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Teaching children with autism to share using video-based interventions Mark, Landa Lea 2010

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       TEACHING CHILDREN WITH AUTISM TO SHARE USING VIDEO-BASED INTERVENTIONS  by  LANDA LEA MARK  B.A. (Honours), University of Guelph, 2006  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF  MASTER OF ARTS in The Faculty of Graduate Studies  (Special Education)    THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) April, 2010  Landa Lea Mark, 2010   ii ABSTRACT   Sharing is a fundamental social skill young children learn during play. Children with autism have a constellation of deficits which contribute to difficulty sharing. Previous research indicates that video-based interventions can teach social and play skills to this population. The purpose of this study was to examine the impact of video-based interventions to increase positive sharing behavior and decrease sharing-related problem behavior in two children with autism. The results suggest that, for one participant, video feedback was associated with positive changes in behavior. Some support was found for video modeling that occurred immediately prior to the target activity for a second participant, despite multiple treatment interference. The results are discussed in the context of previous and future research and implications for practice.  iii TABLE OF CONTENTS  ABSTRACT .............................................................................................................................. ii  TABLE OF CONTENTS ......................................................................................................... iii  LIST OF TABLES ................................................................................................................... vi  LIST OF FIGURES ................................................................................................................ vii  ACKNOWLEDGEMENTS ................................................................................................... viii  CHAPTER 1 ............................................................................................................................. 1 Review of the Literature ........................................................................................................... 1 Autism Spectrum Disorders .................................................................................................. 1 Prevalence ......................................................................................................................... 3 Early Social Development in Children with Autism ............................................................ 4 Imitation ............................................................................................................................ 4 Joint Attention ................................................................................................................... 5 Theory of Mind ................................................................................................................. 5 Play Development ............................................................................................................. 6 Sharing .................................................................................................................................. 8 Sharing in Typically Developing Children ....................................................................... 9 Sharing in Children with ASD ........................................................................................ 11 Teaching Children to Share ................................................................................................ 12 Teaching Sharing to Typically Developing Children and Children with Disabilities Other Than ASD ............................................................................................................. 12 Teaching Sharing to Children with ASD ........................................................................ 19 Statement of the Problem and Research Questions ............................................................ 33  CHAPTER 2 ........................................................................................................................... 36 Method .................................................................................................................................... 36 Participant and Confederate Recruitment ........................................................................... 36 Participants and Confederates ............................................................................................. 37 Participant 1 .................................................................................................................... 37 Participant 2 .................................................................................................................... 39 Setting and Interventionists ................................................................................................. 40 Materials ............................................................................................................................. 40 Toys................................................................................................................................. 40 Video Modeling Tapes .................................................................................................... 41 Measurement ....................................................................................................................... 41 Dependent Variables for Elliot ....................................................................................... 41 Dependent Variables for Iris ........................................................................................... 44 Design ................................................................................................................................. 45 Procedure ............................................................................................................................ 46  iv Confederate Training ...................................................................................................... 46 Probe Procedure .............................................................................................................. 47 Baseline: Elliot and Iris ................................................................................................... 48 Video Modeling Intervention: Elliot and Iris .................................................................. 49 Alternate Procedures for Elliot ....................................................................................... 50 Alternate Procedure for Iris ............................................................................................ 51 Data Collection ................................................................................................................... 52 Training ........................................................................................................................... 52 Inter-observer Agreement (IOA) .................................................................................... 52 Treatment Fidelity ........................................................................................................... 55 Data Analysis ...................................................................................................................... 55  CHAPTER 3 ........................................................................................................................... 57 Results ..................................................................................................................................... 57 Elliot .................................................................................................................................... 57 Circus Toy: Baseline 1 .................................................................................................... 59 Egypt Toy: Baseline 1 ..................................................................................................... 59 Circus Toy: Video Modeling .......................................................................................... 59 Circus Toy: Baseline 2 .................................................................................................... 60 Circus Toy: Video Feedback .......................................................................................... 60 Circus Toy: Baseline 3 .................................................................................................... 60 Generalization ................................................................................................................. 61 Social Validity ................................................................................................................ 61 Iris ....................................................................................................................................... 61 Puzzle: Baseline .............................................................................................................. 63 Puzzle: Video Modeling ................................................................................................. 63 Puzzle: Alternative Video Modeling .............................................................................. 64 Magnet Board: Baseline .................................................................................................. 65  CHAPTER 4 ........................................................................................................................... 66 Discussion ............................................................................................................................... 66 Elliot .................................................................................................................................... 67 Problem Behavior at Baseline ......................................................................................... 67 General Play Behaviors ................................................................................................... 68 Video Feedback .............................................................................................................. 71 Iris ....................................................................................................................................... 73 Measurement of Dependent Variables ............................................................................ 73 Baseline Variability ........................................................................................................ 74 Video Modeling .............................................................................................................. 74 Multiple Treatment Interference ..................................................................................... 76 Clinical Implications ........................................................................................................... 77 Contributions to the Existing Literature ............................................................................. 79 Limitations and Implications for Future Research .............................................................. 80 Conclusion ...................................................................................................................... 81  REFERENCES ....................................................................................................................... 83  v  APPENDICES ........................................................................................................................ 97 Appendix A: Behavioral Research Ethics Board Certificate .............................................. 97 Appendix B: Research Ethics Board Certificate – Amendment ......................................... 98 Appendix C: Participant Initial Letter of Contact ............................................................... 99 Appendix D: Participant Pre-Study Observation Consent Form ...................................... 100 Appendix E: Confederate Pre-Study Observation Consent Form .................................... 102 Appendix F: Participant Consent Form ............................................................................ 104 Appendix G: Confederate Consent Form ......................................................................... 107 Appendix H: Video Modeling Scripts – Elliot ................................................................. 110 Appendix I: Video Modeling Scripts - Iris ....................................................................... 119 Appendix J: Probe Session Protocol - Elliot ..................................................................... 123 Appendix K: Probe Session Protocol – Iris ...................................................................... 125 Appendix L: Probe Session Data Collection Form – Elliot .............................................. 127 Appendix M: Probe Session Data Collection Form – Iris ................................................ 128 Appendix N: Initial Video Viewing Script - Elliot ........................................................... 129 Appendix O: Initial Video Viewing Script – Iris .............................................................. 130 Appendix P: Video Viewing Protocol - Elliot .................................................................. 131 Appendix Q: Video Viewing Protocol – Iris .................................................................... 133 Appendix R: Video Viewing Data Sheet .......................................................................... 135 Appendix S: Social Validity Questionnaire ...................................................................... 136   vi LIST OF TABLES  Table 1 Inter-observer agreement across dependent variables for Elliot ................................ 54 Table 2 Inter-observer agreement across dependent variables for Iris ................................... 55      vii LIST OF FIGURES  Figure 1. Results of video-based interventions for Elliot ....................................................... 58 Figure 2. Latency (in seconds) to major and minor sharing-related problem behavior for puzzle and magnet board toys for Iris ..................................................................................... 62 Figure 3. Frequency of positive sharing behaviors for puzzle and magnet board toys for Iris ................................................................................................................................................. 63  viii  ACKNOWLEDGEMENTS   I have been supported in my journey to complete both my degree and this thesis by many individuals. Since moving to Vancouver I have encountered many knowledgeable, amazing individuals in my field of study. I have learned something valuable from each encounter and from every experience. There are a number of specific individuals whose contributions to my success I would like to acknowledge.  First among these is my advisor and research supervisor Dr. Pat Mirenda. From the moment I met Pat (when she recruited my classmates’ assistance in finding me an apartment in a new city), I knew she would be an advocate for my success. Her support, encouragement, and enthusiasm exceeded my expectations. Although I experienced a number of challenges in the completion of this thesis, Pat was always there to offer assistance and ask the right questions when and where they were needed. I will be forever grateful for all that I have learned from her.  A very close second with regard to providing unconditional support is my husband Nathan. Nathan, thank you for listening when I needed it, understanding when I had to leave the house at all hours, and knowing when to suggest I take a break. I absolutely could not have accomplished all that I have in the last 10 years if it wasn’t for your overwhelming support in all I have done and all I dream of doing.  I also need to acknowledge the support of the rest of the Ontario cohort/UBC Train. I cannot imagine my experience completing this project without having all of you having been a part of it. To Sarah and Adrienne, thank you for your friendship and support when you were right down the street and when you were across the country. To Nadine and Brooke,  ix thank you for inspiring me to continue everyday while we all finished this journey together. I could not have met a more exceptional and unwavering support system.  I would also like to thank my family (and the inventors of Skype) for sending love, guidance and motivation across the miles. Thank you for understanding why I could not be with you for holidays and family events while I pursued my dream. I cannot wait to share all of my future successes with you.  