Facilitating Commenting and Requesting Skills in 3-Year-Old Children With Disabilities

Abstract

The current study evaluated the commenting behaviors and verbal and non-verbal requests of children with disabilities (e.g., developmental delays, specific language impairment) who participated in a shared storybook social communication intervention that included sociodramatic play themes and targeted skills such as initiations, responses, name use, proximity, and turn-taking. Six children who enrolled in a self-contained classroom met the inclusion criteria. A multiple-baseline design was used to determine the effects of the intervention. The social communication intervention was highly effective for all children in increasing the rate of commenting behaviors and for verbal behavior from baseline to intervention. Several implications for practice were derived from the findings. By teaching children social communication strategies, the quality of social interactions that children have with their peers is likely to improve. The intervention offers a more systematic technique for teaching social communication and play skills than do informal strategies commonly used by teachers. Social validity assessments indicated that teachers found the intervention acceptable and produced important changes in behavior.

Keywords

social communication requesting commenting preschool social interaction

Introduction

Targeting social communication skills has been a recent focus of a number of early intervention studies, and their results have indicated a significant beneficial impact on young preschoolers (Laundry, Smith, Swank, & Guttentag, 2008). Social communication skills can include joint attention, expressive and receptive verbal language, and non-verbal communicative gestures and affect (Landa, 2005). These skills mark important milestones in the social and language development of children and provide clues to indicate either typical progress or the possible existence of a disability (Mundy, Card, & Fox, 2000).

Play Script Interventions for Young Children With Disabilities

Research has demonstrated that peer-mediated intervention procedures can be used to increase social communication skills in preschoolers with disabilities (e.g., Goldstein & Wickstrom, 1986; Woods & Poulson, 2006). One such procedure is the use of sociodramatic play scripts, which have been used with children with autism to improve interactions during free play (e.g., Doctoroff, 1997; Goldstein & Cisar, 1992). For example, sociodramatic play scripts were used to teach preschoolers with developmental disabilities to acquire verbal initiations using art materials (Woods & Poulson, 2006). During sociodramatic play script training, adults prompt children to remain in their play roles or to provide specific responses. Sociodramatic play scripts have a number of positive implications, including the ability to teach specific verbal or motor responses during a structured play opportunity, high rates of responses, and success with multiple scripts. Sociodramatic play scripts may be a successful mechanism for pretend play with limited teacher involvement for preschoolers with disabilities. However, generalization to other settings, with untrained peers, or peer play groups is limited. The play script may be applicable only in the classroom in dramatic play centers with toys similar to those tested in the studies and may not provide children with enough spontaneous language to be successful in natural play settings.

Theme-Based Activity Interventions and Shared Storybook Reading Interventions

Given the limitations of sociodramatic play script research, Beilinson and Olswang (2003) and Craig-Unkefer and Kaiser (2002, 2003) developed social communication interventions using theme-based activities rather than play scripts. For example, Craig-Unkefer and Kaiser conducted a social communication intervention which taught at-risk children how to plan their play, converse more spontaneously, and reflect on how they interacted after the play session was over. Results showed that the intervention was successful in increasing the frequency of social interactions and the number of diverse words between children, but a considerable amount of these peer interactions were prompt dependent, suggesting less spontaneous language and more adult-prompted language.

Building on the work of Craig-Unkefer and Kaiser (2002, 2003), we developed a shared storybook reading, social communication intervention that evaluated positive peer interactions and play during theme-based activities with 4-year-old preschoolers (e.g., Stanton-Chapman, Denning, & Jamison, 2008; Stanton-Chapman, Jamison, & Denning, 2008; Stanton-Chapman, Kaiser, Vijay, & Chapman, 2008; Stanton-Chapman, Kaiser, & Wolery, 2006; Stanton-Chapman & Snell, 2011). In each of these studies, children were taught four social communication skills (i.e., initiating, responding, name use, turn-taking) using an intervention approach that included an advanced play organizer component (e.g., teaching target vocabulary words, assigning children play roles, reading the storybook, play planning), structured play sessions within a dramatic theme, and engagement of the children in a brief session to review their performance. The intervention showed immediate and pronounced effects for the majority of participating children in the areas of initiations, responses, turn-taking skills, play interactions (e.g., increases in associative/cooperative play), and vocabulary development for 4-year-old preschoolers. The results from these studies suggested a need to examine more closely the effects of this intervention program (a) with younger preschoolers who have more limited language abilities as more 3-year-olds are enrolled in preschool classrooms due to heightened early intervention efforts, (b) in the classroom setting rather than a pull-out model, and (c) with limited or no adult support for peer interactions.

Current Study

To improve upon these limitations and extend this work, we evaluated the commenting behaviors and verbal and non-verbal requests of children with disabilities (e.g., developmental delays, specific language impairment) enrolled in a self-contained classroom and who participated in a social communication intervention targeting skills such as initiations, responses, name use, proximity, play interactions, and turn-taking. In a separate study conducted with 3-year-olds (Stanton-Chapman & Brown, 2015), we examined the intervention’s effect on parallel play behaviors as all participants had delayed social communication abilities and were mainly non-verbal during play episodes. The aim of the current study was to better understand whether a social communication intervention affects commenting behaviors and verbal and non-verbal requests in 3-year-olds with more limited language abilities. Commenting behaviors and non-verbal and verbal requesting behaviors are targeted in the current study to provide more in-depth information as to how 3-year-olds with social communication delays interact with peers. An increase in the frequency of commenting behaviors and verbal and non-verbal requests from baseline to the intervention’s conclusion was expected despite the children being paired with a peer who also had disabilities. This hypothesis was based on several intervention studies targeting similar skills (Beilinson & Olswang, 2003; Stanton-Chapman, Denning, et al., 2008; Stanton-Chapman et al., 2006; Thiemann & Goldstein, 2004; Timler, Olswang, & Coggins, 2005). Commenting behaviors and verbal and non-verbal requests of children were examined as we expected these skills to be delayed in our target population—3-year-olds with disabilities.

