Using Graphic Symbols to Teach Children With Autism to Enter Into Playgroups

Abstract

Children with autism spectrum disorder (ASD) may encounter difficulties in various aspects of play, including successful entrance into playgroups. This article describes the practical and applied use of an empirically validated strategy that uses graphic symbols to teach young children with ASD to request entrance into playgroups.

Keywords

graphic symbols play preschool initiation

Play and social interactions are essential components of healthy child development (Ginsburg, 2007; Heidemann & Hewitt, 2010; Samuelsson & Johansson, 2006). Through play, children practice numerous skills and roles needed for later life (Mistrett, Lane, & Goetz, 2000; Parham, 2008). Engagement in play provides children with the opportunity to learn about human relationships, explore objects in the environment, learn to solve problems, make decisions, persevere, acquire preliteracy skills, lead and follow others, and experience acceptance (Knox, 2010; Terpstra, Higgins, & Pierce, 2002). Children with disabilities may not have the same quality or quantity of experiences as their typically developing peers and might encounter difficulties in various aspects of play. One aspect of play in which children with disabilities encounter difficulty involves entering into exchanges with peers (e.g., Johnston, McDonnell, Nelson, & Magnavito, 2003; Johnston, Nelson, Evans, & Palazolo, 2003; Nelson, McDonnell, Johnston, Crompton, & Nelson, 2007).

A series of related empirical investigations demonstrated that graphic symbols can be used to teach children with autism spectrum disorder (ASD) to enter into exchanges with peers by requesting entry into playgroups in inclusive preschool classrooms. Further, this research revealed that, once the children successfully entered playgroups, their engagement time and sophistication level of play increased (Johnston, McDonnell, et al., 2003; Johnston, Nelson, et al., 2003; Nelson et al., 2007). As illustrated by the checklist in Figure 1, the intervention strategy used in the context of this series of investigations consisted of the following steps: (a) identifying opportunities to request entrance into playgroups, (b) identifying the communicative behavior(s) to request entry into playgroups, (c) developing a graphic symbol for requesting entrance into playgroups, (d) incorporating the use of a graphic symbol as a classwide strategy, (e) providing specific guidance to teach the child to engage in the target behavior, (f) providing natural consequences contingent on the emission of the target behavior, and (g) monitoring progress. This article describes the steps involved in the implementation of this empirically validated intervention strategy and illustrates the implementation of the strategy through a case example.

Figure 1.

Checklist for developing an intervention strategy using graphic symbols to teach children with autism spectrum disorder to request entrance into playgroups.

Case Example

Ben is a 4-year-old child with ASD who attends an inclusive preschool classroom. Ben uses a few words spontaneously (e.g., more, done, bye-bye) but does not imitate verbal language. Ben participates in small-group and large-group activities in the classroom. However, during free-choice time, Ben rarely engages in play with peers. Instead, Ben typically stands along the side of the classroom and watches the other children. Ben’s educators and his parents are interested in teaching him how to enter into playgroups (see Note 1).

Step 1: Identify Opportunities

The first step is to identify opportunities to implement the intervention. The intervention relies on learner-initiated opportunities in which the child expresses an interest in something or someone (Hancock & Kaiser, 2002). In order to capitalize on learner-initiated opportunities, educators must recognize and respond to the communicative attempts of the child. The communicative attempts may be symbolic (e.g., speaking words, pointing to graphic symbols, using sign language) or presymbolic (e.g., crying, laughing, vocalizing, body language, facial expressions, reaching, pointing). Educators can identify and record communicative attempts through the use of a communication dictionary. A communication dictionary is an observational assessment that results in the creation of a document that helps communication partners recognize and respond to communicative behaviors. In order to create the document, educators (a) observe the child; (b) create a list of communicative behaviors; (c) specify the purpose of each communicative behavior, noting that it is possible for one communicative behavior to serve multiple purposes and/or multiple communicative behaviors to serve one purpose; and (d) indicate how communication partners should respond to each communicative behavior (Siegel & Cress, 2002).

Case example

Ben’s educators observe him during free-choice time in the preschool classroom and complete a communication dictionary. Results of the communication dictionary reveal that Ben uses eye gaze toward activities to indicate interest. On the basis of these data, Ben’s educators define the learner-initiated opportunities for the intervention as instances in which Ben indicates interest in an activity via eye gaze toward the activity but does not initiate or engage in the activity, and they record this definition on the Intervention Summary Form (see Figure 2).

