participants were able to achieve the same levels of performance during coaching and without coaching. This study disagrees with the finding from the current floor time study. During the floor time study, preschool age children were most successful during coaching and levels of performance dropped although not significantly (p >.01) without coaching.

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Implications for Future Research These limitations suggest possibilities for future research. Of greatest necessity is the need to determine if participants of older age would be able to implement the steps of floor time with greater success. Future research should also investigate whether theory of mind has an impact on how well one can implement the steps of floor time and how theory of mind can be measured. It would be important for future studies to execute a long term study on a peer’s ability to expand beyond high interest topics and not perpetuate perseverations. Research should investigate use of the current study as a structured social skills program for school-age children. Classroom teachers could be trained to apply floor time steps into the school curriculum and train all peers beginning with preschool-kindergarten age. Data should be taken to determine if floor time increases positive social behaviors between play partners during classroom free play for all children.

Conclusion Even with the limitations and implications for future research, the outcomes of the study demonstrate that the steps of floor time can be simplified for typical peer understanding and be used during classroom free play time. Preschoolers are capable of learning the steps of floor time with their peers with autism. It was also found that typical peers are able to execute floor time steps with greater success when provided with adult support and facilitation. When the steps of floor time were provided, children with autism exhibited increases in communication behaviors, more specifically verbalizations and commenting when the steps of floor time are implemented. Overall the current study has shown that the floor time intervention is capable of producing high levels of social interaction between typical peers and peers with autism.

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APPENDIX A

Principal Letter Reading Central Whitewater Valley Cincinnati Public Schools

As a second year graduate student in Speech Pathology at Miami University, I am conducting a research study investigating the effects of Stanly Greenspan’s “Floor Time” approach for children with autism and their typical peers. Ann Slone and Sandy Crowell from the Hamilton County Educational Service Center have agreed to participate in this study. The purpose of this study is to teach typical peers in the classroom how to interact with their autistic classmates. The purpose is to also give the child with autism the opportunity to socially interact with their typical peers. The results of this study will hopefully reveal that the “Floor Time” approach is an effective way of getting children with autism and typical peers to interact with one another.

As an individual involved with the autism community, I am aware that many children with autism are being integrated into schools with typically developing peers. Children with autism are having difficulty with social communicative interactions. The literature shows a need for more research at facilitating social interaction between children with autism and their typical peers. I am hoping to add to the literature and demonstrate ways to help increase social interaction in the classroom. I would like to assess a child with autism from your school and a typical peer. The research will consist of taking data on the number of interactions between the student with autism and their typically developing peers. A typical peer will then be taught the “Floor Time” approach to use with their autistic classmate. Time for the research will take about 15 minutes once or twice a week over a 10 week period. A video camera on the two participants will be used to obtain accurate data. All footage and data will be kept confidential in locked files.

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Parents of each student will receive an explanation of the study and consent is necessary for participation. Parents may receive a copy of the experimental results. There are no risks associated with this study and subjects may withdraw at anytime.

Thank you so much for your time and consideration. Your participation is greatly appreciated and crucial to the success of this research study. For any questions or concerns feel free to contact me.

Sincerely,

Nikki Cannon Miami University 513-652-0062 [email protected]

Kathleen Hutchinson Clinical Audiologist Miami University Speech and Hearing Clinic

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APPENDIX B Classroom Teacher Letter

Reading Central Whitewater Valley Cincinnati Public Schools

As a second year graduate Speech Pathology student at Miami University, I am conducting a research study investigating the effects of Stanly Greenspan’s “floor time” approach for children with autism and their typical peers. The purpose of this study is to teach typical peers in the classroom how to interact with their autistic classmates. The purpose is to also give the child with autism the opportunity to socially interact with their typical peers. The results of this study will hopefully reveal that the “floor time” approach is an effective way of getting children with autism and typical peers to interact with one another.

As an individual involved with the autism community, I am aware that many children with autism are being integrated into schools with typically developing peers. Children with autism are having difficulty with social interactions. The literature shows a need for more research at facilitating social interaction between children with autism and their typical peers. I am hoping to add to the literature and demonstrate ways to help increase social interaction in the classroom. I would like to assess a child with autism from your class and a typical peer. The research will consist of taking data on the number of interactions between the student with autism and their typically developing peers. A typical peer will then be taught the “floor time” approach to use with their autistic classmate. Time for the research will take about 15 minutes once or twice a week over a 10 week period. All data will be kept confidential. Parents of each student will receive an explanation of the study and consent is necessary for participation. Parents may receive a copy of the results. There are no risks associated with this study and subjects may withdraw at anytime. Your involvement as the classroom teaching will be to identify a typical peer participant. Selection will be based on the child’s social maturity and their ability to carry out the five steps of “floor time”.