Method

Participants

Sample

All 3-year-old children (N = 8), enrolled in a self-contained preschool classroom serving children with disabilities at one rural elementary school, were screened for possible participation in the study. The eight children were screened for problem behavior, poor social skills, and language delays. Teachers were asked to complete the teacher form of the Child Behavior Checklist (CTRF; Achenbach, 1997) and the teacher form of the Social Skills Rating System (SSRS; Gresham & Elliott, 1990). Children were assessed on the Preschool Language Scale–4 (PLS-4; Zimmerman, Steiner, & Pond, 2002). These measures were completed at pre-intervention (whole class, N = 8) and post-intervention (study participants only, n = 6).

Criteria for participant inclusion

All participants were 3 years old at the introduction of the study and were selected based on meeting one or more of the following criteria: (a) scored at least one standard deviation below the normative mean on the total language score of the PLS-4 (a score of 85 or below; Zimmerman et al., 2002), (b) rated by teachers to have clinical levels of problem behavior on the CTRF (Achenbach, 1997), and/or (c) demonstrated poor social skills as indicated by the teacher report on the SSRS (Gresham & Elliott, 1990); refer to Table 1 for more details. Children selected were considered to be at-risk for language delays, problem behavior, or poor social skills. Children were excluded from participation if they had significant sensory impairments or mental health disorders (e.g., attention-deficit disorder, conduct disorder, oppositional defiant disorder).

Table 1.

Characteristics of Participants.

Participant	Age in months	Race	Gender	Disability	Language skills^a	Problem behavior^b	Social skills^c
Joshua	41	White	M	Development	61	48	75
Ashley	47	White	F	Development	51	41	82
Montel	40	Black	M	Development	50	52	60
Mia	38	White	F	Development	50	52	84
Shontelle	42	Black	F	Language	80	40	89
Blake	36	White	M	Development	89	61	89

Note. Participant names have been changed for confidentiality purposes. Disability = diagnosis written on child’s Individualized Education Plan for the 2008-2009 school year; development = developmental delay; language = language delay.

Poor expressive language or comprehensive language skills = A child was considered for study participation if his or her total standard score was 85 or below on the PLS-4. Bolded value means that the participant met study criteria in this area.

Problem behaviors = A child was considered for study participation if his or her total score was 60 or above on the total problem behavior scale of the Teacher Report Form of the Child Behavior Checklist (CTRF). Bolded value means that the participant met study criteria in this area.

Poor social skills = A child was considered for study participation if his or her total social skill subscale score was 85 or below on the SSRS. Bolded value means that the participant met study criteria in this area.

Six children met the selection criteria for inclusion in the study (see Table 1), and two children were excluded due to significant sensory impairments and non-verbal communication. All six children were receiving special education services under the diagnoses of specific language impairment or developmental delay, and thus, we considered all participants to have a disability.

The children were assigned to peer dyads based on a predetermined protocol. First, the children had to meet the criteria for participant inclusion discussed previously. Second, both children must be available during free play on the same days and times. Children receiving resource therapies (e.g., speech-language therapy, occupational therapy, physical therapy) often worked with their therapists during free play, and thus, both children needed to be able to participate in the current study together during free play. Finally, attempts were made to pair the children by birthday. All six children were placed in girl–boy dyads as a result of their scheduled resource therapies.

Setting

The study took place in a rural elementary school serving preschoolers. All participants were enrolled in the same classroom. This classroom was self-contained—meaning the program provided services to children with special needs (early childhood special education [ECSE]). Two teachers provided instruction to eight students within the classroom: (a) an ECSE teacher with a master’s degree in ECSE and (b) one assistant teacher with a Child Development Associate degree.

Baseline and intervention sessions took place in the morning during free play in the children’s classroom. The entire intervention took place in the dramatic play center that was developed specifically for the current study. When it was a dyad’s turn to participate in the intervention, the two children were asked to remove the center’s card from the planning board and place the card in the envelope outside the intervention center. The interventionist would then implement the intervention with the children while their peers participated in free play in the remaining classroom centers. When the study was taking place in a given day, only the two participants were permitted to play in the intervention center. The intervention center was open to all children on mornings when the current study was not conducted. Play observations took place during free play in the classroom and outside on the playground.

Materials

Play materials used in the baseline and intervention sessions were based on five dramatic play themes presented in the following order: grocery store, doctor, construction, animal doctor, and hair salon/barber. Once each theme was presented one time, the themes were repeated in the same order. This presentation order was based on prior evaluations of the intervention package (e.g., Stanton-Chapman & Snell, 2011). Each dramatic play theme had an accompanying storybook that provided instruction on the intervention’s target behaviors. The storybooks were designed to include pictures of participating children and the exact materials and props used during the intervention sessions. The books were computer generated, after baseline sessions were completed, using a digital camera and template for the book format. The storybooks (a) told a story that illustrated thematic play (e.g., visiting the grocery store), (b) included models for verbalization during role playing (e.g., “The grocery worker says, ‘Can I help you?’”), (c) included specific theme vocabulary (e.g., cart, register), and (d) emphasized three social communication strategies illustrated in the stories with picture icons. The picture icons served as visual cues to assist children in recalling the strategies (i.e., initiations, responses, adjacency).