I am indebted to Meghan O’Rourke and Brooke Myers for their assistance with data coding. Thank you to Dr. Kent McIntosh for your helpful comments and suggestions from proposal to final product. Additional thanks to Dr. Joe Lucyshyn for sitting on my examining committee and for teaching me to have humility and never admire the problem. Lastly, I would like to thank Elliot, Hannah, Iris, and Richelle, along with their families, for allowing me the pleasure of working with them.   1 CHAPTER 1 Review of the Literature  In order to present a framework for the investigation of the effectiveness of a video- based intervention to teach children with autism to engage in sharing behaviors, this chapter will review Autism Spectrum Disorders (ASD); important aspects of early social development in children with ASD; the development of sharing behaviors in both typically developing children and those with ASD; and sharing interventions for children with various disabilities, including ASD. Autism Spectrum Disorders Five separate and distinct disorders are classified under the umbrella of pervasive developmental disorders (PDDs) in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000). More commonly referred to as “autism spectrum disorders” (ASD), they include Autistic Disorder (more commonly referred to as simply autism), Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). This constellation of disorders is characterized by impairments in social interaction skills and communication skills, and by a limited range of interests or activities and/or stereotypical behaviors. The specific diagnostic criteria for Autistic Disorder, as presented in the DSM-IV- TR (American Psychiatric Association), require the presence of a total of six or more items from the following categories:  2 A. Qualitative impairment in social interaction, as manifested by at least two of the following: (1) Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction (2) Failure to develop peer relationships appropriate to developmental level (3) A lack of spontaneous seeking to share enjoyment, interests or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest) (4) Lack of social or emotional reciprocity B. Qualitative impairments in communication as manifested by at least one of the following: (1) Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) (2) In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others (3) Stereotyped and repetitive use of language or idiosyncratic language (4) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level C. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: (1) Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus (2) Apparently inflexible adherence to specific, nonfunctional routines or rituals  3 (3) Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) (4) Persistent preoccupation with parts of objects Further, delays or abnormal functioning must occur in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play. In addition, symptoms should be not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder (American Psychiatric Association, 2000). On a behavioral level, autism has been described as a constellation of behavioral excesses and deficits that are biologically based but that can be successfully addressed through the use of specific strategies in both the social and physical environment (Green, 2001). Despite much research in the area, there is no known cause for ASD at this time. Prevalence In a review of epidemiological studies aimed at answering the question of prevalence of autism (i.e., autistic disorder), Fombonne (2005) found a wide range: from a low of 0.7 per 10,000 to a high of 46.4 per 10,000. He noted that more recent surveys have found higher prevalence rates and suggested that a conservative estimate based on the most recent and largest studies is 13 per 10,000 for autism alone. However, in his own survey (Chakrabarti & Fombonne, 2005), the prevalence of autism was found to be 22 per 10,000. Prevalence estimates for all five of the ASDs combined are between 60 and 65 per 10,000s. The prevalence of Childhood Disintegrative Disorder is the lowest, with limited available estimates placing it around .2 per 10,000 (Fombonne, 2005). Asperger’s Disorder has the next highest prevalence at 2.6 per 10,000, while PDD-NOS has the highest  4 prevalence with a rate of 20.8 per 10,000.  It is clear that prevalence of autism and the entire constellation of ASDs is relatively high, and growing higher. It is also important to note that autism is four to five times more prevalent in males than females (Kope, Eaves, & Ho, 2001). Early Social Development in Children with Autism One of the hallmarks of ASD is difficulty engaging in social interactions with peers. These difficulties stem from deficits in areas that make significant contributions to early social development in typically developing children. Although each of these areas has been considered separately in the literature, there are many commonalities, and they are often discussed with reference to one another. The areas include imitation, joint attention, theory of mind, and play development. Imitation The first area that affects social development in children with ASD is difficulty with imitation. Imitation can take many forms but can generally be defined as copying the actions of others. In a study examining different forms of imitation, Stone, Ousley, and Littleford (1997) found definite impairments in the imitation of children with ASD compared to children with other developmental delays and typically developing children. Overall, children with ASD had more difficulty imitating body actions than actions with objects, and more success with meaningful versus non-meaningful actions. Additionally, it was noted that imitation with objects was more highly correlated with successful play skills than was imitation of actions using only the body. Interventions targeting the imitation abilities of young children with ASD have found that increases in imitation are positively correlated with pretend play (Ingersoll & Schreibman, 2006).  5 Joint Attention Another area of early social deficit in children with ASD is joint attention, which involves the act of seeking others to share activities, enjoyment, and achievements. In children with ASD, this deficit is manifested by a lack of bringing objects to others, a lack of pointing and showing, and an inability to follow the pointing gestures of others that are meant to show (i.e., proto-declarative pointing). Deficits in joint attention skills during play can translate into a lack of eye contact to share enjoyment of a toy (Mundy, Sigman, Ungerer, & Sherman, 1987) and can therefore affect play-based social interactions. Dawson and her colleagues (2004) found that children with ASD were significantly less likely to engage in joint attention behaviors (both responding to adults’ efforts to solicit their attention and initiating attempts to gain adult attention) when compared to children with developmental delays and typically developing children matched for mental age. This same study also found that measures of joint attention alone were able to correctly identify over 80% of children with ASD. Theory of Mind Deficits in both imitation and joint attention have both been framed within the literature as stemming from impairments in another important construct related to social development: theory of mind (Baron-Cohen, 1989; Baron-Cohen, Leslie, & Frith, 1985). Theory of mind has been conceptualized as the ability to “read the minds” of other people – that is, to understand that others have mental states that are different from one’s own, and to think about thoughts (Baron-Cohen et al.; Happé & Frith, 1995). Baron-Cohen et al. proposed that a theory of mind deficit could account for many of the social impairments seen in ASD, as well as impairments in communication and imagination, two areas that are  6 inextricably linked to a child’s social development. A study by Frith, Happé, and Siddons (1994) found that children with ASD who failed tests of theory of mind also showed low levels of sociability in their everyday lives, pointing to the role of theory of mind skills in the development of social competence. Play Development Play is one of the fundamental activities for the promotion of healthy social development in childhood. Given that impairments in social skills and communication, along with a narrow range of interests and activities, are the core areas of deficit that define ASD, it is not surprising that individuals with ASD often have difficulty engaging in a variety of behaviors that are central to play. Included among these are the skills previously discussed, all of which affect the ability of children with ASD to engage in play. In the literature on autism, two fundamental types of play are discussed: symbolic play and functional play. Symbolic play. The assertion that many children with ASD lack symbolic play has been well documented (see Jarrold, Boucher, & Smith, 1993 for a review). The importance of this deficit is such that a lack of symbolic play is included in the diagnostic criteria for Autistic Disorder (American Psychiatric Association, 2000). Symbolic play (also referred to as imaginary, pretend, or nonrepresentational play) is defined according to three key features, as outlined by Leslie (1987). The first defining aspect of symbolic play is that children use one object in their environment to represent another (e.g., using a banana as a telephone). The next feature is attributing properties to items that they do not have (e.g., pretending a shirt is dirty when it is clean). The final manifestation of symbolic play is treating imaginary objects as if they were present (e.g., pretending to eat spaghetti off of a fork).  7 Based on a review of available research on symbolic play, Jarrold et al. (1993) concluded that there is good evidence that children with ASD have impairments in their ability to engage in spontaneous symbolic play. However, the precise nature of this deficit is the subject of some debate. In a paper discussing the nature of play deficits in children with ASD, Jordan (2003) suggested that because research has shown that at least some of these children can engage in pretend play in highly structured scenarios, the deficit is not an issue of ability. Rather, she suggested, it may be that the symbolic play of children with ASD is rigid and stereotyped, which acts as a deterrent to pretend play interactions with peers. Because of this, combined with deficits in joint attention and imitation (as described previously), children with ASD do not experience the social interactions that lead to play flexibility and variability. Jordan also suggested that these same factors can affect functional play. Functional play. Functional play involves the use of a toy or object in the manner for which it was designed. Functional play can be further divided into object-directed play (e.g., putting a train on tracks), self-directed play (e.g., using a face cloth to wipe one’s face), doll- directed play (e.g., brushing a doll’s hair), and other-directed play (e.g., handing a peer a tea cup) (Sigman & Ungerer, 1984). While there is universal agreement that children with ASD lack spontaneous, symbolic play, the findings regarding functional play in this population have been more equivocal. Some research has found that children with ASD display significantly less functional play than peers (Stone, Lemanek, Fishel, Fernandez, & Altemeirr, 1990), while other studies suggest that the differences in functional play between children with ASD and their peers is not significant (Libby, Powell, Messer, & Jordan, 1998), or that differences emerge only when specific aspects of functional play are examined  8 (e.g., simple versus elaborative) (Williams, Reddy, & Costall, 2001). Given this range of findings, combined with the more unambiguous deficits in symbolic play, it has been proposed that the two should not necessarily be viewed as mutually exclusive, but rather as developing along some type of continuum (Williams, Costall, & Reddy, 1999; Williams et al., 2001). These findings are also reflected in the DSM-IV-TR diagnostic criteria for ASD, in which symbolic play is named explicitly, but functional play is not.  Regardless of whether a play sequence is functional or symbolic, they often involve the use of toys or materials that are often central to the play experience. When limited numbers of toys or play materials are available, sharing of these items becomes necessary. Thus, sharing can be viewed as a prosocial behavior that has implications for a child’s interactions and success in play situations. Sharing  The act of sharing is commonly divided into two distinct types (e.g., Barton & Ascione, 1979; Barton & Osborne, 1978; Sawyer, Luiselli, Ricciardi, & Gower, 2005). The first of these is physical sharing, which can occur spontaneously or after a request to share has been made. Physical sharing can take a number of forms: handing materials to another person, allowing someone to take play materials, and simultaneously manipulating materials with a play partner in a common interaction. Physical sharing should be distinguished from turn taking, where two or more individuals engage in an activity in which a back-and-forth exchange is inherent in the task (e.g., playing a board game, playing catch, having a conversation).  The second type of sharing is verbal sharing, which must contain some form of verbal behavior directed towards another person, be it spoken language, sign language, or picture  9 exchange. Verbal sharing can also take many forms. It can be a request to share what another person has (e.g., “Can I use that?”), verbally accepting such a request to share (e.g., answering “sure”), inviting another person to use materials (e.g., “Do you want to play with this?”), and verbally accepting such requests (e.g., responding “yes”). It may be the case that verbal and physical sharing occur simultaneously (e.g., handing a toy to another person while making a verbal offer).  Rheingold, Hay, and West (1976) broke down sharing into three separate behaviors. The first of these is showing or directing a person’s attention to an object through pointing, gaze, or handing over an object. These behaviors have also been conceptualized as initiations related to joint attention (e.g., Mundy, Sigman, & Kasari, 1990). The second behavior is giving an object to another person; and the third is playing with the same object as another person. These final two sharing behaviors are more in line with the common definitions of sharing described previously. Sharing in Typically Developing Children  Chronological age is one of the most important variables affecting the sharing behavior of typically developing children. Many studies have explicitly examined this variable, while others have noted interesting findings related to age. Benenson, Markovits, Roy, and Denko (2003) confirmed the notion that children engage in more sharing behaviors as they age. In their study, children in grade 1 (mean age 7 years) displayed significantly higher levels of toy sharing behavior than children in kindergarten (mean age 6 years 1 month). As the age of participants in studies of sharing decreases, so does the amount of sharing observed, though sharing has been documented even in young children. For example, Hay (1979) found that instances of toy sharing between children and their parents increased  10 in frequency as early as the second year of life. Rheingold et al. (1976) also found evidence of sharing in 15-month-olds (including sharing in the form of joint attention). Sharing in young children may, however, be dependent on factors other than age. In a study of the sharing behaviors of children 2.5 to 3 years of age, Levitt, Weber, Clark, and McDonnell (1985) found that none of the children engaged in spontaneous toy sharing behaviors with peers who had no toys. However, once a child was prompted by his or her mother to share with a toy-deprived child, a majority of children did so. Levitt et al. also found that children were much more likely to share toys if another child had previously shared with them. These results seem to indicate that children aged 3 and younger may have some difficulty sharing without some type of prompting or modeling. Brownell, Svetlova, and Nichols (2009) also found that sharing behavior in young children was affected by age and verbal prompting. While 18-month-old children in their study did not share food even when an adult verbally indicated a desire for the child’s food item, 25-month-old children did share once an adult gave the same verbal indications of desire. Rheingold at al. (1976) also found an interesting interaction between age and response to nonverbal prompts indicating desire for a toy (i.e., reaching one’s hands out, leaning towards the child, and smiling). They found that 18-month-olds were more likely than 15-month-olds to share a toy after nonverbal prompts to share were provided. These results, combined with those of Brownell et al., indicate that very young children will share in response to a variety of prompts. Another variable that may be related to sharing behavior is gender. Interestingly, studies in this area have resulted in mixed findings; some suggest a lack of difference in sharing behavior based on gender, while some suggest otherwise. For example, Benenson et al. (2003) found that, while age significantly impacted toy sharing behavior, gender had no  11 effect. However, Burford, Foley, Rollins, and Rosario (1996) found that preschool-aged girls were significantly more likely to share stickers than boys. These authors also found that sharing between same gender pairs took different forms, with girls sharing through negotiation and boys sharing primarily through coercion. Benenson et al. (2003) also investigated the relationship between the type of toy and the amount of sharing. In a study of children between 5 years 7 months and 6 years 11 months of age, they found that toys that produce an obvious end result (e.g., a hand-held game with a built in buzzer that sounds after a constant amount of time) were shared more frequently than those that did not (e.g., a hand-held video game with no sounds to indicate the end of a turn), regardless of other relevant variables such as age. The types of items that children are expected to share (e.g., toys, food, money, stickers) differs across most studies of sharing in typically developing children, which confounds comparisons to some extent. Sharing in Children with ASD  There has been very little research to date that has specifically examined the sharing behavior of children with ASD and how sharing may be affected by the relevant areas of impairment. Rather, most sharing studies have focused on interventions to teach sharing to children with ASD.  