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Thank you so much for your time and consideration. Your participation is greatly appreciated and crucial to the success of this research study. For any questions or concerns feel free to contact me.

Sincerely,

Nikki Cannon Miami University 513-652-0062 [email protected]

Kathleen Hutchinson Clinical Audiologist Miami University Speech and Hearing Clinic

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APPENDIX C Parent/Guardian Consent Form

My name is Nichole Cannon and I am a first year graduate student in Speech Pathology at Miami University. I am conducting research for my Master’s thesis under the supervision of Dr. Kathleen Hutchinson from the department of Speech Pathology and Audiology.

Your child is invited to participate in a study of Stanley Greenspan’s “Floor Time” approach. “Floor time” is a technique that involves creating a supportive and caring partnership with a child. This technique tunes into a child’s emotional needs in order to foster social growth. The purpose of this study is to use the “Floor Time” approach as a means of increasing the number of communication interactions in the classroom between typically developing peers and peers with autism. There is a need for research in the area of building communication interaction between children with autism and their peers. This research will hopefully prove that “Floor Time” is an effective means of fostering social communicative growth in the classroom. With your consent, your child will be pulled aside in the classroom, for 15 minutes, twice a week. They will interact with their classmate who has autism and learn the 5 steps of “floor time”. The steps are: 1. Observe what the other student is playing. 2. Approach the other student and participate in their activity. 3. Follow the other students lead and imitate what they are doing. 4. Add your own ideas into the activity. 5. The other student responds, which indicates an interaction took place Your child will be video taped during this investigation in order to obtain accurate data. The footage will be kept confidential and stored in the office of the faculty chair in locked cabinets. This research will last approximately 8 weeks. Your participation is completely voluntary and you are free to withdraw at any time.

If you have any further questions about the study please contact Nikki Cannon at 652-0062 or email: [email protected] If you have questions about your rights as a research participant, please call the Office of Advancement of Research and Scholarship at 529-3734 or email: [email protected] .

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Thank you for your participation. I am very grateful for your help and know that this study will be very beneficial to your child and their classmates.

Cut at the line, keep the top section and return the bottom section.

I agree to have my child participate in the study of “Floor Time”. I understand that my participation is voluntary and all information will be kept confidential.

Child’s Name: ______

Parent’s Signature: ______

Date: ______

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APPENDIX D Parent/Guardian Video Taping Consent Form

In the best interest of our student participants, Miami University requires parental consent in order to video tape during research. Video taping is used solely for data collection purposes and all footage will be kept confidential. By signing below, you are giving permission to allow your child to be video taped for research purposes.

Child’s Name (please print):______

Guardian Signature: ______

Date: ______

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APPENDIX E

Typical Peer Assent Explanation

Your teacher said that you could help me teach another kid in your class how to play. I am going to teach you rules that you will follow when you play. While you play I will be video taping you.

If you do a good job following the rules and being a good listener, you will get a sticker each time you help me. When you have earned all the stickers off your chart you will get a prize.

Peer with Autism Consent

STICKER

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APPENDIX F

Level of Functioning Questionnaire For child with autism. Language:

1. Does the child with autism present with echolalia behaviors or repeats the words or phrases of others?

2. Can the child speak in sentences or just single word utterances?

Communication:

1. Does the child spontaneously communicate?

2. If yes to question 1, is the communication limited to adults or does the child communicate with peers?

3. Do they use social gestures such as showing, waving, pointing, head nodding, etc.?

Social Skills:

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1. Does the child seem aware of other peers in their environment or are they fixated on specific objects of interest?

2. Does the child respond to their name when called?

3. Are there any behavioral issues during class time?

Play Skills:

1. Does the child play with peers or independently?

2. Does the child engage in pretend play? If so is their play appropriate?

3. Can they imitative play of others?

4. What activities does the child find enjoyable or motivating?

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Interventions:

1. Has the child been involved in any type of autism intervention program (i.e. ABA- Applied Behavioral Analysis, TEACCH- Treatment and Education of Autistic and Related Communication Handicapped Children or a floor time intervention program)?

Diagnosis: 1. Who officially diagnosed the child (psychologist, medical doctor, etc)

2. What assessment instrument was given to diagnose the child (ex: ADOS- Autism Diagnostic Observation Schedule, CARS- Childhood Autism Rating Scale, etc)?

