1. Evaluation of the PEERS Play Intervention for Preschoolers with Autism Spectrum Disorder (ASD) K. Toth, G-L. Boulware, RM. Leon-Guerrero, A. Wolken, & S.J. Webb Seattle Children’s Research Institute, Center for Child Health, Behavior, and Development, Seattle Background Children with ASD have documented impairments in social communication skills that are related to concurrent language and predictive of later language abilities, adaptive functioning, and academic performance (Toth, Munson, Meltzoff, & Dawson, 2006; McGovern & Sigman, 2005; Sigman & Ruskin, 1999). Even before impairments in social interaction and communication are evident, however, parents of infants who later receive an autism diagnosis often describe their children as having difficulty controlling their attention, affect, and behavior (Dawson, 2008). Difficulties with self regulation in children with ASD can persist into adulthood, impacting relationships, attention, problem solving, and communication (Bradley & Isaacs, 2006; White, Oswald, Ollendick, & Scahill, 2009). Most of the interventions targeting social skills in children with ASD have focused on short term treatments (e.g., 8-12 weeks) and children older than 5 years (Ozonoff & Miller, 1995; Taras, Matson, & Leary, 1998). To our knowledge, only one published study has examined a social skills intervention for preschool aged children with ASD delivered in a group vs. one-to-one setting (Dykstra et al., 2012). Further, self regulation skills have not been the primary focus in prior studies of social skills group interventions for young children with ASD. Measures Table 1. Pre-Treatment, Treatment, and Post-Treatment Assessment Results Two analytic plans were utilized: 1) Pre- and Post-treatment parent, teacher, and clinician ratings on a variety of measures; and 2) A multiple time point, single case design analyzing weekly behavioral codes from video-recordings across multiple domains (social engagement, social communication, play level, cooperative play, and self-regulation). Pre- and Post-Treatment Results Using paired difference t-tests, we found significant positive change on measures of parent ratings of social skills (t=2.755, p=0.04), teacher ratings of social skills (t=4.284, p=0.05), and parent ratings on the Temperament and Atypical Behavior Scale (TABS; t=2.86, p=0.035), a measure of atypical self- regulatory behaviors designed for use with infants and young children. Additionally, on the Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P), a measure of early executive function skills, most children showed positive change in most domains. Results from Behavioral Coding These analyses are still underway. Table 2 summarizes the types of behaviors that were coded weekly over the 6-month treatment phase. Both missed opportunities for social engagement and inappropriate behaviors were coded along with positive behaviors in each category, to capture change both in reductions of negative behaviors and increases in positive behaviors. Most behaviors were coded based on frequency, with some behaviors coded as a percentage of time across the coded period (e.g., amount of time spent in proximity to others) or as a category (e.g., types of play). Presented at IMFAR, May 2015 ▪ karen.toth@seattlechildrens.org This research was funded by a small grant from the Seattle Children’s Research Institute, Center for Child Health, Behavior, and Developmentkaren.toth@seattlechildrens.org Behavioral Coding Table 2. PEERS Play Coding Variables Conclusion Findings from our pilot study indicate that, following the PEERS Play intervention, preschool age children with ASD show clinically significant change in multiple domains including the critical area of self-regulation skills. Future research will include an RCT design and a parent-mediated adjunct to this intervention. For more information about the PEERS Play curriculum, contact Drs. Gusty-Lee Boulware and RinaMarie Leon-Guerrero at PEERS Play in Seattle, www.peersplay.com.www.peersplay.com DomainBaseline (Pre-Treatment)Weekly for 6 MonthsPost-Treatment Cognitive Mullen Scales of Early Learning: AGS Edition Adaptive Vineland Adaptive Behavior Scales-II DevelopmentalAges & Stages, parent Social Social Skills Checklist- PEERS Play form, parent/teacher Social Skills Checklist- PEERS Play form, parent/teacher Social Skills Rating System (SSRS)-parent/teacher Behavioral codes from video Behavioral codes from video Behavioral codes from video Emotion Regulation BRIEF-Preschool- parent/teacher Behavioral codes from video Behavioral codes from video Behavioral codes from video Sensory Short Sensory Profile- parent/teacher Temperament and Atypical Behavior Temperament and Atypical Behavior Scale (TABS) - parent/teacher Treatment HxIntervention History Interview-parent Intervention History Interview-parent DomainBehaviorsDomainBehaviors RegulationShares Identifies emotions Justifies emotions Positive regard Empathy Comfort Calming strategy Cognitive flexibility Problem solving Social CommunicationRequest Protest Greet Comment Respond Seek attention Ask question Answer On topic Shift topic Pause Maintain Social PlayObserves Imitates Takes turns, structured Takes turns, unstructured Sportsmanship Organizes play Follows another’s lead Narrates play Social Play (types)Unoccupied Solitary Onlooker Parallel Associative Cooperative Engagement (Peer-Adult- General) Reciprocal play Shared enjoyment Joins in Invites by sharing Invites by asking Seeks assistance Gives assistance Follows directions Transitions Cognitive Play (types)Non-engaged Functional Dramatic Games w/rules Sustains Play Proximity Y/N (5-minute segments) % of total time Missed BidsCode frequency Methods Study Design This is a single-case design with three phases (see Table 1): 1) Pre-treatment baseline assessment utilizing parent, teacher, and clinician ratings on a variety of measures; 2) Intervention phase consisting of 6 months of weekly 60-minute social groups using the PEERS Play curriculum, all of which were recorded for later behavioral coding, and 3) Post-treatment assessment that duplicated the pre-treatment battery of measures. Participants 6 children with previously diagnosed ASD ages 3 and 4 years participated in the study. Participants were new clients of PEERS Play and participating in their treatment as usual. None of the children had previous social skills group treatment. PEERS Play Intervention The PEERS Play intervention targets social and self regulation skills in preschool aged children with ASD. The curriculum is based on extensive experience with this population and age, principles of applied behavior analysis, and self regulation techniques drawn from The Alert Program ® (Shellenberger & Williams). The PEERS Play intervention follows a weekly group format consisting of structured (e.g., circle time, art) and unstructured (e.g., free play, choice time with a peer) activities. See handout for more information; this manual is currently being prepared for publication. Objectives To evaluate the effectiveness of the PEERS Play intervention, assess change in self regulation skills and social functioning over 6 months of treatment, and manualize the PEERS Play curriculum.