However, many have made the connection between a variety of impairments and a lack of sharing behavior in this population.  As noted previously, children with ASD have deficits in their ability to imitate others. This deficit manifests itself as the inability to imitate both simple and complex actions. Honig and McCarron (1988) found that children with ASD did not learn to engage in prosocial behaviors after simply observing others. A lack of theory of mind may also contribute to low or nonexistent levels of sharing in children with ASD. Children who fail to  12 understand that others do not share their knowledge and feelings, will be less likely to engage in prosocial behaviors such as sharing. Finally, as seen in the work of Rheingold and colleagues (1976), joint attention behaviors, which are almost always impaired in children with ASD, can be thought of as the earliest forms of sharing – the sharing of needs, wants, and interests. Teaching Children to Share  It is clear that sharing is one of the central prosocial behaviors of childhood. When children share with significant adults in their lives, they engage in behaviors that establish important social interactions. Sharing with peers also allows children to form social relationships and to engage in play with others their own age. Children who do not share with peers are likely to have fewer opportunities to experience positive social interactions and can experience peer rejection (Sawyer et al., 2005). Tremblay, Strain, Hendrickson, and Shores (1981) found that physical sharing was related to sustained periods of positive social interaction between typically developing peers from age 3 to age 5 years 9 months. The ability to share has also been found to result in a decrease in unwanted social interactions such as aggression (Bryant & Budd, 1984). Teaching Sharing to Typically Developing Children and Children with Disabilities Other Than ASD  Educators have long recognized the importance of teaching and promoting sharing behaviors in classrooms. Researchers have examined a number of different approaches to teaching sharing to young children in a small number of studies. In some of these studies, typically developing children were taught to share (e.g., Barton & Ascione, 1979; Rogers- Warren & Baer, 1976) while in others, children with behavior problems (e.g., McConnell,  13 Sisson, Cort, & Strain, 1991; Odom, Hoyson, Jamieson, & Strain, 1985) and other impairments (e.g., Barton & Osborne, 1978) were taught to share. Two types of strategies have been explored for teaching typically developing children and children with disabilities (other than ASD) to share: child-specific strategies and peer-mediated interventions. Child-specific interventions. Child-specific interventions consist of instruction, reinforcement, or some combination of these, implemented with the specific intent of establishing or increasing the quality or frequency of a skill (McConnell, 2002). McConnell described five categories of child-specific interventions: (a) basic instruction to increase knowledge, (b) dense reinforcement schedules, (c) social skills training, (d) adult-mediated prompting and reinforcement, and (e) techniques to promote generalization (i.e., self- monitoring). Interventions targeting sharing in typically developing children and those with disabilities other than ASD have used the first four of these strategies. Barton and Ascione (1979) investigated the effect of a multi-component child- specific intervention on the sharing behavior of a group of 32 typically developing preschoolers (mean age 4 years, 2 months). The authors divided the children into four treatment groups. One group was trained in verbal sharing alone, another in physical sharing alone, a third in physical and verbal sharing, and a fourth served as a control group. The treatment package consisted of four key elements. First, the children were given verbal instructions regarding the importance of sharing and how to do it appropriately. Next, a child was selected to model the behavior with an adult instructor. This was followed by having all children model sharing behavior while being prompted and praised for correct sharing. Finally, the adult verbally reviewed sharing with the children. Sharing was taught in one  14 classroom using toys, and generalization to another classroom with art materials was also probed. The outcomes of the sharing training differed for the treatment groups. Children who were taught physical sharing showed evidence of large increases during treatment in both settings. However, once the training ceased, their levels of sharing fell back to baseline levels and no collateral increases in verbal sharing were seen. In contrast, the children who received only verbal sharing instruction did not demonstrate generalization to new settings; however, their levels of verbal sharing also returned to baseline at removal of treatment. Of note is the fact that verbal sharing training led to substantial increases in physical sharing across both settings and materials that were maintained after treatment termination. The children in the verbal and physical sharing group mirrored those in the verbal sharing only condition. Given this, Barton and Ascione (1979) suggested that explicitly teaching verbal sharing may be the most efficient training approach, even if physical sharing is the desired outcome. In another study with typically developing children, Rogers-Warren and Baer (1976) investigated the role of modeling, reinforcement, and children’s self-report of sharing behaviors, in the acquisition of sharing of art materials. Rogers-Warren and Baer sequentially introduced modeling and reinforcement (i.e., edibles, praise) for various types of self- reporting of sharing behaviors (e.g., true reports of behavior, any report of behavior) to teach verbal and physical sharing to 32 children (age range 3 years 2 months to 5 years 6 months). Among the most important finding was that modeling alone did not result in increases in sharing behavior; however, increases were seen once reinforcement for reports of sharing was added. Results also indicated that, once reinforcement for reports of sharing ceased, levels of sharing returned to baseline. This suggests that, at least initially, sharing behavior  15 (in this case, giving up a desired object to another person) is likely to require specific reinforcement in order to increase substantially. Barton and Osborne (1978) measured the impact of a teacher-delivered positive practice intervention on verbal and physical toy sharing behavior of five kindergarteners with hearing impairments (mean age 6 year, 2 months). The positive practice procedure targeted only verbal sharing and consisted of instruction, modeling, and practicing a sharing interaction three times. If students did not share, they received a time-out until they were willing to engage in additional practice. The children did not receive any type of reinforcement for engaging in sharing, so that any improvements could be attributed to the positive practice procedure alone. While verbal sharing was not affected by the intervention, levels of physical sharing rose immediately and remained high. The poor results in the domain of verbal sharing may have been affected by the fact that the children’s verbal skills were weak when the study commenced. It is also important to note that the amount of time engaged in positive practice did not decline over the course of the study. However, results were maintained at a 15 week follow-up after positive practice was discontinued. Cooke and Apolloni (1976) examined the outcome of an intervention package consisting of instructions, modeling, and praise on toy sharing behavior of seven children who were described as learning disabled and lacking in appropriate social-emotional behavior with peers (mean age = 8 years, 6 months). Four of the children received the intervention and three served to demonstrate generalization to untrained classmates. Specific training was sequentially introduced to increase levels of smiling, sharing, positive physical contact, and complimenting. For the trained students, sharing levels remained low until the sharing-specific intervention began, and were maintained above baseline levels thereafter.  16 Similar patterns of increased sharing were seen in the three children who did not receive the intervention directly, once their peers had been trained in sharing. These results are very encouraging as they indicate that training of a few specific children can have positive effects on the sharing behaviors of others. While some studies examined the effects of training instructional packages on sharing specifically, some grouped sharing together with other positive social interaction skills (e.g., positive physical contact, invitations to play, directing the play of others). For example, Strain, Shores, and Kerr (1976) used a combination of verbal and physical prompting, modeling, and praise to teach positive social interaction skills, including sharing. The participants in this study were three males (age range 4 years, 1 month to 4 years, 6 months) who were described as “behaviorally handicapped” and exhibited behaviors such as opposition to and withdrawal from peer and adults. Instruction resulted in increased and stable levels of positive social behavior in all three boys. Reversal to baseline saw the levels of positive social interactions decline, but reintroduction of the treatment package returned rates of positive interactions to elevated levels. These results suggest that children with social skills deficits may need ongoing intervention and support in order to display these behaviors. Strain et al. also monitored the frequency of physical (e.g., biting, kicking) and verbal (e.g., whining, yelling) negative behaviors. During baseline, two of the three boys displayed some problem behavior. Once the intervention began, the levels of problem behavior decreased. Removal of the intervention led to a reversal in these effects and problem behaviours became elevated again. This aspect of the study indicated that training in positive social skills may lead to decreases in negative social behaviors.  17 McConnell et al. (1991) also included sharing as one of several positive social skills taught to four behaviorally handicapped children (age range 4 years, 4 months to 5 years, 8 months) whose problem behaviors included crying, noncompliance, inattention, and insufficient social skills. Social skills were targeted through social skills training (i.e., modeling, prompting, praise, and correction) that was conducted prior to play periods; coaching (i.e., praise and prompting) during play periods; and group coaching using an interdependent group token economy. When social skills training was introduced, three participants displayed gradual increases in social initiations, including sharing. When coaching was introduced, all four students showed immediate and substantial improvements in their social behavior. After a return to baseline, group coaching was introduced but failed to produce meaningful increases in participants’ social skills. This indicates that feedback on an individual, not group, basis may be necessary to elicit positive social skills. While the work of Strain et al. (1976) and McConnell et al. do not permit an analysis of the effectiveness of the intervention packages on sharing specifically, they do add additional support for the use of child-specific techniques to teach social skills such as sharing to children with behavioral handicaps.  Peer-mediated interventions. Peer mediated interventions are those in which children are provided with some type of training (e.g., social skills training, prompting, praise) with the intention that they will facilitate change in the social skills of other children (McConnell, 2002). Although peer-mediated interventions are very popular with children with ASD, their application with other populations is more limited. Two such investigations combined sharing and other social skills in the intervention, limiting the inferences that can be made about sharing specifically.  18  Strain, Shores, and Timm (1977) used peer-mediated methods to teach physical toy sharing and other positive physical and verbal social skills to six males described as behaviorally handicapped (age range 39-53 months). Two peers were trained to increase the frequency of the behaviorally handicapped children’s positive social behaviors through role- playing, verbal instruction, and praise for appropriate social interaction behaviors. When the peer-mediated intervention was in effect, all six boys showed increases in the frequency of positive social interactions in response to peers; and five of the participants increased their own initiations of positive social behaviors. Unfortunately, the extent to which sharing increased is unclear, as sharing behaviors were combined with a number of other social skills.  Odom et al. (1985) also implemented a peer-mediated intervention to teach positive social interaction skills (including verbal and physical sharing) to three males (aged 34-52 months) whose impairments included negative reactions to social initiations by others, impaired vocal communication skills, and (for one child) behaviors associated with autism. Peers attending the same class as the target children were trained to initiate positive social interactions through verbal instruction, modeling, rehearsal, and social reinforcement using a token economy. All three target children displayed increases in positive social interactions once peers began implementing the strategies with teacher prompts. In addition, the rate of peer initiations and target child interactions remained relatively stable after the token economy was removed. This suggests that positive social interactions with the target children alone were sufficiently reinforcing to the peers, at least after initial pairing with adult- mediated social reinforcement.  