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APPENDIX G

Floor Time Developed by Stanley Greenspan Scholastic (1990)

5 Steps to Floor Time

1.) Observation:
Listening and watching the child

2.) Approach- Open the Circle of Communication
Respond to the child’s actions with words and gestures

3.) Follow the Child’s Lead
Encourage the child and do what they are doing
Be calm and give the child attention

4.) Extend and Expand
Talk about what the child is doing and add to what they are doing

5.) Child Closes the Circle of Communication
When the child responds to what you have expanded on, the child responds to your communication with them.

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APPENDIX H Floor Time Steps and Strategies Simplified Version

1. Look and see what your classmate is doing.

2. Go to your classmate. Say their NAME.

3. Do what your classmate is doing and play with him. 4. Ask questions about the game?

Talk about the game.

Give your classmate more toys to play with for their game.

5. When your classmate looks at you or says something. Ask more questions. ???

Give him more toys to play with.

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APPENDIX I

Visual Floor Time Steps

?

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APPENDIX J Data Collection Sheet Typical Peer Implementing 5 Steps of Floor Time

Date:______Child:______Session#_____Observer______Setting:______Activity:______Codes: 1. Observe peer with autism=O 2. Approach peer =A, (words=W or gestures=G) 3. Follow peer’s lead = FP ( Join with object=JO, join action=JA) 4. Extend/Expand on activity:= EX (questions=Q, comments=C, physical involvement=PI (deliver items, insert obstacles during play to encourage interaction)) 5. Close Circle of Communication=CC (Peer responds and interacts)

Time 5 Steps of Floor Time Seconds/Minutes Observe Peer Approach peer Follow peer’s Extend/Expand on Close Circle of Lead Activity Communication

0:00-0:10 O

0:10-0:20 O

0:20-0:30 W P/I G

0:30-0:40 W P/I G

0:40-0:50 CC JO P/I JA Q C PI 0:50-1:00 JO P/I JA Q C PI CC

1:00-1:10 JO P/I JA CC Q C PI 1:10-1:20 JO P/I JA CC Q C PI 1:20-1:30 JO P/I JA Q C PI CC

1:30-1:40 JO P/I JA Q C PI CC

1:40-1:50 JO P/I JA Q C PI CC

1:50-2:00 JO P/I JA Q C PI CC

2:00-2:10 JO P/I JA Q C PI CC

2:10-2:20 JO P/I JA Q C PI CC

2:20-2:30 JO P/I JA Q C PI CC

2:30-2:40 JO P/I JA Q C PI CC

2:40-2:50 JO P/I JA Q C PI CC

2:50-3:00 JO P/I JA Q C PI CC

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3:00-3:10 JO P/I JA Q C PI CC

3:10-3:20 JO P/I JA Q C PI CC

3:20-3:30 JO P/I JA Q C PI CC

3:30-3:40 JO P/I JA Q C PI CC

3:40-3:50 JO P/I JA Q C PI CC

3:50-4:00 JO P/I JA Q C PI CC

4:00-4:10 JO P/I JA Q C PI CC

4:10-4:20 JO P/I JA Q C PI CC

4:20-4:30 JO P/I JA Q C PI CC

4:30-4:40 JO P/I JA Q C PI CC

4:40-4:50 JO P/I JA Q C PI CC

4:50-5:00 JO P/I JA Q C PI CC

5:00-5:10 JO P/I JA Q C PI CC

5:10-5:20 JO P/I JA Q C PI CC

5:20-5:30 JO P/I JA Q C PI CC

5:30-5:40 JO P/I JA Q C PI CC

5:40-5:50 JO P/I JA Q C PI CC

5:50-6:00 JO P/I JA Q C PI CC

6:00-6:10 JO P/I JA Q C PI CC

6:10-6:20 JO P/I JA Q C PI CC

6:20-6:30 JO P/I JA Q C PI CC

6:30-6:40 JO P/I JA Q C PI CC

6:40-6:50 JO P/I JA Q C PI CC

6:50-7:00 CC JO P/I JA Q C PI 7:00-7:10 JO P/I JA Q C PI CC

7:10-7:20 JO P/I JA Q C PI CC

7:20-7:30 JO P/I JA Q C PI CC

7:30-7:40 JO P/I JA Q C PI CC

7:40-7:50 JO P/I JA Q C PI CC

7:50-8:00 JO P/I JA Q C PI CC

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8:00-8:10 JO P/I JA Q C PI CC