The thematic play materials were similar to the types of toys and activities available in preschool classrooms. Play materials matched the toys pictured in the storybooks. To ensure that the materials were culturally appropriate and ethnically valid to many cultures (Barnett, Bell, & Carey, 1995), research staff and classroom teachers of various ethnic backgrounds assisted in selecting toys that were representative of several cultures.

Study Personnel

Interventionist

Two project staff conducted the baseline and intervention sessions. Both interventionists had education degrees in early intervention and early childhood special education and a minimum of 5 years’ experience teaching children at-risk and children with disabilities. First interventionist was assigned to two dyads while the second interventionist was assigned to one dyad. The dyads worked with the same interventionist throughout the baseline and intervention sessions.

Research staff

Master’s degree students in ECSE transcribed and coded for observational data, treatment fidelity measures, and reliability coding. All research staff held bachelor’s degrees in psychology and had practicum experiences in early childhood, at-risk, and ECSE classrooms. To reduce potential bias, all were blind to the study outcomes (e.g., comments, requests) and received 20 hr of training.

Experimental Design and Conditions

A multiple-baseline design across participants (dyads) was used to determine the effects of the social communication intervention (Kazdin, 1994). Baseline measures of commenting behaviors, requests for verbal behavior, requests for non-verbal behavior, and non-verbal requests were conducted simultaneously and continuously under the same conditions to describe participants’ current level of performance. The intervention was then applied to the first dyad while baselines were extended and monitored in the remaining dyads. The second dyad began intervention when data stability occurred for Dyad 1. This pattern continued until all dyads started the intervention condition. Causality was established by the change in one baseline (where the intervention had been introduced) when there was no concurrent change in another baseline (where the intervention had not been introduced; Kazdin, 1982). Replication of the results was achieved by applying the treatment to additional participants following a baseline period. This design has been found to be especially effective in evaluating interventions targeting an increase of social behaviors (Tawney & Gast, 1984).

Baseline

Baseline sessions were conducted 2 to 3 times per week due to scheduling constraints at the school, mandatory literacy skills assessments. Children were asked to play in the intervention dramatic play center. The interventionist did not prompt the children to interact with the toys or peers once the session started. The interventionist only interceded if there was a safety concern in which one or both of the children would get hurt. Baseline sessions were 10 min in length each and were videotaped using a digital camcorder on a tripod. Baseline sessions occurred on separate days for each dyad.

Intervention

Intervention sessions were conducted 4 to 5 times per week and were approximately 20 to 25 min in length each, all occurring on separate days for each dyad. Length of time varied based on the amount of talking done by the participants. Average session length was 23.45 min. Each session with a particular dyad used one of five different dramatic play themes (grocery store, doctor, construction, animal doctor, and hair salon/barber). Once all five play themes were presented, the themes were repeated. Each intervention session had three parts: (a) the advanced play organizer, (b) the play session, and (c) the review session. We selected the format to resemble the “plan-do-review” sequence used in the High Scope Curriculum (Hohman & Weikart, 2002) and used in many Head Start classrooms and preschool classrooms, including the classroom used in the current study. All parts of each session were videotaped using a digital camcorder on a tripod. The intervention was used to teach the following social communication skills: (a) Talk to your friend (Initiations): verbally initiating a conversation or play episode to a peer (e.g., intelligible utterances, directed to peer, within speaking distance of peer—adjacency), (b) Listen then respond to what your friend says (Responding): verbally responding to peer verbal initiations with adequate responses (e.g., topic related, intelligible, directed to the peer, not interrupting your friend while he or she is talking, not talking at the same time as your friend), (c) Proximity: playing within speaking distance with or near a peer, (d) Use your friend’s name (Name Use): stating a peer’s name to gain his or her attention before talking to him or her, and (e) Take a turn and give your friend a turn (Turn-taking): taking an appropriate number and length of turns in conversation or play (e.g., sufficient turns, not dominating the conversation, pausing for the peer to talk, taking turns to maintain conversation or play, asking for clarification, providing clarification, not interrupting a peer when he or she is talking).

Advanced play organizer

The advanced play organizer component was approximately 10 min in length and had four parts: (a) instructing target vocabulary words, (b) teaching the roles for each theme, (c) reading the storybook and teaching the social communication strategies, and (d) planning play. The interventionist first taught the target vocabulary words that corresponded to the day’s play theme (e.g., grocery, doctor, construction, animal doctor, barber shop/hair salon) using a direct instruction approach. Initially, the interventionist labeled each object, asked the children to imitate the word, and showed how the object could be used during the play session. In subsequent sessions, the interventionist asked the children to label the object and demonstrate how it could be used. For each theme, a list of approximately 10 theme-related words were taught during the course of the intervention.

The children were then introduced to the roles for each theme (e.g., doctor and patient, barber and customer, grocery worker and shopper). The interventionist used pictures from the storybook to discuss the role storybook characters played in the particular theme. After the interventionist described the roles related to the play theme, she read the storybook to the children. The social communication strategies were taught during the storybook reading. The storybooks were designed so that pages could be added or deleted. As new social communication strategies were introduced in intervention, the interventionist added those pages to the storybook.

When the interventionist finished reading the storybook to the children, they planned their play. First, each child selected which role he or she would like to play in the theme using picture icons. Second, the interventionist reviewed these roles by using the pictures in the storybook (e.g., “The barber cuts the customer’s hair”). Third, the social communication strategies were reviewed by showing the icons and having the children think of opportunities when the strategies could be used during their play (e.g., “The doctor could say, ‘Help me.’”). Finally, the interventionist had the children practice using the social communication strategies (e.g., “Say, ‘I need the hammer.’”).

