Billy was a second-grade student with moderate mental retardation and some autistic-like behaviors. He participated in activities with second- and third-grade peers for approximately a third of his school day. He participated in intensive one-to-one and small-group instruction in a special education classroom for the remainder of the time. Billy used single word or simple phrases to communicate but generally did so only to request preferred items (i.e., ball, music, juice). He was able to play with several toys appropriately (balls, cars, tape player), could label several foods appropriately, and addressed many self-care needs (eating, washing hands, dressing with pull-over/pull-up clothes). He learned to match pictures, to sort by size and color, and to follow simple picture schedules. His instructional program targeted expressive communication training (sound production for common objects, requesting items using a communication board), functional item use (toys, mealtime items, classroom materials), following one- and two-part commands, self-care skills, and preacademic skills (e.g., sorting, matching, one-to-one correspondence). Behavior problems included occasional tantrums and crying, typically when Billy was tired, sick, or frustrated; stereotypic behaviors, such as rocking and jumping repetitively; and task avoidance in new situations (running, falling out of his chair). Billy was generally happy and responsive to positive reinforcement including a token system (chips on a token board exchanged for preferred activities and edibles) and hugs and smiles from adults.

Social programs for Billy occurred throughout the school day and included multiple peers from his school (see Table 9.3). Because Billy spent approximately two thirds of his day receiving one-to-one and small-group instruction, peers were recruited from two classrooms for social programs, and some peer activities were conducted in a reverse mainstreaming format (peers went to the special education classroom). Programs were designed, similar to Jimmy’s, to include both instructional activities (e.g., following directions, language training) as well as social times (e.g., free time, lunch, recess). Billy’s programs focused on peer interactions that best fit his ability level and thus included peers as helpers, as well as playmates with social activities including the use of imitation, picture schedules, communication board icons, and simple gross motor activities. Educators sought to improve Billy’s social competence in the following contexts:

• Playgroup with one to three peers practicing appropriate use of toys and social interaction skills
  
  
• Games in play stations (free time) during which peers engaged Billy in imitating actions and functional object use
  
  
• Lunch helpers with rotating peers who monitored his use of a picture activity schedule, encouraged his use of words, and practiced simple matching activities
  
  
• Recess buddies who engaged in an obstacle course routine, affection activities, and playing ball
  
  
• Picture Exchange Communication System (PECS; Bondy & Frost, 1994) training with both the teacher and peers as language partners to promote initiation skills
  
  
• Snack group to promote peer initiation
  
  
• Home socialization activities with siblings

Lunch Helpers

Because lunchtime was short, peers were asked to help Billy 1) follow a picture schedule for obtaining his lunch and utensils and cleaning up afterward, 2) name items to eat or drink, and 3) play simple matching games during the last 5 minutes when students were generally finished eating but waiting for the lunch period to end.

Two picture schedules were used for the lunch routine. These followed routines used to teach picture schedules developed by MacDuff and colleagues (e.g., MacDuff, Krantz, & McClannahan, 1993). To start lunch, the sequenced picture steps were children waiting in line, placing the ticket in the holder, collecting silverware from a bin, collecting milk from a bin, accepting the lunch tray from the cafeteria worker, and sitting at the table. The teacher worked with Billy using a simulated lunch routine to teach the steps of the activity and initially prompted him during lunch to follow the schedule. As Billy became independent with most steps in the sequence, peers were asked to monitor his completion of the schedule. They observed his completion of each step, checked off the step on the schedule, and praised Billy after every step or two.

During lunch, peers were taught to make five communication initiations to Billy and monitor his performance by making a check on a data sheet in the center of the table. The paraprofessional modeled examples of initiations during the first few minutes of lunch (e.g., “I like juice” before a drink, “good cake” after taking a bite, “pickles and ketchup” while looking at a hamburger). Peers prompted Billy by saying, “Look, Billy,” prior to their initiations, gently touching his wrist as a delay tactic to prompt his imitation prior to a bite or a drink, pointing to the juice box, and so forth as gestural prompts, or providing a verbal prompt (e.g., “Say ‘good juice’”).