Figure 2.

Ben’s intervention summary form.

Step 2: Identify the Communicative Behavior

The next step involves identifying the communicative behavior(s) that the child will display to request entry into playgroups. Children’s communicative behaviors to request entry into playgroups can be verbal/vocal (e.g., saying, “Can I play?”), gestural (e.g., signing “want” + “play”), and/or graphic (e.g., pointing to a symbol representing “Can I play?”). Educators make decisions regarding the most efficient and effective communicative behavior(s) to teach based on the child’s skills/abilities (e.g., a child with severe physical disabilities may be better able to eye-gaze toward a symbol than use verbal or gestural communication) as well as features related to the communicative environment (e.g., a child’s use of sign language may not be effective in a classroom in which peers do not know sign language).

Some educators or parents may express concern that teaching a child to communicate using graphic symbols or gestures will decrease their motivation to learn/use verbal language. This concern is not supported in the literature. Specifically, Millar, Light, and Schlosser (2006) conducted a review of literature published between 1975 and 2003 to examine the impact of gestural and graphic mode instruction on the spoken language of individuals with development disabilities. Results of their review revealed that, across studies, more than 85% of participants demonstrated either no change in verbal language use or an increase in verbal language use when taught either graphic or gestural communication. Millar et al.’s finding was supported by Johnston, Nelson, et al. (2003) and Nelson et al. (2007), who noted that verbal language (with or without the use of the graphic symbol) increased from baseline rates for preschool-age children with ASD who were taught to use a graphic symbol to request entry into playgroups. Furthermore, the use of the graphic symbol decreased across time for some participants as they became more successful in their use of verbal language or other means of entering playgroups. This suggests that graphic symbols may be successfully used as a communicative support for children who are transitioning from nonsymbolic forms of communication to spoken language.

Case example

Ben’s educators and parents note that Ben is physically capable of emitting verbalizations. However, Ben does not consistently imitate verbal language. Given the difficulties involved in prompting verbalizations if a child is not verbally imitative, and the need for peers to understand and respond to Ben’s communicative behaviors, Ben’s educators and parents decide to teach him to use a graphic mode of communication and record this on the Intervention Summary Form (see Figure 2). See the next section for additional information regarding the graphic symbol that is used.

Step 3: Develop a Graphic Symbol

The third step in developing the intervention involves creating a graphic symbol for the child to use to request entrance into playgroups. Graphic symbol options include written words (i.e., traditional orthography), line drawings, photographs, product logos, parts of objects, miniature objects, and real objects. Studies comparing graphic symbol systems have revealed that a general hierarchy exists with regard to the degree to which different graphic symbols are iconic (i.e., easier to recognize or guess at the meaning without prior instruction). Based on their research, Mirenda and Locke (1989) suggested that real objects were the most iconic, followed by color photographs, black-and-white photographs, miniature objects, black-and-white line drawings, Bliss symbols (i.e., a series of meaning-based shapes that can be combined into black-and-white line drawings to create messages), and traditional orthography, respectively. This hierarchy is important to consider given that symbols that are more iconic may be easier to learn (Mirenda & Locke, 1989). However, the use and usefulness of a symbol may be more important than the iconicity (Namy, Campbell & Tomasello, 2004). Although symbol hierarchies offer some guidance, educators should also use assessment strategies in graphic symbol selection. Assessment strategies include interviews (e.g., asking parents if a child can identify family members in a photo album, asking paraeducators if a child can identify favorite characters from a book containing colored line drawings) as well as direct observation (e.g., watching a child identify peers from a class photo). Assessments might also include structured opportunities that can be created to further assess the appropriateness of a specified graphic symbol system. One strategy for creating structured opportunities involves matching to sample (Reichle & Wilkinson, 2012). When conducting an assessment using matching to sample, the educator presents the child with an object and then places two graphic symbols (e.g., two colored line drawings) in front of the child, with one of the line drawings being the object. The educator then asks the child to match the object with its corresponding symbol. After conducting multiple trials with a variety of different objects and graphic symbols, and randomizing the position of the graphic symbols so that the child cannot use position as a cue for responding, the educator can identify the child’s understanding of the relationship between various graphic symbols and the objects that the graphic symbols represent. Once a decision regarding the graphic symbol is made, educators can identify a way to ensure that the symbol is portable and accessible (e.g., the symbol can be worn like a necklace on a breakaway lanyard, attached at the waist through a belt loop, added to the child’s current augmentative or alternative communication system).