19  Odom et al. (1985) also measured the occurrence of both physical (e.g., hitting, taking unoffered objects) and verbal (e.g., crying, name-calling) problem behaviors. Two of the three target participants displayed slightly elevated levels of problem behavior during baseline. For both of these participants, the peer-implemented intervention did not result in any substantial reductions in problem behavior. In fact, the intervention appeared to result in spikes in problem behavior for these two boys. These results, combined with those of Strain et al. (1976), suggest that, if reduction in problem behaviors is a desired outcome, peer- mediated interventions may not be as effective as those that are child-specific. Teaching Sharing to Children with ASD The approaches used to teach sharing to children with ASD are generally similar to those that have been applied to teach sharing to other populations. While some peer-mediated interventions have been reported, child-specific interventions are much more common. Such child-specific interventions utilize three main approaches to teach sharing behaviors:  (a) direct teaching via in vivo modeling, prompting, and various types of reinforcement; (b) Social Story™ interventions; and (c) video-based instruction. Peer-mediated interventions. In a study described as “naturalistic action research” (p. 216) Whitaker (2004) examined the effect of peer training on the shared play of 10 children with ASD, ages 6 to 7. In this study, shared play was defined as “time spent in close physical proximity, attending to and playing with the same materials” (p. 217) as the facilitating peer. Typically developing peers (in their final year of elementary school) were taught to support play interactions with children with ASD through verbal explanations, modeling, and role play activities. The peers were given four guidelines for their play session interactions: get close, follow the child’s lead, speak slowly and use simple language, and  20 make the interactions fun. During play sessions, the peers were prompted according to these guidelines as necessary. Unfortunately, Whitaker did not provide results for individual children and did not provide graphs documenting the results. He did state that the average rate of sharing behaviors (across all 10 children) was 42% during baseline and 66% in the final play session following peer training; however, this difference was not statistically significant. Despite the methodological limitations, this study suggests that peer-mediated interventions, which have been quite successful in teaching other social skills (McConnell, 2002), might be used to facilitate sharing in children with ASD. Child-specific interventions using direct teaching. Child-specific interventions that make use of direct teaching techniques are the most common method for teaching sharing to children with ASD. Sawyer et al. (2005) used a combination of techniques to increase the amount of sharing of a variety of play materials (i.e., toys, books, craft materials) with peers in a 4-year-old boy with autism who had only basic speech and was able to follow one-step directions in familiar routines. The multi-element intervention began with an adult instructor explaining what sharing was and why it was important (i.e., verbal priming), followed by modeling of both verbal and physical sharing by a peer and the instructor. The instructor then physically prompted the child with autism to share with a typically developing peer, and provided feedback and praise during the interaction. During play sessions that were used for data collection, the instructor also provided prompts and praise for sharing after reminding the child what sharing was and why he should engage in sharing behaviors. After approximately 10 days, the intervention was scaled back and included only prompting and praise during play sessions. Results indicated that the intervention was successful in increasing both physical and verbal sharing and that the adult was able to decrease the level  21 of prompting that was needed to facilitate sharing behaviors. Notably, when verbal priming and modeling were removed from the intervention package, physical sharing began to decrease but verbal sharing continued to increase. Once priming and modeling were reintroduced, physical sharing increased dramatically and the previous level of verbal sharing was maintained. The design of this investigation prohibits definitive conclusions about which aspects of the intervention were responsible for the increases in sharing behavior, but it appears that priming and/or modeling may have been effective for this one child. Strain and Kohler (1995) used some of the same strategies to teach physical and verbal sharing along with a number of other social skills (i.e., requesting help, displaying affection) to three male preschoolers with ASD (ages 3-4). The boys took part in class-wide social skills training that consisted of modeling, rehearsal with assistance from a teacher, and rehearsal without assistance. During data collection, the classroom teacher reviewed the social skills that were relevant for a specific activity (including sharing), provided prompts and praise, and gave post-session rewards to the target children when they displayed specific levels of the target behaviors. Unfortunately, Strain and Kohler collapsed sharing together with five other target social interaction variables, so changes specific to sharing were not examined. However, the intervention did result in increased levels of positive social interactions for all three boys. Levels of negative behavior also were monitored but their occurrence was so low that the results were not reported. Kamps et al. (1992) also completed a study examining the effect of small group instruction on the social skills of three children with autism (age 7 years). Included among these social skills was the behavior of “sharing materials” (p. 282). The social skills training was based on published curricula by McGinnis and Goldstein (1984) and Walker, Hops, and  22 Greenwood (1988), but the specific strategies that were used were not described. As with the Strain and Kohler (1995) study, sharing was included with a number of other social skills for analysis (e.g., giving and accepting compliments, inviting other to join an activity). Thus, it was not possible to determine the intervention effect on sharing alone. However, the authors did find that, overall, the average frequency of positive social interactions increased during the intervention and was maintained above baseline levels during a post-training follow-up. It is worth noting that Strain and Kohler, Sawyer et al. (2005), and Kamps et al. all had classroom staff implement the interventions. Reinecke, Newman, and Meinberg (1999) examined sharing in three 4-year-old boys with ASD using a token economy system. The participants were provided with tokens noncontingently during baseline. During intervention, they were verbally prompted to take a token each time they engaged in physical sharing with another child; after five tokens were earned, they were traded for edible reinforcers. All three boys engaged in low levels of sharing during baseline, achieved large increases in the level of sharing during token reinforcement, returned to a low level of sharing when the token system was removed, and returned to a high level of sharing when it was reintroduced. While this study lends some support for the use of a token economy to teach sharing, there are some methodological concerns. The most important of these is that, during intervention, children who did not share spontaneously were provided with verbal and physical prompts to do so. Sharing responses were counted as correct if a child shared either independently or with a verbal prompt only; no data were taken on prompted versus independent sharing. Thus, it is not clear whether the tokens alone or the verbal prompts were responsible for the increased sharing that was observed.  23 In another child-specific approach to teaching sharing, DeQuinzio, Townsend, and Poulson (2008) used forward chaining and contingent social interaction to teach sharing to four children with autism (age range 8 years, 10 months to 10 years, 10 months). DeQuinzio et al. defined sharing as a complex interaction involving three elements: showing, giving, and playing. These responses were taught through the use of physical prompting, pre-recorded audio prompts, rehearsal, and positive toy-play interactions when the child completed the response chain. All four participants never completed the sharing chain during baseline. Once the intervention began, the level of completed sharing chains rose and remained high; in fact, three of the four participants engaged in sharing during 100% of intervals by the end of the intervention. This study lends support to the notion that complex sharing (i.e., joint attention behaviors) can be taught to those with autism. Odom and Strain (1986) compared the use of a peer-mediated intervention with a child-specific intervention. Peers were trained to behave differently depending on the condition in place. In the peer-mediated sessions, peers were taught to initiate sharing interactions with three children with autism (all age 4). Peers were trained on these initiations through the use of verbal discussion, modeling, practice, feedback, and reinforcement. In the child-specific intervention, the teacher verbally and physically prompted the child with autism to engage in sharing behaviors. In this condition, peers were told not to initiate interactions with their classmates with autism but to respond to the classmates’ attempts to play if they occurred. Results indicated that the frequency of sharing was higher when the child-specific intervention was in place for two of the three children. The only occurrence of negative behavior in this study was observed in one child when the peer-mediated intervention was in place. This study provides some evidence that, while sharing can be  24 improved through the use of peer-mediated interventions, sharing behaviors may be more suited to interventions that are child-specific and rely more on direct teaching. Child-specific interventions using Social Stories™. Social Stories™ were first described by Gray and Garand (1993) and since that time have risen in popularity as an intervention for people with ASD of all ages. Social Stories™ are designed to provide information that helps an individual with ASD to understand appropriate social responses that their impairments in language, social skills, and flexibility may have otherwise inhibited (Ali & Frederickson, 2006). The popularity of Social Stories™ is understandable given that they incorporate many features that are appealing: they are concrete and visual; they are created for specific routines, social situations or skills; they are relatively easy and inexpensive to create; and they provide explicit, unambiguous information. By definition, Social Stories™ must contain certain types of sentences and these must conform to a specific ratio (Gray, 2004). There are currently six types of sentences that can be included in Social Stories™: 1. Descriptive: sentences that state facts and do not contain assumptions or opinions (the most common sentence type); 2. Perspective: sentences that describe a person’s internal state; 3. Cooperative: sentences that state what other people will do to help the reader; 4. Directive: sentences that suggest possible behaviours and responses in which the reader could engage; 5. Affirmative: sentences that state shared values in order to support the statements of previous sentences; and  25 6. Control: sentences that are written by the reader him- or herself to assist recall of the Social Story™ content. Through the use of these sentence types, a Social Story™ is written to acknowledge achievements, answer relevant “wh” questions, use positive language, and match the literacy level of the target individual (pictures may be used) (Gray). Along with the growing popularity of Social Stories™ has emerged a body of research aimed at examining their effectiveness for individuals with ASD (for reviews, see Ali & Frederickson, 2006; Quirmbach, Lincoln, Feinberg-Gizzo, Ingersoll, & Andrews, 2009; Reynhout & Carter, 2006). Social Stories™ have been used effectively (often in tandem with other interventions) to target positive changes in many behaviors including: tantrum behaviors (e.g., Adams, Gouvousis, VanLue, & Waldron, 2004; Lorimer, Simpson, Myles, & Ganz, 2002); understanding emotions (Bernad-Ripoll, 2007); succeeding in situations involving change and novelty (e.g., Gray & Garrand, 1993; Ivey, Heflin, & Alberto, 2004); improving meal-time behaviors (e.g., Bledsoe, Myles, & Simpson, 2003; Rowe, 1999); social communication skills (e.g., Scattone, 2008; Thiemann & Goldstein, 2001), and reducing disruptive or inappropriate behaviors (e.g., Norris & Dattilo, 1999; Ozdemir, 2008). Another application of Social Stories™ that has been examined in the literature involves play skills. Within these studies, sharing behaviors have been targeted, both in combination with other play skills and in isolation. For example, Barry and Burlew (2004) used Social Stories™ to teach a variety of play behaviors to two children (ages 7 and 8) with severe autism and limited expressive language. A Social Story™ was created for each child that described appropriate play with peers, including sharing; unfortunately, the specific form  26 of sharing taught was not detailed and the text of the Social Stories™ was not provided in the published study. For one participant, introduction of the story resulted in an immediate increase in the amount of time spent engaged in appropriate play. However, for the second participant, introduction of the same story led to a decrease in the amount of time he engaged in socially appropriate behavior. Because sharing was examined along with other appropriate play behaviours, the precise effects on sharing cannot be assessed. In an early study, Swaggart et al. (1995) used Social Stories™ to address sharing and sharing-related behaviours in two 7-year-old boys with PDD/autism. Swaggart et al. defined sharing as giving a requested item to a peer; sharing-related behaviours included the amount of time engaged in parallel play, aggressive behaviors, grabbing materials (for participant 2), and screaming (for participant 1). For both children, gains were made in the percentage of sessions in which voluntary sharing occurred. Additionally, small gains were seen in the amount of parallel play; and decreases were seen in aggression, screaming, and grabbing materials. This study is methodologically limited as it used a simple AB design and the Social Stories™ were used in combination with other social skills training procedures that were not detailed. Thus, the effect of the stories alone is not clear. Kuoch and Mirenda (2003) used a Social Story™ intervention to target reductions in negative behaviors associated with being asked to share in a child (3 years, 10 months) with autism. The specific behaviors of concern were aggression, yelling, and crying. The Social Story™ did not focus on these behaviors, but instead centered around positive sharing behaviors. After introduction of the Social Story™, the occurrence of problem behaviors related to the boy’s refusal to share decreased. When the Social Story™ was withdrawn, the levels of problem behavior remained low. Anecdotal reports suggested that sharing behaviors  27 generalized to new materials and to new people. This study suggests that the negative behaviors associated with refusal to share can be positively affected through the use of Social Stories™, even in young children. In a final study of sharing behaviours, Crozier and Tincani (2007) examined the impact of a Social Story™ with a young boy (5 years, 1 month of age) with high functioning autism. The specific behaviors measured for change were related to appropriate block play with peers and included three sharing behaviors (asking for materials, offering materials, and using materials cooperatively) as well as making appropriate comments. The Social Story™ was read to the child immediately before block play and was the only intervention strategy used. With the introduction of the Social Story™, appropriate play increased and decreases in inappropriate behaviors (e.g., hitting, kicking, yelling) also were seen. Removal of the Social Story™ resulted in a reversal of these trends. Upon reintroduction of the Social Story™, the highest levels of appropriate behavior and lowest levels of inappropriate behavior were seen. Unfortunately, these results were not maintained over time and it was unclear what proportion of the increases were attributable to the sharing behaviours versus commenting. The authors suggested that Social Stories™ may need to be a permanent feature for some children, or may need to be combined with other strategies to promote maintenance. Overall, the evidence for the use of Social Stories™ to affect sharing-related behaviors is positive, but is lacking the specificity and/or experimental rigor to make definitive statements regarding effectiveness. Child-specific interventions using video-based interventions. Two types of video- based teaching procedures have become popular interventions for those with ASD: video modeling and video feedback. Video modeling involves watching a video/DVD recording of  28 desirable behaviors with the intent that the person with ASD will imitate the behaviors when appropriate (Bellini & Akullian, 2007). Video modeling has been used to teach a range of skills to children and adolescents with ASD, including self-help and daily living skills (Alcantara, 1994; Keen, Brannigan, & Cuskelly, 2007; Lasater & Brady, 1995; Norman, Collins, & Schuster, 2001; Shipley-Benamou, Lutzker, & Taubman, 2002), language skills (Buggey, Toombs, Gardener, & Cervetti, 1999; Charlop & Milstein, 1989; Maione & Mirenda, 2006), play skills (Bellini, Akullian, & Hopf, 2007; D’Ateno, Mangiapanello, & Taylor, 2003; MacDonald, Clark, Garrigan, & Vangala, 2005), prosocial skills (Reeve, Reeve, Townsend, & Poulson, 2007), imitation skills (Kleeberger & Mirenda, in press), academic skills (Kinney, Vedora, & Stromer, 2003), and perspective-taking skills (Charlop- Christy & Daneshvar, 2003). Video modeling also has been used to reduce problem behaviors (Buggey, 2005; Schreibman, Whalen, & Stahmer, 2000). Video modeling may be successful with individuals with ASD for a number of reasons. McCoy and Hermansen (2007) suggested that, in order to successfully imitate, individuals with ASD need help finding an appropriate frame of reference. Video models offer this frame of reference by focusing attention on one or more specific skills. Video modeling also allows for control over irrelevant or distracting aspects of the environment (Bellini & Akullian, 2007; Charlop-Christy, Le, & Freeman, 2000). Video models have been shown to be more successful in children with ASD than live or in vivo models (Charlop- Christy et al.), perhaps because many children with ASD enjoy watching movies and television. Sherer et al. (2001) found support for this notion when participants who demonstrated a previous preference for viewing videos benefitted more from video models;  29 other authors (e.g., Buggey, 2005; Lasater & Brady, 1995) have also provided anecdotal reports to this effect. Many formats have been used to create video models. McCoy and Hermansen (2007) suggested that video models can be classified as one of five types: adult models, peer models, video self-modeling (VSM), point-of-view models, and mixed models. Additionally, Keen et al. (2007) made use of animation in a video model to teach toilet training. Although both adult and peer models can be either familiar or unfamiliar to the target individual, McCoy and Hermansen found that familiar models are most commonly used. Video self-modeling involves having the child watch a video of him- or herself that has been generally edited to show only the desired behavior (e.g., Buggey, 2005). In a study comparing other-models and self-models, Sherer et al. (2001) found that the two approaches were equally successful. Point-of-view models involve filming the desired behavior from the child’s perspective (e.g., Hine & Wolery, 2006). Mixed models combine two to more of the other four methods. With advancing technology, some studies have also embedded video models into computer programs (Mechling, Pridgen, & Cronin, 2005; Simpson, Langone, & Ayres, 2004). In fact, computer-embedded video models were used in the only video modeling study to date that has explicitly examined sharing. Simpson et al. taught sharing of school materials to four students (ages 5 and 6) diagnosed with autism and speech and/or language delays. The instruction consisted of slides presented on a computer screen that contained a definition of sharing (i.e., “sharing means to let others use your things,” p. 243), reasons for sharing, and embedded video clips of sharing interactions featuring the children’s peers. Four videos were made of different sharing interactions and the students reviewed all of these one time, although it was not clear when video-watching took place relative to sharing opportunities.  