Shih, W., Dean, M., Kretzmann, M., Locke, J., Senturk, D., Mandell, D., Smith, T., & Kasari, C. (2019). Remaking recess intervention for improving peer interactions at school for children with Autism Spectrum Disorder: Multisite randomized trial. School Psychology Review, 48, 133-144.

Reviewed by: Nishi Kadakia, MA and Robert H. LaRue, PhD, BCBA-D
Rutgers, The State University of New Jersey

Why research this topic?

Procedures to teach specific skills for individuals with autismThe current investigation evaluated the effectiveness of a social skills intervention for individuals with autism spectrum disorder (ASD). While evidence exists to support the use of social skills interventions, much of the research has been conducted in outpatient clinic settings with trained professionals, rather than in generalized settings, such as schools. In addition, few randomized trials evaluating school-based social skills interventions exist and of those that do, none have examined school staff directly implementing the plans. The purpose of the current investigation was to implement a multi-site randomized clinical trial to evaluate the effectiveness of a social skills intervention called Remaking Recess for improving playground relationships while implemented by paraprofessionals and supervised by research personnel.

What did the researchers do?

The authors designed a multisite randomized controlled trial to evaluate the effectiveness of Remaking Recess in urban school districts in Los Angeles, Philadelphia, and Rochester. After assessing eligibility, 80 students with autism between the ages of 5 and 11 met inclusion criteria for the study. The 80 students were randomized into two groups; an immediate intervention group who received the Remaking Recess treatment immediately (current school year) and the wait-list control group that would receive the treatment the next school year.

The Remaking Recess (RR) intervention consisted of ten 30-minute sessions of active information sharing and coaching between the school staff and a coach from the research team, during lunch or recess. Additionally, six to ten sessions were dedicated to reviewing strategies, flexible coaching, and troubleshooting problems. During the active sessions, the coach aided the school staff in integrating intervention strategies that enabled social inclusion for the children with ASD. The coaches taught the school personnel four key skills: (a) to identify children who did not engage with others or showed difficulty in peer interactions on the playground; (b) to use strategies to help the children engage with each other; (c) to learn when to facilitate and when to fade support to help the children maintain the social skill; and (d) to troubleshoot and refine the intervention as issues came up. The coaches trained staff by providing topic information, modeling the intervention strategies, and providing feedback on the implementation. The coaching was systematically faded over the course of the study. Various forms of assessment were used throughout the study, from screening to the post-intervention follow up. Assessment measures were implemented before intervention (baseline), at the end of intervention, and 4-6 weeks post intervention. Children were assessed using the Playground Observation of Peer Engagement (POPE; Kasari, Rotheram-Fuller, & Locke, 2005) and the Friendship Survey (Cairns & Cairns, 1994) at each assessment point. The POPE is a structured observation of peer engagement that coded the durations of engagement with peers and solitary playtime. The Friendship Survey allowed the students to list the names of their friends and who they interacted with as a measure of their social network.

School personnel were also assessed at baseline, at the end of intervention, and four to six weeks post intervention. The school staff was given the Teacher Perception of Children’s Social Skills and Classroom Conduct questionnaire to assess the child’s strengths and challenges in social interaction. The consistency and quality of RR implementation was rated by blind observers, coaches, and the school personnel themselves (self-report). Following intervention, school personnel also rated how the RR intervention fit into their school’s climate.

What did the researchers find?

The authors found that children engaged in less solitary play and more parallel play (baseline vs. post intervention) during recess in the RR condition relative to the control group. However, comparison between baseline and the four-week follow up was not statistically significant, suggesting a lack of maintenance. In addition, there were no significant treatment effects for peer engagement. There was a statistically significant increase in the number of peers the children in the RR group nominated as friends from baseline to follow up for the RR intervention. While these findings are encouraging, the friendship nominations were not always reciprocated.

The blind observer data indicated that there were significant increases in staff strategy use in the RR group (30% of strategies in pre-intervention to 52% post-intervention). The coach ratings also indicated a significant increase in the use of the RR strategies from the pre-intervention to the post-intervention (36% to 76%). The school personnel self-ratings also suggested a statistically significant increase in RR strategy use (74% in pre-intervention to 90% at post-intervention and 85% at follow up).

What are the strengths and limitations of the study?

The present study was useful in that it provided an evaluation of the RR intervention in an applied setting. In addition, the intervention was delivered by school personnel, which had been a gap in the research literature. Another strength was that the authors used a variety of outcome measures for both children and the paraprofessionals. To evaluate the integrity of implementation, the authors used blind observers, coach ratings, and paraprofessional self-report.

Some limitations included that each school district had varying policies and climates that affected the ability to implement the Remaking Recess intervention. Some of the districts were facing reductions in staff-to-student ratios while other schools had multiple days where inclement weather prevented outdoor recess time. In addition, some schools had eliminated recess altogether. Another potential limitation was that follow-up sessions were only conducted four to six weeks after intervention. Follow up observations at six months or a year could provide a better evaluation of maintenance of the benefits of the RR intervention.

What do the results mean?

The purpose of the current study was to teach paraprofessionals to implement a social skills intervention to help improve peer relationships for children with ASD. The overall results were mixed. The RR intervention did not result in any significant differences in the amount of peer engagement during the study. However, solitary play did decrease, which suggests that the children did engage in parallel play near other students. Another important finding was that the students in the RR group had an improvement in their peer connections in the classroom as measured by how many students they nominated as friends at the end of intervention. An additional finding was that the researchers were able to successfully train paraprofessionals to implement the intervention. Both coaches and the paraprofessionals themselves reported an increase in the implementation of the RR intervention. However, the interventions were still labeled as difficult to implement in a school context. The authors suggested that future researchers may consider adapting strategies to improve peer relationships in nontraditional contexts (e.g., indoor activities) when interactive behaviors are restricted. Further research may also allow better understanding of how to continue to decrease solitary play while increasing joint peer engagement.

References:

Cairns, R., & Cairns, B. (1994). Lifelines and Risks: Pathways of Youth in Our Time. New York: Cambridge University Press.

Kasari, C., Rotheram-Fuller, & Locke. J., (2005). The Development of the Playground Observation of Peer Engagement (POPE) Measure. Unpublished manuscript. Los Angeles, CA: University of California Los Angeles.

Citation for this article:

Kadakia, N., & LaRue, R. H. (2021). Research synopsis: Remaking Recess intervention for improving peer interactions at school for children with autism spectrum disorder: Multisite randomized trial. Science in Autism Treatment, 18(10).

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