Case example

Ben’s educators use a combination of assessment strategies to identify an appropriate graphic symbol system. The assessments reveal that Ben discriminates among colored line drawings. On the basis of this information, Ben’s educators choose to use a colored line drawn symbol representing “Can I play?” and record that decision on the intervention summary form (see Figure 2). In an effort to make the symbol portable as well as visually appealing to Ben and his peers, the educators glue the symbol to construction paper cut into the shape of a key that is later described to Ben and his peers as a “key to play” and then laminated. Once laminated, the educators punch holes into the top of the key so that it can be worn as a necklace on a breakaway lanyard, and hook-and-loop fabric is added to the back of the key so that it can be looped through a belt loop and worn at the hip.

Step 4: Introduce the Classwide Strategy

Classwide intervention strategies involve the entire class of students in the process of learning and can be used to manage behaviors as well as teach academic skills. In preschool classrooms, educators can introduce classwide intervention strategies in the context of large-group activities, such as circle time. The instructional strategies used in the large-group activity will vary based on the intervention goals, as well as the skills and abilities of the children, but may include explicit instruction, closed- and open-ended questions, and role-play. Instruction in a classwide strategy can also include models that demonstrate the target behavior in the natural context (Garfinkle & Schwartz, 2002; Lee, Odom, & Loftin, 2007). For example, during free-choice time, the educator can provide a model of a request to enter a playgroup by approaching a group of children and saying, “Can I play?” while simultaneously showing the children the corresponding graphic symbol.

Case example

Ben’s educators decide to introduce the classwide strategy, referred to as “keys to play,” during circle time because it occurs immediately prior to free-choice time. During this introduction, the educators facilitate a discussion of the variety of ways that children can request entry into playgroups (e.g., using verbal, gestural, and/or graphic modes of communication), allow children to role-play how to request entry into playgroups using different modes of communication, and discuss the importance of children’s allowing a peer to play with them when he or she asks (Harrist & Bradley, 2003). At the end of this instruction, all students in the class are given a graphic symbol and are encouraged to use the symbol to request entrance into playgroups. Throughout free-choice time, educators encourage peers to use the graphic symbol and verbal language to request entrance into playgroups. The educators also model the desired behavior. Specifically, immediately following a learner-initiated opportunity, an educator approaches the children that Ben is looking at and says, “Can I play?” while simultaneously showing the children the corresponding graphic symbol.

Step 5: Provide Specific Guidance

The fifth step in the intervention involves providing specific guidance to teach the child to request entry into playgroups. Specific guidance can take many forms, including the use of response prompts that are directed specifically at the child’s behavior (Feeley & Jones, 2012). Response prompts can be verbal, gestural, or physical. Verbal prompts include comments (e.g., “You can ask your friend to play”), questions (e.g., “Do you want to play with your friend?”), or verbal instructions (e.g., saying, “I want to play”). Gestural prompts involve motions (e.g., pointing) that direct the child’s attention toward a specific behavior option (e.g., pointing to the symbol representing “Can I play?”). Finally, physical prompts involve physically assisting the child to engage in the correct behavior (e.g., the educator physically guides the child through the behavior using hand-under-hand guidance).

Effective use of prompts can result in the child’s engagement in the target behavior without any errors (e.g., Mackay, Soraci, Carlin, Dennis, & Strawbridge, 2002). Using prompts in the initial stages of intervention helps a child produce the correct behavior, but prompts should eventually be faded so the child engages in the target behavior without assistance. Educators can use the evidence-based strategies of a least-to-most prompt hierarchy and time delay to support prompt fading (Feeley & Jones, 2012). Least-to-most prompting begins when the educator provides a minimal prompt, and then the educator progresses through increasingly intrusive prompts until the child performs the desired behavior. When using time delay, the educator introduces a pause between the communicative opportunity and the delivery of a prompt. This delay provides the child with an opportunity to emit the target behavior without any prompt. If the child produces a correct behavior before the delay ends, the educator delivers reinforcement. If the child does not engage in the target behavior before the delay ends, the educator delivers the next prompt in the hierarchy.