30 All four children displayed some unprompted sharing behaviors before the intervention (in fact, one had an increasing trend in sharing behaviors during baseline); however, introduction of the video modeling package led to elevated levels of sharing for all. However, it was not clear if video modeling was responsible for increases in sharing because sharing opportunities were provided to all four children in a group and the sharing behavior of one student may have served as a prompt to the others. In addition, generalization to other settings or materials and maintenance were not explored. In addition to video modeling, video feedback has been used less often with individuals with ASD, and a few studies to date suggest that it is a promising intervention alternative. Video feedback involves videotaping a target individual performing specific behaviors and then co-reviewing the videotape so that the person can evaluate his or her own behaviors. Video feedback generally involves a number of steps. The first step is to video record the individual in the situation where the desired target behavior should occur, with both positive and negative examples. The individual then views the video while a trainer provides feedback regarding his or her performance. The type of feedback that is provided by the trainer will vary, depending on the skill being taught and the abilities of the individual receiving the training. Lasater and Brady (1995) used video feedback to increase fluency of self-help skills in two boys (aged 14 and 15) diagnosed with ASD. The video feedback procedure used consisted of a four-step questioning sequence aimed at having the boys identify whether or not they performed the task correctly, errors that were made, and examples of both correct and incorrect behaviors via discrimination training. The four step sequence began with an open ended question (e.g., “What is happening?”) and was followed by a question aimed at  31 identifying errors (e.g., “Why did you have to repeat a step?”). This was followed by a multiple choice question aimed at identifying correct and incorrect behaviors, and finally a statement of the incorrect behavior followed by asking what should be done differently. The discrimination training consisted of the trainer asking the boy to identify instances of correct and incorrect behaviors. Video feedback was paired with behavior rehearsal (role play) and trainer debriefing (feedback while performing the task). The video feedback package resulted in large increases in accuracy and moderate increases in fluency for both boys. Meaningful differences in accuracy and fluency of generalization self-help tasks also were seen. Embregts (2000, 2002) used video feedback to improve the social behavior of young adults with mild mental retardation/intellectual disability, two of whom also were diagnosed with ASD (aged 14 and 16). Embregts began intervention with video feedback pre-training in which each participant was asked to identify appropriate and inappropriate social behaviors both verbally and in videotapes of fellow group home members, unfamiliar individuals, and themselves. Then, each participant watched him/herself on videotapes which were paused to identify appropriate or inappropriate social behaviors. The trainer and the participant watched the video simultaneously, independently evaluated the behaviors, and then compared their evaluations. Participants earned praise and tokens towards a pre-selected reinforcer for agreements; disagreements were resolved by viewing the tape again. In the 2000 study, Embregts also had a participant state why he/she had acted appropriately or inappropriately and describe the consequences. In both studies, the two participants with ASD showed increases in appropriate social behavior and decreases in inappropriate social behavior. In Embregts (2000) there was no evidence of generalization to non-targeted behaviors (e.g., those not specifically seen in the videos) for the participant with ASD.  32 Two studies have combined video feedback with other interventions to teach language skills to children with autism. Thiemann and Goldstein (2001) combined video feedback with Social Stories™ and written text prompts to increase social communication in five children with autism (age range 6-11). The children first read a Social Story™ and then answered comprehension questions about the story, read and practiced text cues, engaged in a 10-minute social interaction, and finally engaged in video feedback. The video feedback procedure involved providing the child with a sheet of paper stating each target skill next to columns with yes and no text and icons. The children watched themselves on videotape and, when it was paused, identified whether or not they engaged in the target behavior. This intervention package featuring video feedback was effective for teaching specific social communication skills to children with autism, with evidence of generalization in two children. Maione & Mirenda (2006) also supplemented a video modeling intervention with video feedback effectively. Video modeling alone was not successful in increasing the frequency of appropriate verbalizations for a 5-year-old boy related to a toy car set with which he had an intense preoccupation. When video feedback was added to the intervention, the average frequency of verbalizations increased. However, in the case of this specific toy, additional prompts (verbal and visual) were necessary to attain a more stable level of responding. In this study, video feedback consisted of the child watching a videotape of himself and a peer engaged in toy play and identifying whether or not he was engaged in “good talking.” This study adds to the small body of research suggesting that video feedback can be a successful intervention to teach appropriate self-help and social skills to individuals  33 with autism of various ages and abilities. Video feedback has not been used to date as an intervention to increase sharing behaviors. Statement of the Problem and Research Questions The deficits in communication and social skills that are present in children with ASD, combined with the presence of rigidity and stereotyped behaviors, translate into numerous impairments in social development. Specific impairments in imitation, joint attention, and theory of mind have wide-ranging effects on the play behaviors of children with ASD. Sharing is one of the fundamental play behaviors that all children must learn in order to develop positive social relationships with peers and others. The development of sharing among typical children is affected by age, prompting from adults, gender, and the type of materials expected to be shared. While these variables may also be important in the development of sharing among children with ASD, deficits in imitation, theory of mind, and joint attention further complicate the development of this important prosocial behavior. However, there is evidence that the behaviours that constitute sharing can be explicitly taught. Typically developing children and children with disabilities other than ASD have been taught to share through both child-specific and peer-mediated strategies. Successful child-specific strategies include verbal instruction, modeling, rehearsal, prompting, praise, tangible reinforcement, positive practice, and token economies. Many of these same techniques have been used successfully to teach peers how to facilitate sharing behavior in others. This research has shown that teaching children to engage in verbal sharing can result in generalization to physical sharing and that teaching sharing to some children in a specific context (e.g., a preschool) may result in increases in sharing among untaught children in that  34 context. This research has also indicated that modeling alone may not be sufficient to increase sharing behavior, and some external reinforcement may be necessary. As with typically developing children, both child-specific and peer-mediated strategies have been used to develop sharing repertoires in children with ASD. In general, peer-mediated interventions have been used less often than child-directed interventions with this population, but have demonstrated some success. It appears that child-directed strategies may be more effective than those that are peer-mediated; such strategies include direct instruction, Social Stories™, and video-based interventions. Studies utilizing direct instruction have shown that class-wide instruction, social skills curricula, and token economies may be effective for teaching sharing. Direct instructional packages typically incorporate modeling, priming, prompting, and/or reinforcement. Social Stories™ also have been used to teach sharing and to address problem behaviors associated with a reluctance to share. Though this research is positive, more sharing-specific research is needed in order to determine their exact impact. Only one study to date has examined the effectiveness of video-based interventions to teach sharing, despite the fact that these approaches have been used successfully to teach other social skills to children with ASD. Simpson et al. (2004) used computer-embedded video modeling to affect sharing behaviors in children with ASD, and demonstrated increases in existing repertoires of sharing behaviors. The increasing popularity of video-based instruction suggests the importance of research into its effectiveness with a variety of behaviors, including sharing. Video-based interventions are easy to create and implement as an intervention to teach a behavior that has important social implications.  35 It is also important to examine whether the use of video-based interventions to teach sharing result in decreases in problem behaviors related to reluctance/refusal to share. To date, changes in problem behaviors not specifically related to sharing have been measured after general social skills training (e.g., Odom et al. 1985; Strain et al. 1976) where levels of sharing were not specifically addressed. Changes in problem behaviors related explicitly to sharing have been examined after the use of a Social Story™ that targeted sharing (Kuoch & Mirenda, 2003), but increases in sharing behaviors themselves were not explicitly documented. Research on the effects of video-based treatments on both the frequency of sharing behaviors and frequency of sharing-related problem behaviors can aid in determining their effectiveness for use in teaching these skills.  The current study aimed to explore the use of video-based interventions to teach sharing behaviors and to reduce sharing-related problem behavior. The specific questions addressed were as follows: 1. Is there a functional relationship between video-based interventions and increased toy sharing behaviors in children with ASD? 2. Is there a functional relationship between video-based interventions and decreased problem behaviors related to refusal/reluctance to share? 3. Will video-based interventions result in generalization of increased toy sharing and decreased problem behaviors related to refusal/reluctance to share in non-targets toys?  36 CHAPTER 2 Method Approval for this study was obtained in August 2009 from the Behavioral Research Ethics Board of the Office of Research Services and Administration at the University of British Columbia (Appendix A). Approval of an amendment to the original submission was obtained in December 2009 (Appendix B). Participant and Confederate Recruitment Two participants were recruited through ABA-Learning Centre (ABA-LC), a service agency in Vancouver, British Columbia. Behavior Consultants within ABA-LC were informed of the purpose of the study, the basic procedures that would be followed, and the inclusion and exclusion criteria required for participation. The Behavior Consultants were provided with a recruitment letter (Appendix C) to give to families on their caseloads whose children met the study criteria and who they believed would be interested in having their child participate. Two families contacted the researcher and expressed interest in having their children with ASD participate. The researcher visited the homes of the two families and observed one 20 minute play session between each potential participant and a sibling who was nominated by each parent as a potential confederate. Prior to the observation, parents were asked to sign observation consent forms for both the participants and the siblings (Appendix D and E). The observations confirmed that both participants and their siblings met the inclusion criteria and were invited to participate. The following inclusion criteria were applied to the participants: 1. At least 4 years of age with a diagnosis of ASD 2. Interested in watching television or videos at home for at least 15 minutes at a time  37 3. Able to engage in a preferred play activity for at least 10 minutes at a time 4. Engages in little or no toy sharing with other children 5. Exhibits problem behavior (e.g., whining, verbal protests, refusal to play, grabbing, etc.) when required to share toys with other children 6. Has a sibling or peer available for intervention probe sessions 7. Lives in a home where English is the primary spoken language The following inclusion criteria were applied to the confederates: 1. At least 3 years of age 2. Capable of communicating vocally in English, using at least short sentences 3. Able to comply with simple instructions in order to facilitate sharing opportunities (e.g., “Ask X to give you the magnet”) 4. Able to engage in primarily positive interactions with other children during toy play. Parents signed consent forms for both the participants (Appendix F) and the confederates (Appendix G). Participants and Confederates Participant 1 All names used to refer to participants and confederates in this manuscript are pseudonyms. The first participant was Elliot, a boy who turned 9 shortly after the study commenced. Elliot was diagnosed with ASD when he was 3 years 9 months old by a private psychologist, using the Autism Diagnostic Interview – Revised (Rutter, Le Couteur & Lord, 2003). A psychoeducational assessment completed by a psychologist when Elliot was 8 years 5 months of age indicated that his full scale IQ on the Weschler Intelligence Scale for Children – 4th Edition (Wechsler, 2003) was 96. Subtest scores were 95 (37th percentile) for  38 verbal comprehension, 116 (86th percentile) for perceptual reasoning, 83 (13th percentile) for working memory, and 94 (34th percentile) for processing speed. On the Test of Semantic Skills – Primary (Bowers, Huisingh, LoGiudice, & Orman, 2002), he received a receptive language standard score of 97 (41st percentile; age equivalency of 8:4) and an expressive language standard score of 86 (17h percentile; age equivalency of 7:7). An assessment of Elliot’s problem solving abilities using the Test of Problem Solving (Huisingh, Bowers, LoGiudice, 2005) at age 7 years 11 months revealed a total problem solving standard score of 82 (12th percentile; age equivalency <6:0)  Elliot attended a centre-based intervention program for children with autism for 8 months following his diagnosis, prior to his entrance to kindergarten. Elliot attended his community school from kindergarten until grade 3 and, 2 months prior to the beginning of the study, began a 4 hour/day home schooling program. Elliot also had 3-hour visits from a behavior consultant twice monthly to advise his parents regarding modifications to the home school curriculum. Elliot spoke in full sentences and was interested in a wide range of topics, but would occasionally perseverate on a theme for 2-3 days. He had a number of friends in his neighborhood and participated in play dates approximately once monthly. He also participated in a number of activities in his community, including swimming, skiing, and art lessons. Elliot’s twin sister Hannah (who was 8 years 11 months old at the study onset) served as his confederate during the study. Like Elliot, Hannah was home-schooled and had been for 2 months preceding the study. Prior to this, she had attended the same community school as Elliot. She had been diagnosed with mild-moderate dyslexia at 8 years 4 months but had no  39 other identified social, emotional or cognitive impairments. Hannah participated in a number of community activities, including soccer, skiing, and swimming lessons. Participant 2 Iris was 4 years 5 months old when the study began. Iris was diagnosed with autism at age 3 years 3 months by a private psychologist, using the Autism Diagnostic Observation Schedule (Lord, Rutter, DiLavore, & Risi, 1999) and the Autism Diagnostic Interview – Revised (Rutter et al., 2003). Iris is unable to speak and communicates through a combination of four manual signs and approximately 25 pictures that she exchanges to express basic needs (i.e., to request food and activities). Iris attended a centre-based early intervention program for children with autism for 15 hours/week during the study, and had done so for 12 months prior to its inception. Iris and her family also received weekly 1 hour visits from a behavior consultant who worked on improving Iris’s functional communication and leisure skills at home. These consultations had taken place for 9 months prior to the beginning of the study. Iris also attended a preschool with typically developing children 10 hours/week and had done so for 2 months prior to the start of the study.  