Play session

The children then played with the thematic materials for 10 min. The interventionist first helped the children get into their assigned roles by directing them to the specific items and/or costumes (e.g., aprons for grocery workers, lab coats for doctor) related to the roles. The interventionist sat in the play area with the children but did not prompt for peer interactions. The interventionist recorded data on each child’s use of the social communication strategies during the play session for application in the review session. The interventionist discreetly tallied on paper each time a child used a social communication strategy. In addition, specific examples of children eliciting social communication behaviors were recorded for use in the review session.

Review session

At the conclusion of the play session, the children moved away from the toys in the play area and reviewed their performance in the play session with the interventionist. The review session was approximately 5 min in length. First, the interventionist reviewed the thematic roles with the children. Second, the interventionist reviewed the use of target vocabulary words with the children. Finally, the interventionist reviewed the children’s use of the social communication strategies.

Measurement

Measurement included language, behavioral, and social assessments before and after the intervention, and repeated observational measures of child performance and treatment fidelity measures. Interobserver agreement reliability (IOA) was assessed on observational and treatment fidelity measures for 20% of the sessions.

Transcription

Transcription procedures for baseline and intervention conditions followed four steps. First, videotaped sessions were downloaded from the video camera onto the computer. Second, the 10-min baseline sessions and the 10-min play sessions were transcribed word-for-word by research staff using the Systematic Analysis of Language Transcripts software (SALT; Miller & Chapman, 1985). Although SALT codes are not reported, the software allowed us to appropriately code and analyze our observational data. Research staff were trained to a criterion of 90% for five successive practice sessions—meaning their transcriptions agreed on 90% or more of the transcribed codes with a second independent transcription coder. Reliability indicated that both coders agreed with the content (i.e., what the adult and children said or did). Finally, the interventionist then verified the transcripts of their baseline and intervention sessions for accuracy.

Child communication measures

Once transcriptions of each baseline or intervention session were complete, the session was coded using the Peer Language and Behavior Code (PLBC; Stanton-Chapman, Kaiser, Vijay, & Craig-Unkefer, 2003). The PLBC measures verbal and non-verbal interactions between children. Coders were not informed about the purpose of the study or the experimental condition of the videotapes they coded. Reliability standards were established (refer to “Interobserver Agreement” section later in this article for more information), and a second coder was used to provide this check. Definitions for target behaviors can be found in Table 2.

Table 2.

Language and Play Behavior Observation Definitions.

Target behavior	Definition
Commenting behaviors	Statements made by a peer on another peer’s activities or relevant events that occur during the interaction. The intent of the child is to explain or interpret activities or an event that occurred during the peer interaction. Examples: Mine! My car. Baby eat.
Requests for verbal behavior	Verbal inquiries from one child to another that are distinguishable from declarative statements by having the sentence structure of a question or a definite questioning intonation. It includes information questions that begin with a WH-word or How and yes/no questions. Examples: Why? Do you want it? How?
Requests for non-verbal behavior	Verbal inquiries in which a peer asks another peer to perform a physical act such as orienting or obtaining attention or requesting an object or requesting an action or requesting to stop an action. Examples: Push car. Drink milk.
Non-verbal request	The intention of the child is to get the peer to provide assistance, material, or attention or to stop engaging in some behavior without saying anything. Examples: A child hands peer a doll.

Procedural Fidelity Measures

Preparation of intervention materials, advanced play organizer, and review session procedural fidelity

To determine whether the intervention procedures were implemented as described, fidelity of treatment checklists were completed for 20% of the intervention sessions, selected at random (Stanton-Chapman, 2005). Videotapes of the entire session were viewed and scored by a research staff member (other than the interventionist) who was blind to the outcomes of the study. Criterion for fidelity of treatment was the correct completion of 95% of the 95 prescribed procedural items on the checklist. Reaching criterion level indicated that the interventionist organized, described, and demonstrated the toys used in the play theme; read the storybook; discussed and modeled the use of the social communication strategies; attended to the children’s activities during the play session; and reviewed the children’s use of the social communication strategies and target vocabulary words in the review session.

Interobserver agreement

Interobserver agreement was calculated on the PLBC used to code behavior during baseline and intervention sessions. One research staff member coded all baseline and intervention sessions. To assess reliability, a second research staff member coded a random selection of 20% of the baseline and intervention sessions. Reliability observations were equally distributed across all five dyads and experimental conditions. Using a computer-based reliability program (SALTRELY; Tapp, 2003), a sequential comparison of the coded data was made on a point-by-point basis. The program scored an agreement if both coded a behavior and scored a disagreement if they differed on an identified behavior. Reliability was assessed using an exact agreement formula in which the total number of agreements was divided by the total number of agreements plus disagreements and multiplied by 100. To account for chance agreement, Cohen’s (1960) kappa was calculated. Fleiss (1981) characterized kappa values: 0.40-0.60 (fair), 0.60-0.75 (good), and greater than 0.75 (excellent).

IOA was high across all dyads, measures, and experimental conditions. IOA for commenting behaviors for the baseline conditions averaged 99% (range = 95-100) and kappa values averaged 0.92. Requests for verbal behavior for the baseline conditions averaged 97% (range = 93-100) and kappa values averaged 0.86. IOA for commenting behaviors for the intervention conditions averaged 98% (range = 93-100) and kappa values averaged 0.94. Requests for verbal behavior for the intervention conditions averaged 94% (range = 84-100) and kappa values averaged 0.92. IOA for non-verbal behavior for the baseline conditions averaged 91% (range = 89-100) and kappa values averaged 0.88. IOA for non-verbal requests for the baseline conditions averaged 98% (range = 93-100) and kappa values averaged 0.94. IOA for non-verbal behavior for the intervention conditions averaged 93% (range = 90-95) and kappa values averaged 0.82. IOA for non-verbal requests for the intervention conditions averaged 95% (range = 90-96) and kappa values averaged 0.92.