8:10-8:20 JO P/I JA Q C PI CC

8:20-8:30 JO P/I JA Q C PI CC

8:30-8:40 JO P/I JA Q C PI CC

8:40-8:50 JO P/I JA Q C PI CC

8:50-9:00 JO P/I JA Q C PI CC

9:00-9:10 JO P/I JA Q C PI CC

9:10-9:20 JO P/I JA Q C PI CC

9:20-9:30 JO P/I JA Q C PI CC

9:30-9:40 JO P/I JA Q C PI CC

9:40-9:50 JO P/I JA Q C PI CC

9:50-10:00 JO P/I JA Q C PI CC

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APPENDIX K

Data Collection Sheet Communication Interactions with Peers

Date: ______Child: ______Session#_____Observer______Setting:______Activity:______Codes for Communication Interaction Purposes with Typical Peers • Means of Expression: Vocalization=V, Gesture=G, Imitative Response (Echo)=IR, unintelligible utterances=U • Communication Function: Requesting=R, Refusing=RF, Commenting=C, Sharing=S • Joint Attention= directed toward peer=D, not directed toward peer=ND • Eye Contact= Peer=P Peer with Autism Time Communication Interaction Purposes Seconds/Minutes Means of Expression Communication Function Joint Attention Eye Contact (Verbal/ Nonverbal) 0:00-0:10 V G IR U R RF C S D ND P 0:10-0:20 V G IR U R RF C S D ND P 0:20-0:30 V G IR U R RF C S D ND P 0:30-0:40 V G IR U R RF C S D ND P 0:40-0:50 V G IR U R RF C S D ND P 0:50-1:00 V G IR U R RF C S D ND P 1:00-1:10 V G IR U R RF C S D ND P 1:10-1:20 V G IR U R RF C S D ND P 1:20-1:30 V G IR U R RF C S D ND P 1:30-1:40 V G IR U R RF C S D ND P 1:40-1:50 V G IR U R RF C S D ND P 1:50-2:00 V G IR U R RF C S D ND P 2:00-2:10 V G IR U R RF C S D ND P 2:10-2:20 V G IR U R RF C S D ND P 2:20-2:30 V G IR U R RF C S D ND P 2:30-2:40 V G IR U R RF C S D ND P 2:40-2:50 V G IR U R RF C S D ND P 2:50-3:00 V G IR U R RF C S D ND P 3:00-3:10 V G IR U R RF C S D ND P 3:10-3:20 V G IR U R RF C S D ND P 3:20-3:30 V G IR U R RF C S D ND P 3:30-3:40 V G IR U R RF C S D ND P 3:40-3:50 V G IR U R RF C S D ND P 3:50-4:00 V G IR U R RF C S D ND P 4:00-4:10 V G IR U R RF C S D ND P 4:10-4:20 V G IR U R RF C S D ND P 4:20-4:30 V G IR U R RF C S D ND P 4:30-4:40 V G IR U R RF C S D ND P 4:40-4:50 V G IR U R RF C S D ND P 4:50-5:00 V G IR U R RF C S D ND P

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5:00-5:10 V G IR U R RF C S D ND P 5:10-5:20 V G IR U R RF C S D ND P 5:20-5:30 V G IR U R RF C S D ND P 5:30-5:40 V G IR U R RF C S D ND P 5:40-5:50 V G IR U R RF C S D ND P 5:50-6:00 V G IR U R RF C S D ND P 6:00-6:10 V G IR U R RF C S D ND P 6:10-6:20 V G IR U R RF C S D ND P 6:20-6:30 V G IR U R RF C S D ND P 6:30-6:40 V G IR U R RF C S D ND P 6:40-6:50 V G IR U R RF C S D ND P 6:50-7:00 V G IR U R RF C S D ND P 6:50-7:00 V G IR U R RF C S D ND P 7:00-7:10 V G IR U R RF C S D ND P 7:10-7:20 V G IR U R RF C S D ND P

7:20-7:30 V G IR U R RF C S D ND P 7:30-7:40 V G IR U R RF C S D ND P 7:40-7:50 V G IR U R RF C S D ND P 7:50-8:00 V G IR U R RF C S D ND P 8:00-8:10 V G IR U R RF C S D ND P 8:10-8:20 V G IR U R RF C S D ND P 8:20-8:30 V G IR U R RF C S D ND P 8:30-8:40 V G IR U R RF C S D ND P 8:40-8:50 V G IR U R RF C S D ND P 8:50-9:00 V G IR U R RF C S D ND P 9:00-9:10 V G IR U R RF C S D ND P 9:10-9:20 V G IR U R RF C S D ND P 9:20-9:30 V G IR U R RF C S D ND P 9:30-9:40 V G IR U R RF C S D ND P 9:40-9:50 V G IR U R RF C S D ND P 9:50-10:00 V G IR U R RF C S D ND P

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