Iris’s sister Richelle was 8 years 7 months old at the study onset and served as her confederate. Richelle attended a local elementary school where she was in grade 3. Richelle was meeting academic expectations in all subjects at school and was active in community activities (e.g., Girl Guides, swimming lessons, sports teams). She had no identified learning, social/emotional, or behavior problems.  40 Setting and Interventionists  Both the initial observation and all subsequent toy sharing probes took place in family living rooms for both Elliot and Iris at times that were convenient for their families. Elliot’s video modeling and video feedback sessions occurred in the same room as the toy sharing probes. Elliot watched the video models on a laptop computer and viewed video feedback tapes on a television. Iris viewed video models on a desktop computer in her family’s home office located just off the living room. The experimenter completed the first video modeling session for both Elliot and Iris and provided training to their parents on how to conduct video modeling sessions. Elliot’s mother or his home school teacher conducted his video viewing sessions and Iris’s mother and father conducted her viewing sessions. The experimenter implemented all of the video feedback sessions with Elliot. Materials Toys  Parents were asked to identify several toys with which their children with ASD played most often and with which they previously displayed a reluctance/refusal to share. Two social toys for each child (i.e., toys with which two children could easily play together; Quilitch & Risley, 1973) were chosen as targets for the video-based interventions. The toys selected for Elliot were a PlayMobil circus set containing a cage, five animals, three people, and a variety of other circus props (e.g., balance beam, fire hoop) and a PlayMobil ancient Egypt toy set containing a tomb, five people, three animals, and a number of other Egyptian-themed items (e.g., urns, fans). The toys selected for Iris were a 24-piece Dora the Explorer (Nickelodeon) cardboard jigsaw puzzle and a Max and Ruby (Magnetic  41 Creations) magnet board set (a magnetic board featuring different backgrounds and 55 small magnets that could be placed on these scenes). Video Modeling Tapes The video modeling tapes made for both Elliot and Iris featured two unfamiliar adult actors (one male and one female). One videotape was made for each toy, featuring examples of each type of sharing that was relevant to each child (see Measurement section), in proportion to the types of sharing with which he/she had the most difficulty. The scripts used for the circus (5 minutes 40 seconds) and Egypt (5 minutes 36 seconds) toys for Elliot and for the puzzle (3 minutes 9 seconds) and magnet board (2 minutes 12 seconds) toys for Iris are provided in Appendix H. Each video reflected the verbal abilities of the target child and the sibling. For example, in Iris’s videos one of the adult actors spoke and the other did not (since Iris’s sibling spoke but she did not), while in Elliot’s videos both actors spoke. Measurement All toy sharing probe sessions were videotaped for the purposes of data coding. Two sets of dependent variables were measured in the study, one for Elliot and the other for Iris. For Elliot, data were represented as the percentage of sharing opportunities resulting in positive sharing or sharing-related problem behavior. For Iris, data were recorded as the latency to sharing-related problem behavior and the frequency of positive sharing behaviors per session. Dependent Variables for Elliot Four behaviors in which Elliot’s sister Hannah engaged were identified and coded as presenting sharing opportunities (PSOs) to Elliot. Four related positive sharing behaviors  42 (PSBs) and five sharing-related problem behaviors (SRPBs) were coded for Elliot. All behaviors are described in this section. 1) Grabbing (SRPB) occurred when Elliot gained physical possession of a toy with which Hannah was currently playing, without first requesting the toy or verbally indicating he was about to take or touch the toy. Grabbing did not have to follow a sharing opportunity presented by Hannah. 2) Asking (PSO) occurred when Hannah asked Elliot for a toy with which he was currently playing or a toy that was in the general play area. The request was delivered using an appropriate/normal tone of voice and using appropriate language. a) An appropriate response to a request (PSB) by Elliot involved any of the following within 5 seconds of Hannah’s asking: (a) relinquishing physical possession of a toy to Hannah, (b) giving a toy to Hannah or allowing Hannah to take a toy within the play area, (c) providing a socially appropriate reason for maintaining possession of a toy (e.g., “I’m playing with it now,” “Sorry, I need it”), (d) verbally agreeing to let Hannah take a toy from him or from the play area (e.g., “Okay, you can have it”), or (e) verbally indicating the location of a requested toy (e.g., “I don’t have it; it’s over there”). b)  A request refusal (SRPB) occurred if Elliot failed to respond to Hannah’s request within 5 seconds, either physically (i.e., by turning away from Hannah and/or maintaining possession over toy) or vocally (i.e., by crying, whining, yelling, or throwing a toy). 3) Offering (PSO) occurred when Hannah verbally invited Elliot to take a toy with which she was currently playing or another toy within the play area.  43 a) Accepting or declining an offer (PSB) occurred when Elliot physically took possession of a toy that Hannah offered, affirmatively acknowledged her offer, or declined her offer politely (e.g., he said “No thank you,” “no,” or shook his head no). b) An offer refusal (SRPB) occurred when Elliot responded to Hannah’s offer of a toy by pushing the toy away, saying “no” in a loud or inappropriate tone of voice, or failing to respond. 4) Initiating co-manipulation (PSO) occurred when Hannah simultaneously touched the same toy with which Elliot was currently playing, and the touching did not result in a change of possession of the toy. a) Allowing co-manipulation (PSB) occurred when Elliot allowed Hannah to simultaneously touch the toy with which he was playing. b) Refusing to allow co-manipulation (SRPB) occurred when Elliot refused to allow Hannah to co-manipulate a toy with which he was playing, either physically (i.e., by turning away from Hannah and/or taking sole possession of toy) or verbally (i.e., by crying, whining, saying “no” in an inappropriate tone of voice, or yelling). 5) Taking (PSO) occurred when Hannah took physical possession of a toy with which Elliot was currently playing or had played previously during the session, and/or a toy that was within 1 foot of him, without first issuing a verbal request to do so. Taking was coded only when the taking was clearly seen by Elliot (i.e., his back was not to the toy and he was attending to Hannah’s actions). a) Allowing to take (PSB) occurred when Elliot permitted Hannah to gain possession of a toy that met the above criterion.  44 b) A refusal to allow to take (SRPB) occurred when Elliot refused to allow Hannah to take a toy with which he was playing, either physically (i.e., by turning away from Hannah and/or taking sole possession of toy) or verbally (i.e., by crying, whining, saying “no” in an inappropriate tone of voice, or yelling). Dependent Variables for Iris Dependent variables for Iris were of three types: the latency to minor sharing-related problem behavior; the latency to major sharing-related problem behavior; and the frequency of positive sharing behaviors per session. The frequency of positive sharing behaviors per session was used instead of rate because a combination of the variability in session length and the number and timing of sharing opportunities per session resulted in inflated rates of positive sharing per minute for the shortest sessions.  Major sharing-related problem behaviors included the following: 1) Grabbing, defined as Iris aggressively removing a toy from Richelle’s possession; 2) Leaving, defined as Iris physically removing herself from the play area; and 3) Tantruming, defined as Iris making loud whining noises accompanied by thrashing her arms or legs to indicate protest.  Minor sharing-related problem behaviors included refusals to share in the form of: 1) Turning away from Richelle with a toy or a piece of a toy; 2) Attempting to take sole possession of a toy/pieces of a toy (e.g., gathering puzzle pieces into a pile); and 3) Removing a toy piece from where Richelle had placed it (e.g., removing a puzzle piece Richelle had inserted).  45 Latency variables for both minor and major problem behaviors were recorded in seconds from the moment when Iris and Richelle began playing together (when they were both seated within 1 foot of the toy) to the first instance of both minor and/or major sharing- related problem behaviors by Iris. Latency was rounded up to the nearest second. Major problem behaviors resulted in data collection for that session ending immediately, while minor behaviors did not.  Positive sharing behaviors by Iris included the following, in the absence of problem behavior: 1) Allowing Richelle to simultaneously touch a toy with which Iris was playing or allowing Richelle to touch or move a piece of the toy with which Iris had previously played; 2) Allowing Richelle to take a toy with which Iris had previously played or that was within 1 foot of Iris; and 3) Engaging in shared play by allowing Richelle to play with a toy at the same time as Iris (e.g., allowing her to put a magnet on the board). Shared play was coded only when Richelle’s action was clearly seen by Iris (i.e., her back was not to the toy and she was attending to Richelle’s actions). Design A multiple-baseline, multiple-probe design across two different toys for each participant was planned to assess the effects of a video modeling intervention on positive toy sharing behaviors and sharing-related problem behaviors. The planned multiple baseline design was to consist of two phases: baseline and video modeling. Generalization probes also were planned. This experimental design was deemed to be more appropriate than a withdrawal design because it was expected that learning would occur. Video modeling was to  46 be introduced in a staggered fashion as the stability of dependent variables was established in baseline. For Elliot, the design was changed following three sessions of video modeling with the first toy because the data showed trends in the direction opposite that which was planned – that is, sharing related problem behaviors increased and positive sharing behavior decreased. Thus, a return to baseline phase was instituted for three sessions, followed by a video feedback phase for three sessions and a final return to baseline for three sessions. The final return to baseline was instituted to examine the potential of a treatment reversal. Unfortunately, the baseline for the second toy showed evidence of drift in the desired direction during the prolonged intervention period for the first toy, so intervention was not instituted with the second toy. For Iris, the design changed following four sessions of video modeling with the first toy because the data showed no meaningful changes when video modeling sessions were conducted 30-60 minutes prior to the session. Thus, video modeling that occurred immediately before the session was instituted. Unfortunately, video modeling had to be discontinued and the study terminated after four sessions of immediate video modeling (15 total probe sessions) due to multiple treatment interference (see Results section). Procedure Confederate Training Prior to the baseline phase, both of the confederates (Hannah and Richelle) took part in a brief 20 minute training session with the experimenter focusing on how to create sharing opportunities for their sibling with ASD. The experimenter described each type of sharing opportunity and then engaged in role play with both of the target toys for each participant.  47 Training sessions were complete when Hannah and Richelle were able to demonstrate how to create each type of sharing opportunity independently. Hannah was trained to create four different types of opportunities, as described previously: (a) asking for toys, (b) offering toys, (c) touching toys with which Elliot was playing, and (d) taking toys with which Elliot had played previously or that were in close proximity to him. The experimenter prompted Hannah before each probe session by reminding her to initiate all four types of opportunities in each session.  Richelle was trained to create three different types of sharing opportunities for Iris: (a) touching or moving a toy/piece of a toy with which Iris was playing, (b) taking one or more pieces of the toy that were close to Iris, and (c) engaging in shared play by putting a piece in the puzzle or placing a magnet on the magnet board. Prior to the first probe session with Iris and Richelle, the experimenter created flashcards with simple written prompts (i.e., touch, take, play). During the session, the experimenter showed the cards to Richelle and she created appropriate corresponding sharing opportunities. Because Richelle created a sufficient number of each type of opportunity spontaneously during the first session, the cue cards were not used in subsequent sessions. Probe Procedure  Probe sessions were used to assess the frequency or latency of the dependent variables for Elliot and Iris across baseline and intervention phases. Probe sessions occurred in Elliot’s and Iris’s homes 2-3 times per week, depending on their availability. Probe sessions for Elliot averaged 9 minutes in length (range = 5-13 minutes) for both the circus and Egypt toys across all phases. Probe sessions for Iris averaged 30 seconds in length for the puzzle (range = 0-172 seconds) and averaged 47 seconds (range = 2-97 seconds) for the  48 magnet board across all phases. During each probe session, the target toy was placed on the floor of the living room and all other toys were removed from the immediate area in order to facilitate sharing and encourage play with the target toy only. Both dyads were told to “play together” with the target toy. The experimenter provided no prompting or reinforcement to either Elliot or Iris related to sharing behaviors during probe sessions. When the probe session was completed, the experimenter told the children that play time with the current toy had ended and removed the toy from the environment. The experimenter instructed the participants and confederates to engage in a neutralizing activity for 5 minutes (e.g., play a computer game, read a book, watch a video) and then introduced the second toy. The order of toy presentation was counter-balanced across sessions. Probe sessions were video recorded for later scoring. Appendices J and K provides details of the probe session protocols for both Elliot and Iris, respectively. Scoring protocols for probe sessions are found in Appendices L and M for Elliot and Iris, respectively. Baseline: Elliot and Iris  During baseline probes, the participants and their confederates were instructed to play together with the target toys as described previously, with no video-based intervention. Baseline sessions required approximately 25 minutes for Elliot (i.e., two 10 minute toy probe sessions and one 5 minute break) and approximately 7 minutes for Iris (i.e., two toy probe sessions averaging 35 seconds each and one 5 minute break). When a stable baseline was established for a target toy, that toy was moved into the intervention phase.  