Social Validity

Evaluators for the social validity measure included three early childhood teachers who held master’s degrees in ECSE. The teachers did not teach at the elementary school where the study took place. Their teaching experience varied from 2 years to 7 years. All teachers were blind to the purpose of the study and experimental conditions. They were asked to rate the acceptability of the intervention procedures and whether they thought the intervention had produced socially important changes in behavior. To evaluate the acceptability of the intervention procedures, the teachers were asked to view two randomly selected videotapes (one baseline session and one intervention session) from each dyad from beginning to end. After viewing the videotapes, the teachers were asked to complete a 10-item questionnaire using a 5-point Likert-type scale (5 = agree, 4 = somewhat agree, 3 = neutral, 2 = somewhat disagree, 1 = disagree). Example items included (a) overall, the intervention procedures were acceptable to me, (b) the intervention requires too much time to implement, and (c) the intervention procedures would be easy to implement in my classroom. Means and standard deviations were calculated to analyze the results.

To evaluate whether the intervention had produced socially important changes in behavior, teachers were again asked to view randomly selected videotapes from each dyad. The teachers viewed 1-min video clips of each dyad in a baseline session and in an intervention session. Clips were taken from the first baseline sessions and the last intervention sessions for each dyad. The order of tape clip presentation (baseline condition, intervention condition) was randomly selected; teachers could not determine the difference between the two conditions based on the content of the video clips, other than by judging child performance. After watching each video clip, teachers were asked to rate the behavior of the children shown in the video clip using a 10-item questionnaire. Baseline sessions video clips were included in the social validity assessment for normative comparison (Foster & Mash, 1999) purposes. If teachers gave baseline clips a rating of strongly agree or agree for behaviors taught in the intervention, then we would know that the intervention did not demonstrate a change in participant behavior as baseline levels were zero for the randomly selected baseline video clips. Teachers did not rate baseline video clips as strongly agree or agree in the current study. Sample questions included the following: (a) the children in the video clip were initiating with one another, (b) the children in the video clip listened while their peer was talking to him or her, (c) the children shared toys, and (d) the children did not interrupt a peer when he or she was talking. A 5-point Likert-type scale was used to assess their agreement or disagreement with each item (5 = agree, 4 = somewhat agree, 3 = neutral, 2 = somewhat disagree, 1 = disagree). Means and standard deviations were calculated to analyze their responses.

Data Analysis Procedures

Observational data were collected for each session from videotapes. These data were summarized and graphed to examine patterns in the data through visual inspection. The data were analyzed individually, but the analyses are based on dyads—meaning the data are dependent on the behaviors of both children (Kenny, Kashy, & Cook, 2006). For this reason, we made the decision to conduct a multiple-baseline design using commenting behaviors, requests for verbal behavior, requests for non-verbal behavior, and non-verbal requests as the primary dependent measure (to determine baseline stability and when to introduce intervention). In addition, the performance of the first child in each dyad (Joshua, Montel, Shontelle) was used to determine stability of baseline and introduction of the intervention.

We calculated the Non-Overlap of All Pairs (NAP; Parker & Vannest, 2009) to evaluate improvement in child behavior across intervention phases. We chose NAP as a supplement to visual analysis because NAP has been shown to equal or to outperform other overlap indices in its accuracy and its robust correlation with visual analysis (Parker & Vannest, 2009). The NAP statistic is calculated as the percentage of all pairwise comparisons across phases, wherein NAP equals the number of comparison pairs showing no overlap, divided by the total number of comparisons. After calculating NAP scores, we rescaled scores to a 0% to 100% scale, where 0% signifies a chance-level result (Parker, Vannest, & Davis, 2011).

Results

Commenting Behaviors and Requests for Verbal Behavior

Figure 1 displays data on the frequency of commenting behaviors and requests for verbal behavior for the six children. Commenting behaviors and requests for verbal behavior, whether or not they received an immediate response from a peer, are included. For commenting behaviors, a change in level and an ascending trend occurred with Shontelle and Blake. Commenting behavior frequencies remained primarily above baseline levels throughout the intervention phase for Joshua, Ashley, Mia, and Montel. For requests for verbal behavior, a change in level and an ascending trend occurred for all six children.

Figure 1.

The number of commenting behaviors and requests for verbal behavior by child.

We computed the effect sizes of the intervention program on commenting behaviors and requests for verbal behavior for each child, using the percentage of NAP: 0 to 0.31 = weak effects, 0.32 to 0.84 = medium effects, 0.85 to 1.0 = large or strong effects. Table 3 presents effect size results for commenting behaviors and requests for verbal behavior. Four children (Ashley, Mia, Shontelle, Blake) had strong effects for commenting behaviors. Two children (Joshua, Montel) had medium effects for commenting behaviors. Four children (Joshua, Ashley, Shontelle, Blake) had strong effects for requests for non-verbal behaviors. Two children (Mia, Montel) had medium effects for requests for verbal behavior.

Table 3.

Percentage of Non-Overlap of All Pairs (NAP) Data.

Participants	Commenting behaviors	Requests for verbal behaviors	Requests for non-verbal behavior	Non-verbal requests
Participants	NAP	NAP	NAP	NAP
Joshua	0.83^a	0.93^b	0.90^b	1.0^b
Ashley	0.97^b	0.97^b	0.97^b	0.97^b
Montel	0.83^a	0.93^b	0.83^a	1.0^b
Mia	0.93^b	0.97^b	0.70^a	0.97^b
Shontelle	1.0^b	0.97^b	1.0^b	1.0^b
Blake	1.0^b	0.97^b	1.0^b	0.97^b

Note. NAP between 0 to 0.31 is considered a weak effect.