Simple matching games were played only when Billy completed lunch before the end of the period (one to two times per week for about 5 minutes). Billy was asked to match photos of toys used in the playgroups (both exact matches and similar matches such as different types of cars) and action pictures (e.g., jumping, climbing, playing ball). This matching activity was designed as a maintenance task to stimulate interaction (peers gave the photos to Billy and took turns) and as a deterrent to inappropriate behavior that occurred when Billy was bored.

A second picture schedule was used at the end of lunch and included the following steps: place items on tray, walk to trash bin in line with peers from table, throw away trash, place tray on cart, and follow peers in line to doorway.

Eating was an enjoyable activity for Billy. Thus, completing the picture schedule to obtain lunch was highly motivating. Initially, Billy received tokens on his reinforcement chart for learning the picture sequence. He eventually progressed to one token after the sequence was completed. Also, spontaneous verbal imitations were reinforced with tokens (prompted imitations were praised but not reinforced with a token). All spontaneous communication (labels, requests) was acknowledged and praised by peers and the paraprofessional placed a token on his reinforcement chart.

Recess Buddies

Peer intervention was conducted during three recess activities: an obstacle course with three to four peers, kickball, and affection activities (small group of peers singing songs and playing movement games) during indoor recess. During the morning recess, Billy could choose to join an activity in progress or practice gross motor skills in a parallel play fashion with the paraprofessional prompting skills (kicking the ball, climbing). The occupational therapist assisted one day per week, modeling skills for Billy and the paraprofessional. The recess buddies program was initiated daily during the afternoon recess.

All peers in Billy’s homeroom class participated in the recess buddies program with rotations of three to four peers each week. The obstacle course consisted of a sequence of gross motor activities in a designated area of the playground. This activity was similar to the play stations in the cafeteria, except that outdoor equipment was used and Billy followed the lead of peers rather than a picture schedule. Peers took the materials to the playground, set up the obstacle course, chose a partner for the activity (one peer was with Billy), and took turns running the course. Obstacle course activities included relay races (teams), scooter board races (teams), split races (half running/half scooter boards), use of the playground equipment as part of the course, and incorporation of items into routines such as balls, jump ropes, balloons, or tunnels. As with the play stations, the adult initially taught the class the “system” and recruited ideas from peers for obstacle course activities. The adult also demonstrated ways to model and prompt Billy’s participation, with assistance, directions, and feedback faded over time.

Billy was just beginning to learn kickball skills. Therefore, during some recesses when he was not running the obstacle course, Billy practiced kicking the ball (peers volunteered to roll him the ball) and running to bases. He engaged in approximately eight trials of kicking and running with the adaptive physical education coach supervising one recess per week with Billy and several classmates. The goal was to have Billy join in real kickball games with peers similar to Jimmy’s case study.

Billy and his peers also engaged in affection activities (e.g., McEvoy et al., 1988). The affection activities were group songs and games that included an affection behavior as part of the routine (e.g., “If you’re happy and you know it, hug a friend,” “Simon says, give a high five.”) Additional affection behaviors included patting someone on the back, shaking hands, winking at a friend, and clapping games. These activities were used with Billy during indoor recess and occasionally as part of morning routines.

The paraprofessional who supervised the obstacle course game initially used Billy’s token system to reinforce completion of each part of the course, with a candy jar at the end of the course (each student took a piece of candy as they finished). As Billy learned the routines, he was motivated to engage in the obstacle course with peers without the token system; however, the candy jar was maintained. In addition, the recess buddies for the week went for a soda with the paraprofessional after the Friday recess. Intermittent token reinforcement was provided during the kickball practice and affection activities.


References

Bondy, A., & Frost, L. (1994). The picture exchange communication system (PECS): Application with young children with autism. Cherry Hill, NJ: Pyramid Educational Consultants.

MacDuff, G., Krantz, P., & McClannahan, L. (1993). Teaching children with autism to use photographic activity schedules: Maintenance and generalization of complex response chains. Journal of Applied Behavior Analysis, 26, 89–97.

McEvoy, M., Nordquist, V., Twardosz, S., Heckaman, K., Wehby, J., & Denny, R. (1988). Promoting autistic children’s peer interaction in an integrated early childhood setting using affection activities. Journal of Applied Behavior Analysis, 21, 193–200.