49 Video Modeling Intervention: Elliot and Iris  During this phase, probe sessions continued to occur 2-3 times per week. Daily video modeling sessions were added during this phase. For Elliot, a video model featuring two unfamiliar adults engaging in appropriate toy sharing (see Appendix H) with the circus toy set was introduced first. For Iris, a video model featuring two unfamiliar adult actors playing with and sharing the puzzle was introduced. Both Elliot and Iris viewed the video model once per day at a time that was convenient for the family. On days when a probe session was scheduled to occur, the videos were viewed 30-60 minutes before the probe session began. On probe days, Elliot and Iris watched the video and were then directed to engage in a neutral activity (i.e., an activity not related to the targeted toys in the study).  All video modeling sessions were supervised by either the experimenter, a parent, or Elliott’s home school teacher, in order to ensure that the participants sat and attended to the video in its entirety. The first viewing of the video model for both children was supervised by the experimenter. For Elliot, the experimenter introduced the video and pointed out one instance of each type of target positive sharing behavior. For Iris, the experimenter introduced the video and Iris was allowed to watch it uninterrupted (Appendices N and O contain the scripts for the first video viewing sessions for Elliot and Iris, respectively). After the introductory session, Elliot and Iris were simply instructed that it was time to watch the video and no further instruction or explanation was provided (see Appendices P and Q for the video viewing protocols for Elliot and Iris, respectively). The individual supervising video viewing did not discuss the videos with Elliot or Iris before, during, or after the viewing. After each video viewing, the individual who supervised the viewing completed a video viewing data sheet (Appendix R).  50 Alternate Procedures for Elliot Data for Elliot across the first 3 sessions of video modeling showed deterioration in positive sharing behavior and an increase in sharing-related problem behavior. Because both were in the opposite direction than was desired, a decision was made to employ a video feedback procedure with Elliot instead. Return to baseline. A baseline was re-established by discontinuing video modeling and re-instituting baseline procedures as described previously, which resulted in a baseline with trends in the desired direction within 3 sessions. Video feedback. Following the return to baseline, a video feedback intervention was instituted for 3 sessions, implemented by the experimenter. During these sessions, Elliot viewed a video of himself and Hannah engaging in previous sharing probe sessions. Before viewing each video, Elliot was provided with a sheet of paper that was divided into sections labeled “good sharing” and “bad sharing.” Elliot was instructed to choose comic book hero stickers to earn for episodes of good sharing and was told that he would receive stickers with a red X on them for episodes of bad sharing. During the first video feedback session, the experimenter played the videotape of a previous sharing probe session and, when a sharing opportunity and response by Elliot occurred, paused the videotape and identified the interaction as either “good sharing” or “bad sharing” until two examples of each had been labeled. After the first session, Elliot began to label the type of sharing response spontaneously and accurately when the videotape was paused. When a sharing response was labeled correctly, Elliot was provided with a corresponding sticker, which he placed on the appropriate side of his “good sharing/bad sharing” sheet. Correct identifications of both good and bad sharing were also followed by praise. When an instance of bad sharing was  51 identified, Elliot was asked “What could you do to make that into good sharing?” If Elliot provided an appropriate answer, he was praised; if he was unable to generate a correct response independently, he was presented with a forced choice (e.g., “Should you give her the lion or should you ignore her?”). No feedback was provided regarding any other aspects of play. When the video feedback session was complete, Elliot was directed to a neutralizing activity for 30 minutes and then he and Hannah played with the toy according to the general probe procedures outlined previously. Return to baseline. Following video feedback with the circus toy, the intervention was withdrawn in order to assess the potential for a reversal of the trends achieved during video feedback. The return to baseline occurred over a span of 22 days. Generalization. Generalization probes were completed for Elliot after the data stabilized for both positive sharing and sharing-related problem behavior during the video feedback intervention. A total of three generalization probes were completed. Generalization probes followed the same general probe procedures as described previously. The toys used for generalization probes were mutually agreed upon by Elliot and Hannah. The first generalization probe used a PlayMobil® castle set with corresponding figurines (e.g., horses, knights, swords), the second used a Diva Princess make up set (Markwins International), and the final was completed with four stuffed animals from Elliot’s stuffed animal collection. The average length of generalization sessions was 6 minutes (range = 4-8 minutes). Alternate Procedure for Iris As described previously, Iris viewed the video modeling tape daily during the first intervention phase; on probe days, these viewings occurred 30-60 minutes before probe sessions commenced. Thus, by the fourth probe session (session 9), she had viewed the video  52 models a total of 8 times (4 on probe days and 4 on non-probe days). The data indicated a decreasing trend in the latency to major and minor sharing-related problem behavior as well as a decreasing trend in the frequency of positive sharing behaviors over these four sessions. Because of this deterioration in sharing behavior, a decision was made to continue daily video modeling viewing, but to have Iris view the model immediately before the probe sessions, rather than 30-60 minutes prior. This commenced on session 10. Data Collection Training  The experimenter trained a research assistant (RA) to record occurrences of all target behaviors to a minimum of 85% accuracy for both Elliot and Iris. The RA was provided with operational definitions of each dependent variable and was trained in a 2-hour session, during which the operational definitions were reviewed and the RA and experimenter viewed two example videotapes for each child (one for each toy). While watching the videos, examples and non-examples of each type of positive sharing behavior and sharing-related problem behavior were highlighted. For Iris, instruction also was provided about how to measure latency to occurrences of minor or major problem behavior.  Elliot’s mother and Iris’s father were trained by the experimenter to implement the video modeling intervention. The parents were provided with a copy of the video viewing protocol detailing the procedures to follow (see Appendices P and Q). The experimenter reviewed the protocol with them and answered any questions. Inter-observer Agreement (IOA)  The experimenter coded data from all probe sessions from the videotapes onto appropriate data sheets (Appendices Q and R). The RA independently coded 30% and 38%  53 of probe sessions for Elliot and Iris, respectively. Sessions coded by the RA were selected at random across all phases for both participants. For frequency variables, an agreement was scored when both the experimenter and the RA coded the same occurrence of a dependent variable; disagreements occurred when one observer recorded an occurrence when the other observer did not (Cooper, Heron, & Heward, 2007). IOA was calculated by dividing the total number of agreements by the number of agreements and disagreements, multiplied by 100. For Iris, the latency to minor and/or major sharing-related problem behavior was also examined, and an agreement was counted if the latency timed by the researcher was within ±1 second of that timed by the RA. Latency agreement was calculated by dividing number of agreements by the number of agreements and disagreements, multiplied by 100 (Cooper et al., 2007). IOA for Elliot’s data is summarized in Table 1. Overall, IOA averaged 92% for all dependent variables (range = 33%-100%) across toys. Disagreements were resolved by consensus.  54  Table 1 Inter-observer agreement across dependent variables for Elliot  Circus toy Egypt toy Variable Mean % Range (%) Mean % Range (%) Grabbing 89 67-100 100 Asking 78 33-100 100  Appropriate response to request 78 33-100 100  Request refusal 100  100 Offering 100  100 Accepting or declining an offer 100  100 Offer refusal 100  100 Initiating co-manipulation 100  75 50-100  Allowing co-manipulation 100  75 50-100  Refusing to allow co-manipulation 100  100 Taking 72 62-80 75  Allowing to take 72 62-80 75  Refusal to allow to take 100  100  IOA for Iris’s data is summarized in Table 2. Overall, IOA for both latency variables was 100% and IOA all dependent variables averaged 90% (range = 0-100%) across toys. Disagreements were resolved by consensus.  55 Table 2 Inter-observer agreement across dependent variables for Iris  Puzzle Magnet board Variable Mean % Range (%) Mean % Range ((%) Latency to minor problem behaviour 100  100 Latency to major problem behaviour 100  100 Allow move/touch 67 0-100 100 Allow take 89 67-100 100 Allow shared play 100  84 50-100 Treatment Fidelity The experimenter completed a probe session protocol checklist (Appendix J) to provide a measure of fidelity for 59% of Elliot’s probe sessions. The experimenter also attended 15% of Iris’s video viewing sessions and independently coded the accuracy of implementation by her parents, using the video viewing protocol (Appendix Q). Treatment fidelity was calculated by dividing the total number of steps completed accurately by the total number of accurate plus inaccurate/missed steps and multiplying by 100. Treatment fidelity for Elliot averaged 95% (range = 85-100%). Fidelity for Iris averaged 98% (range = 91- 100%). No inter-observer agreement was measured for either participant’s fidelity measures. Data Analysis  Visual analysis of the data was employed in order to assess the impact of the intervention. For Elliot, changes in the percentage of opportunities resulting in positive sharing and sharing-related problem behaviors were examined based on the level, trend, and variability in the data. For Iris, the same was done while also examining the latency to minor  56 and major problem behavior and the frequency per session of sharing-related problem behavior.  57 CHAPTER 3 Results  The goals of this study were to determine whether the use of video-based interventions with children with ASD would result in 1) increases in positive toy sharing behaviors, 2) decreases in sharing-related problem behaviors, and 3) generalization of the above to non-targeted toys. The data were analyzed using graphs for each participant, with two toys each. As a result of modifications to the original research design, experimental control was not established for either participant. However, the interventions were associated with improvements in child behavior on one toy for both Elliot and Iris. Elliot Results for Elliot are displayed in Figure 1. Visual analysis of the data indicated that video modeling was not successful in increasing positive sharing behaviors and decreasing sharing-related problem behaviors for the circus play set; in fact, the opposite occurred for both types of behaviors. Following a successful return to baseline, video feedback was introduced and immediate changes in the desired direction were seen: positive sharing behavior increased and sharing-related problem behavior decreased. A return to the baseline condition failed to result in a reversal of these improvements; in fact, the trends established after the introduction of video feedback generalized successfully to three new toys. Unfortunately, a video-based intervention was only applied to a single toy after the second toy (an Egypt play set) showed drift in the desired direction during the prolonged baseline for the first toy. A phase-by-phase analysis of the data is provided in the sections that follow.  58   KEY: VM = Video Modeling; VF = Video Feedback  Figure 1. Results of video-based interventions for Elliot  59  Circus Toy: Baseline 1 During the initial baseline for the circus toy set, there was a slight decreasing trend in the percentage of sharing opportunities that resulted in positive sharing behavior and a slight increasing trend in those that resulted in sharing-related problem behavior. Both trends, which were opposite to the desired direction, were evidenced across four baseline sessions spanning 10 days. Egypt Toy: Baseline 1 During the extended baseline phase (which spanned a total of 43 days), the data representing both the percentage of opportunities resulting in positive sharing behavior and sharing-related problem behavior were variable, with an overall increasing trend for the former and an overall decreasing trend for the latter. Because the data stabilized at 100% of opportunities resulting in positive sharing behavior and no sharing-related problem behavior during sessions 10 and 12, the video modeling intervention was not initiated for this toy. Circus Toy: Video Modeling The video modeling probe sessions occurred over a span of 8 days, during which Elliot viewed the video modeling tapes 7 times. In the first session after the introduction of video modeling (session 5), the percentage of opportunities that resulted in positive sharing behaviors jumped to 100% and sharing related problem behavior did not occur. However, in the two subsequent sessions (sessions 6 and 7), there was a decreasing trend in positive sharing behavior and an increasing trend in sharing-related problem behavior. These trends were opposite to the anticipated results. 60  Circus Toy: Baseline 2 The second baseline phase took place over 7 days with the circus toy set. When this phase was initiated (session 8), the data for positive sharing behaviors continued to show a decreasing trend, dropping as low as 43% of sharing opportunities (session 10). The percentage of opportunities that resulted in sharing-related problem behavior also continued to display an increasing trend after re-instatement of baseline, rising to a high of 71% of sharing opportunities (session 10). Circus Toy: Video Feedback With the initiation of video feedback (session 11), the percentage of sharing opportunities that resulted in positive sharing by Elliot reached 100% and remained stable at this level across all three sessions. Sharing-related problem behavior did not occur in any of the sessions. The first two video feedback sessions occurred within 5 calendar days. After session 12, Elliot’s family began their Christmas vacation. The third video feedback session (session 13) occurred 30 days later, once the family returned. Circus Toy: Baseline 3 A third baseline phase was introduced to assess the potential for a reversal of improvements seen during the video feedback treatment, following session 13. The first withdrawal probe occurred 14 days later (session 14). For the entire 22 days of this phase, the percentage of opportunities resulting in sharing-related problem behavior remained at low levels and opportunities resulting in positive sharing behavior remained at high levels. 61  Generalization Following the video feedback phase for the circus toy, generalization probes that occurred over a span of 21 days with three different toys resulted in 100% of positive sharing behaviors and no instances of sharing-related problem behavior. Social Validity  Elliot’s mother was asked to complete a social validity questionnaire (Appendix S) after the study was completed. The questionnaire included questions related to the acceptability of the intervention procedures and the social validity of the outcomes. Elliot’s mother agreed that sharing was an important skill for her son to learn, that she understood the procedures used and that they were appropriate, as well as that her son had a meaningful decrease in sharing-related problem behavior. She somewhat agreed that Elliot displayed a meaningful increase in his positive sharing behavior. Elliot’s mother also indicated that the intervention was not disruptive to the family’s routines. Iris Results for Iris are displayed in Figures 2 and 3. Visual analysis of the data for both latency to problem behavior (Figure 2) and the frequency of positive sharing behaviors (Figure 3) indicated that, when the video model (VM) was viewed 30-60 minutes prior to probe sessions, there was no change in the dependent variables. However, when an alternative video modeling (AVM) procedure was introduced such that the video model was viewed immediately prior to probe sessions, improvements were seen in both the latency to major sharing-related problem behavior and the frequency of positive sharing behavior. Unfortunately, these results were not stable or enduring, and the intervention was only 62  applied to a single toy due to multiple treatment interference. A phase-by-phase analysis of the data is provided in the sections that follow.  