NAP between 0.32 to 0.84 is considered a medium effect.

NAP between 0.85 to 1.0 is considered a strong effect.

Requests for Non-Verbal Behavior and Non-Verbal Requests

Figure 2 displays data on the frequency of requests for non-verbal behavior and non-verbal requests for the six children. For non-verbal behaviors, a change in level and an ascending trend occurred for Ashley, Shontelle, and Blake. Non-verbal behavior frequencies remained primarily above baseline levels throughout the intervention phase for Joshua and Montel. For non-verbal requests, a change in level and an ascending trend occurred for all six children. Table 3 presents effect size results for requests for non-verbal behavior and non-verbal requests. All six children had strong effects for non-verbal behavior and non-verbal requests.

Figure 2.

The number of requests for non-verbal behavior and non-verbal requests by child.

Procedural Fidelity

To determine whether the preparation of intervention materials, advanced play organizer, and review sessions were implemented as described, fidelity of treatment checklists was completed for 20% of the intervention sessions (randomly selected). The average score for treatment fidelity for preparation of intervention materials, advanced play organizer, and review sessions was 97% (range = 93%-100%). This score indicates that the procedures were fully implemented by the interventionist.

Social Validity

Finally, we explored the social validity of intervention findings by asking (a) did preschool teachers find the intervention procedures to be socially acceptable? and (b) did preschool teachers rate the behavior changes as being socially important? In the assessment of social validity following completion of the study, three preschool teachers with master’s degrees in ECSE rated the acceptability of intervention procedures and socially important changes in behavior. Scores on the acceptability of intervention procedures could range from a minimum of 0 to a maximum score of 40. Mean intervention procedure acceptability across children was rated as 34 (SD = 4.0, range = 29-40) by Teacher 1, 39 (SD = 2.6, range = 36-40) by Teacher 2, and 40 (SD = 0, range = 40) by Teacher 3. Scores on socially important changes in behavior could range from a minimum of 0 to a maximum score of 40. The mean ratings of baseline video clips on social importance were 9.5 (SD = 8.1, range = 0-15) for Joshua and Ashley, 11 (SD = 3.6, range = 7-14) for Montel and Mia, and 13 (SD = 5.5, range = 8-19) for Shontelle and Blake. Mean ratings of intervention clips on social importance were 32.5 (SD = 3.1, range = 30-36) for Joshua and Ashley, 36.0 (SD = 1.7, range = 34-37) for Montel and Mia, and 38.5 (SD = 1.5, range = 34-37) for Shontelle and Blake.

Discussion

In the present study, commenting behaviors and verbal and non-verbal requests of children participating in a social communication intervention were evaluated. The purpose of the study was to explore the effects of the social communication intervention on the frequency of verbal and non-verbal requests and commenting behaviors in participating children. Overall, the social communication intervention was moderately to highly effective in increasing commenting behaviors, requests for verbal behavior, requests for non-verbal behavior, and non-verbal requests. These findings are consistent with those of other studies that examined the social interactions of children with disabilities (Goldstein, English, Shafer, & Kaczmarek, 1997; Goldstein & Wickstrom, 1986; Spohn, Timko, & Sainato, 1999; Stanton-Chapman, Denning, et al., 2008; Stanton-Chapman, Jamison, et al., 2008; Stanton-Chapman, Kaiser, et al., 2008; Stanton-Chapman et al., 2006; Storey, Smith, & Strain, 1993). However, the earlier studies, in contrast to the current study, targeted older preschoolers (i.e., 4- and 5-year-old children) and grouped target children with typically developing or at-risk peers. What makes the results of this study unique is the fact that two children with disabilities were partnered in the intervention and both children had gains in language skills. This finding is especially important to children enrolled in self-contained ECSE classrooms with no access to typical peers. Although the findings from this study should not minimize the placement of children in least restrictive environments or the value of inclusion, it does demonstrate that positive social communication outcomes can occur in self-contained classrooms when an emphasis is placed on social communication skills.

In the current study, four participants had extremely delayed language abilities (Joshua, Ashley, Montel, Mia). During the baseline phase for verbal behaviors (i.e., commenting behaviors, requests for verbal behavior), all of these individuals had zero rates of talking. With the introduction of the intervention program, the children verbally interacted with their peers, but overall rates were low. Although the frequency of verbal interactions was low, given the children’s extremely delayed language abilities, low rates of verbal interactions are a huge improvement over their baseline performance and appropriate for their language abilities, a conclusion similarly raised by Franco, Davis, and Davis (2013) who showed increases in verbal interactions with primarily non-verbal children with autism participating in a prelinguistic milieu teaching intervention. Future research should examine which elements of the intervention program (e.g., vocabulary instruction, storybooks) lead to positive outcomes. Our guess is that the individualized storybooks accompanied with intervention strategy icons embedded within the stories were most helpful. The individualized storybooks were very similar to social stories which are gaining more evidence in the literature as an effective teacher tool (e.g., Karkhaneh et al., 2010) to use with young children with disabilities.

Rates of non-verbal communication (requests for non-verbal behavior and non-verbal requests) also showed improvements from the baseline through intervention phases. This finding highlights the importance of measuring both verbal and non-verbal social communication skills in young children with disabilities; especially in children with significant language delays. The results from the current study do indicate that it is possible to teach children with disabilities, no matter how delayed their language, how to socially interact with peers. Future research is needed to explore the factors that influence children’s motivation to respond verbally or non-verbally.