Case example

Ben’s educators develop a plan for providing guidance and record that plan on the Intervention Summary Form (see Figure 2). Specifically, when presented with a learner-initiated opportunity, the educators use a least-to-most prompting hierarchy that progresses from an indirect gestural prompt (e.g., looking expectantly at Ben), to a direct gestural prompt (e.g., pointing to the graphic symbol representing “Can I play?”), to a partial physical prompt (e.g., guiding Ben’s hand to the graphic symbol), and finally, to a full physical prompt (e.g., physically helping Ben to show the graphic symbol to a peer to request entry into the playgroup). If Ben emits a correct behavior, the educators ensure that a natural consequence is delivered. If Ben emits an incorrect behavior (e.g., no response or an incorrect response), the educators provide the next most intrusive prompt in the hierarchy until Ben emits a correct behavior. In an effort to further support prompt fading, Ben’s educators use time delay by inserting a 5-s delay following the opportunity, following the model, and between each prompt in the hierarchy. If Ben engages in the target response within 5 s of the opportunity, the educator supports his access into the playgroup. If Ben does not engage in the target behavior within 5 s, the educator provides the next higher level of assistance in the hierarchy.

Step 6: Provide Consequences

The next step involves providing positive consequences contingent on the emission of the target behavior (Feeley & Jones, 2012). The natural consequence for requesting entry into a playgroup involves playing with the materials and/or peers in the group. However, sometimes these natural consequences are not provided in a way that is reinforcing to a child. For example, a child may request entry into a playgroup but be ignored by peers. Further, a child may not know how to play with materials after entering the playgroup. Given this, educators who implement the intervention may need to prompt peers to respond affirmatively to the child’s request and/or may need to support the child’s play with materials.

Case example

Ben’s educators assign themselves to different areas of the classroom in order to support all of the children, including Ben, during free-choice time. Adopting this staffing pattern also allows Ben’s educators to see his learner-initiated opportunities, model the target behavior, provide prompts, and ensure that consequences for Ben engaging in the target behavior are immediate and of high quality.

Step 7: Progress Monitoring

The final step in designing and implementing the intervention is to monitor progress by collecting data on the child’s engagement in the target behavior as well as on the prompts that are provided. Collecting data on child performance allows educators to monitor the effectiveness of the intervention and troubleshoot as needed. If the data suggest that the intervention is effective with regard to increasing the child’s engagement in the target behavior, the educator might consider creating opportunities to use the newly acquired behavior in different activities (e.g., small-group time) or in different settings (e.g., home, day care). Conversely, if the data suggest that the intervention is not effective, the educator may choose to examine the types of errors emitted and consider modifications to the intervention, such as using a different prompting strategy (Feeley & Jones, 2012, for a review), increasing the quality of the consequences provided for correct responses, and/or reexamining the purpose of the child’s behavior that signals a learner-initiated opportunity to ensure that the behavior is emitted to express interest in an activity. Collecting data on the prompts that are provided allows educators to monitor the fidelity of intervention implementation. If the data reveal that the intervention is not being implemented with high levels of fidelity across all individuals who are implementing the intervention, the educators may choose to retrain those individuals.

Case example

Ben’s educators develop a strategy for monitoring progress (see Figure 3). As noted by Figure 3, educators record (a) the level of prompt needed to elicit Ben’s target response (graphic and/or gestural request to enter a playgroup), (b) whether Ben’s engagement in the target response is correct or incorrect, (c) whom Ben’s communication is directed to, (d) the type of error if Ben emitted an error response, and (e) comments, if needed, to clarify/explain recorded data.

Figure 3.

Ben’s progress monitoring form.

Conclusion

Play and social interactions are essential components of healthy child development (Ginsburg, 2007; Heidemann & Hewitt, 2010; Samuelsson & Johansson, 2006). As noted in this article, children with disabilities, like Ben, may not have the same quality or quantity of experiences as their typically developing peers and may encounter difficulties entering into playgroups. This article summarized the steps involved in the implementation of an intervention strategy based upon a series of related empirical investigations supporting the use of graphic symbols to teach children with ASD to enter into playgroups (Johnston, Nelson, et al., 2003; Nelson et al., 2007). Teaching the important skill of entering into playgroups will create the opportunity for children with ASD to participate in play and practice the myriad of skills and roles needed throughout life.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Notes

References

Feeley

Jones

(2012). Instructional strategies. In Johnston

Reichle

Feeley

Jones

(Eds.), Augmentative and alternative communication strategies for individuals with moderate to severe disabilities (pp. 119–154). Baltimore, MD: Brookes.