Limitations

A major limitation of the current study is that children were not expected to use highly sophisticated language to receive credit for using verbal language. For example, a child received credit for a commenting behavior if he or she said “car” to a peer. Given the language abilities of the majority of the participants (over two standard deviations below the mean), we felt it was more important for the children to receive credit to the fullest extent possible for any verbal communication, provided that the utterance met our established definitions. Results of the study may have varied if we used more stringent definitions or expected more than a one-word utterance. Thus, researchers must keep the developmental abilities in mind when observing language behaviors.

Second, measurement challenges experienced during intervention implementation prevented us from collecting follow-up and/or generalization data. Participants were scheduled to start baseline and intervention on a 1- to 2-week delay with follow-up sessions at the conclusion of the study, but school calendar restraints, administrator requests, child illnesses and vacations, school testing requirements, and school closings due to weather presented us with numerous challenges that compromised our wishes for a complete study. While these challenges are expected when conducting research in authentic settings, the result was a limited amount of time to test the intervention program. We collected data until April when we were asked to stop coming to the school as older grades were participating in state standardized tests, and the school did not want outside visitors in the building during this time. In addition, the use of videotapes rather than direct observation also complicated the study. Most of our videotapes were without flaws, but practical problems were encountered that made some videotapes unusable (e.g., no sound recorded, unplanned events during taping, like fire drills) and required us to repeat taping. Repeat taping needed to be done twice: (a) a baseline session with Joshua and Ashley and (b) an intervention session with Shontelle and Blake. Future research should consider the use of fewer data points to demonstrate intervention effectiveness and use direct observation as a means to collect data.

Third, teachers were asked to rate social validity based on intervention targets (e.g., initiating to a peer) rather than study outcomes (e.g., commenting, requesting) as we thought teachers would be able to decipher baseline video clips from intervention clips easier as the majority of children were non-verbal in the baseline condition. In addition, we requested teachers to evaluate a change in children’s behavior first and then they evaluated the acceptability of the intervention procedures. It is possible that the teachers looked for specific words or behaviors when evaluating the video clips. While we do not think this occurred, we cannot rule it out.

A fourth limitation is the use of NAP to determine effect sizes. Although it has better sensitivity than other effect size methods (e.g., PND), NAP does not take trend into account (Parker et al., 2011). Thus, it is possible that NAP calculations inflate effect sizes.

Implications

Several implications for practice can be derived from the present study findings. First, social competence is correlated to both communication and play skills. Early intervention strategies for children with social communication delays are critical to their developing social competence. A key component of social communication intervention is embedding instruction in conversation and play. When children are minimally engaged with peers (e.g., making brief comments or using verbal or non-verbal requests), there are many opportunities to teach functional skills without disrupting the flow of the social interaction. Stanton-Chapman (2015) provides a conceptual framework to assist early childhood teachers in thoughtfully planning when and how to scaffold children during peer interactions. This approach is not unusual, but has high social congruence with methods teachers naturally use with preschoolers, differing perhaps mainly in their intensity and their systematic application. The social communication intervention described in the current study offers a more systematic technique for teaching social communication and play skills than do informal strategies commonly used by teachers. Future research might consider assessing maintenance of skills at 1 month, 3 months, and 6 months. Follow-up assessments should also include generalization observations of the children in various settings, with other peers, and during different times of the school day. If children are expected to use the learned strategies across time and in different settings, it is important to determine whether or not they can generalize the strategies when presented with different situations.

Footnotes

Declaration of Conflicting Interests

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

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

Achenbach

T. M.

(1997). Guide for the caregiver-teacher report form for ages 2-5. Burlington: Department of Psychiatry, University of Vermont.

Barnett

D. W.

Bell

S. H.

Carey

K. T.

(1995). Designing preschool interventions: A practitioner’s guide. New York, NY: Guilford.

Beilinson

J. S.

Olswang

L. B.

(2003). Facilitating peer-group entry in kindergarten with impairments in social communication. Language, Speech, and Hearing Services in the Schools, 34, 154-166.

Cohen

J. A.

(1960). Coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 37-46.

Craig-Unkefer

L. A.

Kaiser

A. P.

(2002). Improving the social communication skills of at-risk preschool children in a play context. Topics in Early Childhood Special Education, 22, 3-13.

Craig-Unkefer

L. A.

Kaiser

A. P.

(2003). Increasing peer-directed social-communication skills of children enrolled in Head Start. Journal of Early Intervention, 25, 229-247.

Doctoroff

(1997). Sociodramatic script training and peer role prompting: Two tactics to promote sociodramatic play and peer interaction. Early Childhood and Developmental Care, 136, 27-43.

Fleiss

J. L.

(1981). Statistical methods for rates and proportions (2nd ed.). New York, NY: Wiley.

Foster

S. L.

Mash

E. J.

(1999). Assessing social validity in clinical treatment research: Issues and procedures. Journal of Consulting and Clinical Psychology, 67, 308-319.

10.

Franco

J. H.

Davis

B. L.

Davis

J. L.

(2013). Increasing social interaction using prelinguistic milieu teaching with nonverbal school-age children with autism. American Journal of Speech-Language Pathology, 22, 489-502.

11.

Goldstein

Cisar

C. L.

(1992). Promoting interaction during sociodramatic play: Teaching scripts to typical preschoolers and classmates with disabilities. Journal of Applied Behavior Analysis, 25, 265-280.

12.

Goldstein

English

Shafer

Kaczmarek

(1997). Interaction among preschoolers with and without disabilities: Effects of across-the-day peer intervention. Journal of Speech, Language, and Hearing Research, 40, 33-48.

13.

Goldstein

Wickstrom

(1986). Peer intervention effects on communicative interaction among handicapped and nonhandicapped preschoolers. Journal of Applied Behavior Analysis, 19, 209-214.

14.

Gresham

F. M.

Elliott

S. N.

(1990). Social skills rating system manual. Circle Pines, MN: American Guidance Service.

15.

Hohman

Weikart

D. P.

(2002). Educating young children: Active learning experiences for preschool and child care programs (2nd ed.). Ypsilanti, MI: High Scope Press.

16.

Karkhaneh

Clark

Ospina

M. B.

Seida

J. C.

Smith

Hartling

(2010). Social Stories™ to improve social skills in children with autism spectrum disorder: A systematic review. Autism, 14, 641-662.

17.

Kazdin

A. E.

(1982). Single-case experimental designs. In Kendall

P. C.

Butcher

J. N.

(Eds.), Handbook of research methods in clinical psychology (pp. 461-490). New York, NY: Wiley.

18.

Kazdin

A. E.

(1994). Behavior modification in applied settings (5th ed.). Pacific Grove, CA: Brookes/Cole.

19.

Kenny

D. A.

Kashy

D. A.

Cook

W. L.

(2006). Dyadic data analysis. New York, NY: Guilford.

20.

Landa

R. J.

(2005). Assessment of social communication skills in preschoolers. Mental Retardation and Developmental Disabilities Research Reviews, 13, 16-25.

21.

Laundry

S. H.

Smith

K. E.

Swank

P. R.

Guttentag

(2008). A responsive parenting intervention: The optimal timing across early childhood for impacting maternal behaviors and child outcomes. Developmental Psychology, 44, 1335-1353.

22.

Miller

Chapman

(1985). Systematic analysis of language transcripts. Madison, WI: Language Analysis Laboratory.

23.

Mundy

Card

Fox

(2000). EEG correlates of the development of infant joint attention skills. Developmental Pyschobiology, 36, 325-338.

24.

Parker

R. I.

Vannest

K. J.

(2009). An improved effect size for single-case research: Nonoverlap of all pairs. Behavior Therapy, 40, 357-367.

25.

Parker

R. I.

Vannest

K. J.

Davis

J. L.

(2011). Effect size in single-case research: A review of nine nonoverlap techniques. Behavior Modification, 35, 303-322.

26.

Spohn

J. R.

Timko

T. C.

Sainato

D. M.

(1999). Increasing the social interactions of preschool children with disabilities during mealtimes: The effects of an interactive placemat game. Education & Treatment of Children, 22, 1-18.

27.

Stanton-Chapman

T. L.

(2005). Intervention procedures manual for social communication skills intervention: Preschool version. Unpublished manuscript, University of Virginia, Charlottesville.

28.

Stanton-Chapman

T. L.

(2015). Promoting positive peer interactions in the preschool classroom: The role and the responsibility of the teacher in supporting children’s sociodramatic play. Early Childhood Education Journal, 43, 99-107. doi:10.1007/s10643-014-0635-8

29.

Stanton-Chapman

T. L.

Brown

T. S.

(2015). A strategy to increase the social interactions of 3-year-old children with disabilities in an inclusive classroom. Topics in Early Childhood Special Education, 35, 4-14.

30.

Stanton-Chapman

T. L.

Denning

C. B.

Jamison

K. R.

(2008). Exploring the effects of a social communication intervention for improving requests and word diversity in preschoolers with disabilities. Psychology in the Schools, 45, 644-664.

31.

Stanton-Chapman

T. L.

Jamison

K. R.

Denning

C. B.

(2008). Teaching social pragmatic skills to young children at-risk. Early Childhood Services: An Interdisciplinary Journal of Effectiveness, 2, 225-251.

32.

Stanton-Chapman

T. L.

Kaiser

A. P.

Vijay

Chapman

(2008). Teaching social interaction skills to children at-risk for emotional and behavioral disorders. Journal of Early Intervention, 30, 188-212.

33.

Stanton-Chapman

T. L.

Kaiser

A. P.

Vijay

Craig-Unkefer

(2003). The peer language and behavior code. Unpublished manuscript, Vanderbilt University, Nashville, TN.

34.

Stanton-Chapman

T. L.

Kaiser

A. P.

Wolery

(2006). Building social communication skills in Head Start children using storybooks: The effects of prompting on social interactions. Journal of Early Intervention, 28, 197-212.

35.

Stanton-Chapman

T. L.

Snell

M. E.

(2011). Promoting turn-taking skills in preschool children with disabilities: The effects of a peer-based social communication intervention. Early Childhood Research Quarterly, 26, 303-319.

36.

Storey

Smith

D. J.

Strain

P. S.

(1993). Use of classroom assistants and peer-mediated intervention to increase integration in preschool settings. Exceptionality, 4, 1-16.

37.

Tapp

(2003). SALTRELY: Program for comparing observation data. Unpublished software, Vanderbilt University Kennedy Center, Nashville, TN.

38.

Tawney

J. W.

Gast

D. L.

(1984). Single subject research in special education. Columbus, OH: Merrill.

39.

Thiemann

K. S.

Goldstein

(2004). Effects of peer training and written text cueing on social communication of school-age children with pervasive developmental disorder. Journal of Speech, Language, and Hearing Research, 47, 126-144.

40.

Timler

G. R.

Olswang

L. B.

Coggins

T. E.

(2005). Social communication interventions for preschoolers: Targeting peer interactions during play group entry and cooperative play. Seminars in Speech and Language, 26, 170-180.

41.

Woods

Poulson

C. L.

(2006). The use of scripts to increase the verbal initiations of children with developmental disabilities to typically developing peers. Education & Treatment of Children, 29, 437-457.

42.

Zimmerman

I. L.

Steiner

V. G.

Pond

R. E.

(2002). Preschool Language Scale-4, revised. Columbus, OH: Merrill.