Garfinkle

A. N.

Schwartz

I. S.

(2002). Peer-imitation: Increasing social interactions in children with autism and other developmental disabilities in inclusive preschool classroom. Topics in Early Childhood Special Education, 22, 26–38.

Ginsburg

K. R.

(2007). The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics, 119(1), 182–191.

Hancock

T. B.

Kaiser

A. P.

(2002). The effects of trainer-implemented enhanced milieu teaching on the social communication of children with autism. Topics in Early Childhood Special Education, 22, 39–54.

Harrist

A. W.

Bradley

K. D.

(2003). You can’t say you can’t play: Intervening in the process of social exclusion in the kindergarten classroom. Early Childhood Research Quarterly, 18, 185–205.

Heidemann

Hewitt

(2010). Play: The pathway from theory to practice. St. Paul, MN: Redleaf Press.

Johnston

McDonnell

Nelson

Magnavito

(2003). Implementing augmentative and alternative communication intervention in inclusive preschool settings. Journal of Early Intervention, 25, 263–280.

Johnston

S. S.

Nelson

Evans

Palazolo

(2003). The use of visual supports in teaching young children with autism spectrum disorder to initiate interaction. Augmentative and Alternative Communication, 19(2), 86–103.

Knox

S. H.

(2010). Play. In Smith

J. C.

O’Brien

J. C.

(Eds.), Occupational therapy for children (6th ed., pp. 540–554). Maryland Heights, MO: Mosby Elsevier.

10.

Lee

Odom

S. L.

Loftin

(2007). Social engagement with peers and stereotypic behavior of children with autism. Journal of Positive Behavior Interventions, 9, 67–79.

11.

Mackay

H. A.

Soraci

S. A.

Carlin

M. T.

Dennis

N. A.

Strawbridge

C. P.

(2002). Guiding visual attention during acquisition of matching to sample. American Journal on Mental Retardation, 107(6), 445–454.

12.

Millar

Light

Schlosser

(2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech Language Hearing Research, 49, 248–264.

13.

Mirenda

Locke

P. A.

(1989). A comparison of symbol transparency in nonspeaking persons with intellectual disabilities. Journal of Speech and Hearing Disorders, 54, 131–140.

14.

Mistrett

Lane

Goetz

(2000). A professionals guide to: Assisting families in creating play environments for children with disabilities (Grant No. H024B50051). Retrieved from http://letsplay.buffalo.edu/products/PlayManual.pdf.

15.

Namy

Campbell

Tomasello

(2004). The changing role of iconicity in non-verbal symbol learning: A U-shaped trajectory in the acquisition of arbitrary gestures. Journal of Cognition and Development, 5(1), 37–57.

16.

Nelson

McDonnell

A. P.

Johnston

S. S.

Crompton

Nelson

(2007). Keys to play: A strategy to increase the social interactions of young children with autism and their typically developing peers. Education and Training in Developmental Disabilities, 42(2), 165–181.

17.

Parham

L. D.

(2008). Play and occupational therapy. In Parham

L. D.

Fazio

L. S.

(Eds.), Play in occupational therapy for children (2nd ed., pp. 3–39). St. Louis, MO: Mosby.

18.

Reichle

Wilkinson

(2012). Teaching learners to correspond graphic symbols to objects and events. In S. Johnston, J. Reichle, K. Feeley, & E. Jones, AAC strategies for individuals with moderate to severe disabilities (pp. 249–278). Baltimore, MD: Brookes.

19.

Samuelsson

I. P.

Johansson

(2006). Play and learning: Inseparable dimensions in preschool practice. Early Child Development and Care, 176(1), 47–65.

20.

Siegel

Cress

C. J.

(2002). Overview of the emergence of early AAC behaviors: Progression from communicative to symbolic skills. In Reichle

Beukelman

D. R.

Light

J. C.

(Eds.), Exemplary practices for beginning communicators (pp. 25–57). Baltimore, MD: Brookes.

21.

Terpstra

J. E.

Higgins

Pierce

(2002). Can I play? Classroom-based interventions for teaching play skills to children with autism. Focus on Autism and Other Developmental Disabilities, 17(2), 119–126.