KEY: VM = video modeling procedure; AVM = alternative video modeling procedure  Figure 2. Latency (in seconds) to major and minor sharing-related problem behavior for puzzle and magnet board toys for Iris  63   Figure 3. Frequency of positive sharing behaviors for puzzle and magnet board toys for Iris Puzzle: Baseline During four baseline probe sessions with the puzzle, the data indicated a low, stable latency to instances of minor problem behavior and a decreasing trend in the latency to major problem behavior (Fig. 2). Iris also engaged in very low levels of positive sharing behaviors (Fig. 3). Puzzle: Video Modeling Daily video modeling was introduced for a total of 8 consecutive days. Iris viewed the video model 30-60 minutes prior to four probe sessions that occurred during this time. 64  However, no meaningful improvement was evident in either the latency to major or minor sharing-related problem behavior or in positive sharing behaviors. Puzzle: Alternative Video Modeling Beginning with session 10, an alternative procedure was instituted whereby Iris continued to view the video model daily, but did so immediately prior to probe sessions rather than 30-60 minutes prior. An immediate increasing trend was seen in the latency to major sharing-related problem behavior and the frequency of positive sharing behavior across the first two sessions (session 10 and 11), although there was no meaningful change in the latency to minor sharing-related problem behavior. Unfortunately, following session 11, Iris’s parents secured the advice of a professional who was not involved in the study, and who advised them to initiate an intervention that interfered with the potential effectiveness of the video modeling procedure. Specifically, they were advised to provide Iris with deep pressure massage and hugs if she became distressed or agitated while she was engaged in non-preferred activities or when she refused to engage in an activity. They instituted this intervention for 3 days between sessions 11 and 12. Sessions 12 and 13 both showed a sudden and immediate decrease in both the latency to major sharing-related problem behavior and the frequency of positive sharing behaviors. This was followed by Iris’s refusal to participate in either the puzzle activity or the magnet board activity across two additional probe sessions (sessions 14 and 15, spaced 3 and 7 days after session 13), accompanied by signs of protest. Because of this, following consultation with Iris’s parents, a decision was made to terminate their participation in the study. 65  Magnet Board: Baseline During the first seven baseline probe sessions for this toy, the latency to major sharing related-problem behaviors (Fig.2) and frequency of positive sharing behaviors (Fig.3) were both highly variable, ending with a decreasing trend for both before study participation was discontinued. Iris displayed stable, low levels of latency to minor sharing-related problem behavior during this time. During the last two baseline probe sessions (sessions 14 and 15), as noted previously, Iris refused to participate in the activity, and study participation was terminated. 66  CHAPTER 4 Discussion A significant amount of previous research indicates that video modeling is an evidence-based intervention that is effective at teaching a range of skills to individuals with ASD (Bellini & Akullian, 2007). A second type of video-based intervention, video feedback, has also shown some promise in this regard (e.g., Embregts, 2000; Lasater & Brady, 1995). This study contributes to previous research on the use of video-based interventions to teach social and play skills. During the first baseline phase, Elliot engaged in some sharing related problem behavior and also displayed the ability to engage in positive sharing. The introduction of video modeling was not successful in increasing positive sharing and decreasing sharing-related problem behaviors; in fact, trends opposite to the desired directions were seen. The introduction of a second baseline phase saw positive sharing behaviors continue to deteriorate and problem behaviors increase. Following this baseline, video feedback was instituted and showed evidence suggestive of a basic effect, as reflected in an immediate change in the level of both types of dependent variables. A final return to baseline was implemented in an attempt to achieve a reversal of the results of the video feedback intervention. However, the results of video feedback were not reversible over several weeks. Generalization to three non-targeted toys was also observed during this time. Iris engaged in very few positive sharing behaviors and was able to engage in shared toy play for only short periods of time during baseline. After introducing a video modeling intervention 30-60 minutes prior to her expected engagement with a toy, no meaningful changes in either positive sharing behavior or the amount of time Iris engaged in toy play before engaging in problem behavior were seen. However, when Iris viewed the video model 67  immediately before she was expected to engage in shared toy play, there was an immediate increase in both the frequency of positive sharing behavior and the latency to major sharing related problem behavior. Unfortunately, multiple treatment interference following two sessions of immediate video modeling resulted in the inability to continue Iris’s participation in the study and to evaluate the impact of the intervention. Elliot  Elliot’s results will be discussed with regard to the following issues: problem behavior at baseline, general play behaviors, why the video modeling intervention was not successful, and the success of the video feedback intervention. Problem Behavior at Baseline Pre-study observations revealed that Elliot engaged in spontaneous sharing behavior during the majority of opportunities to share and that he would only occasionally display sharing-related problem behavior. However, the intensity of the problem behaviors that Elliot did display were a serious enough concern for his mother that she was eager to enroll him in the study. Her concerns centered largely on his inability to share in an age-appropriate manner with his sister and with peers. Baseline data for the circus toy supported the pre- observations, in that Elliot engaged in a low rate of sharing-related problem behavior as well as a relatively high rate of positive sharing behaviors. In retrospect, it would have been useful to measure the intensity of problem behavior in addition to the rate, since it was intensity that was the primary concern for Elliot’s mother.  Compared with the circus play set, the Egypt set began with higher levels of problem behavior and lower levels of sharing-related problem behavior. However, across subsequent baseline sessions the Egypt toy set showed evidence of drift in the desired direction. This 68  appeared to be related, in some way, to Elliot and Hannah’s preference for the Egypt toy. Instances of increased sharing-related problem behavior during sessions 4, 8, and 9 of the Egypt toy’s baseline corresponded to sessions when Hannah engaged in elevated levels of problem behavior herself (i.e., refusing to allow Elliot to play with certain parts of the toy set, screaming “no”), thereby provoking more sharing-related problem behavior by Elliot. Upon consideration, it would have been useful to directly compare the sharing-related behavior of both siblings, since there appeared to be an interaction between the two. General Play Behaviors After beginning the study and analyzing data from the toy probe sessions, it became clear that both Elliot (and his sister Hannah) engaged in some problem behavior related to a lack of cooperative play skills in general, as well as problem behaviors that were specifically related to sharing. Neither of these issues were evident during the pre-study observations, nor were they identified as problematic by the children’s mother. Because the purpose of the study was to examine sharing-related problem behavior only, no interventions to address either general play difficulties (e.g., negotiating a play theme, playing together versus separately) or non-sharing-related problem behaviors were instituted. Hence, behaviors related to issues other than sharing are not reflected in the data. Ineffectiveness of Video Modeling It was anticipated that the video modeling intervention would increase the percentage of sharing opportunities that resulted in positive sharing behavior and would reduce sharing- related problem behavior. Interestingly, the video modeling intervention quickly became associated with increased sharing-related problem behaviors that were above baseline levels and decreased positive sharing behaviors that were below those seen in baseline. These 69  trends were accompanied by actions and statements from Elliot suggesting that the video modeling tapes were not sufficiently interesting or developmentally appropriate for him. For example, during his first viewing of the circus videotape, Elliot engaged in a number of verbal and nonverbal behaviors that appeared to indicate boredom (e.g., “This is boring”; pretending to yawn). During the second video modeling probe session, both Elliot and Hannah (who had joined Elliot in viewing the videos) agreed to play “like the movie.” This was accompanied by both children laughing while engaging in exaggerated examples of play from the video modeling tapes and making mocking statements such as, “We’re sorry, this is going to be funny” or “It’s just so stupid.” Previously, video modeling has been implemented successfully with individuals with autism from age 3 to 20 (Bellini & Akullian, 2007) and has been used to teach play-related skills to children aged 3 to 15. Thus, it does not seem likely that Elliot’s age alone influenced the effectiveness of the video modeling intervention. However, previous video modeling research focusing on play skills featured participants who, although similar in age to Elliot, were significantly more affected by ASD with regard to language and communication skills, intellectual functioning, existing play and social skills, and problem behavior (Charlop- Christy et al., 2000; MacDonald et al., 2005; Nikopoulous & Keenan, 2003). Therefore, it is likely that some combination of Elliot’s age and relatively high ability contributed to the video modeling intervention being associated with trends in the direction opposite to that desired. In addition, baseline probe sessions with the circus toy revealed that Hannah and Elliot’s play often took the form of each of the siblings playing with different parts of the circus toy separately and playing together only occasionally. Discussions with Elliot’s 70  mother confirmed that this type of parallel play was common with most of the toys with which the siblings engaged. Combined with a lack of cooperative play skills when the siblings did play together, this pattern of parallel play may have contributed to Elliot’s and Hannah’s comments that the video modeling tapes were “funny” or “stupid,” because they featured two actors who played together extensively in a very cooperative manner. In hindsight, it would have been more appropriate to create videotapes that featured actors engaging in play that was more similar to the way Elliot and Hannah typically played and coming together to engage in sharing interactions. A final factor related to the failure of video modeling for Elliot has to do with the nature of sharing behavior in contrast to the behaviors taught in previous studies targeting play skills. Elliot was presented with opportunities during play that required him to either give up a toy or to engage with it simultaneously with his sister. On the other hand, with the exception of the sharing study by Simpson et al. (2004), previous video modeling play studies taught participants to either play with toys by themselves or to play with an adult experimenter with whom they were not expected to share toys or activities (D’Ateno et al., 2003; MacDonald et al., 2005; Nikopoulos & Keenan, 2003, 2004). In these studies, researchers successfully taught play skills through video modeling alone, with no additional intervention elements or external reinforcement provided. It is likely that the behaviors taught via video modeling in these studies acted as behavioral cusps (Rosales-Ruiz & Baer, 1997) by creating access to new reinforcers, or as behavioral traps (Baer & Wolf, 1970) by creating self-perpetuating reinforcement within the activities. In Elliot’s case, it appeared that he was not being “trapped” by either automatic or naturally-occurring positive reinforcement from Hannah as a result of engaging in positive sharing. 71  Video Feedback  It was clear that the video feedback intervention had a clear, immediate association with increases in Elliot’s positive sharing and decreases sharing-related problem behavior. There are a number of elements that likely contributed to these results. The first of these is that Elliot was provided with opportunities to earn external positive reinforcement during video feedback. This took the form of earning both comic book hero stickers for examples of good sharing, and social reinforcement from the experimenter for correctly identifying his behavior as either good or bad sharing. Elliot was quite motivated to earn the stickers and praise and, as such, was much more engaged in the video feedback sessions than he had been during the video modeling sessions. Previous research has also documented the positive effect of explicit reinforcement for sharing (Rogers-Warren & Baer, 1976). A second element of the video feedback intervention that may have contributed to its association with positive behavior changes was the highlighting of specific instances of good and bad sharing during each video feedback session. This is in contrast to the video modeling sessions, in which instances of positive sharing were pointed out only during the first video viewing and in which no instances of sharing-related problem behavior were featured. After the first video feedback session, Elliot was able to identify both positive- and negative- sharing behaviors spontaneously and accurately, indicating that he learned to evaluate his own behaviors in this regard. Additionally, Elliot made statements that conveyed his embarrassment when instances of sharing-related problem behavior were pointed out. Thus, highlighting may have functioned as a mild form of punishment for Elliot.  A third consideration is that the video feedback intervention may have been more developmentally appropriate than the video modeling intervention (as discussed previously). 72  The only study to date that has incorporated video feedback related to verbal behavior during play featured a child 3 years younger than Elliot (Maione & Mirenda, 2006). While previous video modeling research focused on play skills has been successful with younger individuals who were more significantly affected by ASD than Elliot, video feedback interventions have been used most extensively with individuals closer to Elliot’s age or older who were more similar to him in terms of developmental level (e.g., Embregts, 2000, 2003; Thiemann & Goldstein, 2001). Thus, the limited research on video feedback suggests that it may be more appropriate than video modeling for individuals with ASD and relatively intact cognitive, language, and problem-solving skills such as Elliot.  One of the most striking findings of the current study was the sustainability of video feedback for Elliot. Not only did this intervention have an immediate association with positive changes in behavior, these changes were maintained over an extended time period. While the first two video feedback sessions occurred in close temporal proximity, the third and final session (session 13) – which was more like a “booster” session after a significant break from previous exposures – took place 30 days later, following a Christmas break. These three sessions of video feedback were followed by 14 days of no intervention during the withdrawal phase, with evidence of no meaningful change over 3 probe sessions that spanned an additional 8 days. Although there was a slight change in both dependent variables during the final session, this was the result of a single instance of Elliot failing to respond to an offer presented by Hannah, a relatively minor sharing-related problem behavior. Thus, the time period from the second video feedback session (session 12) to the end of the withdrawal phase (session 17) was 52 days, during which Elliot received only one exposure to video feedback in session 13. 73  A final positive outcome was that evidence of generalization was found 2 weeks after the final video feedback session, across three different toys. In hindsight, probes with the generalization toys prior to the introduction of the intervention would have increased confidence in this outcome. Nonetheless, it appears that improvements following video feedback were maintained over several weeks and carried over to a variety of toys and activities for Elliot. Iris  Iris’s results will be discussed with respect to the following issues: the differences in dependent variables between participants, baseline variability for one toy, the timing of video modeling, and the presence of multiple treatment interference. Measurement of Dependent Variables  At the outset of the study, it was anticipated that the same dependent variables that were measured for Elliot would also be measured for Iris. However, it became clear very quickly that these dependent variables were not suitable for Iris for several reasons. First, they did not adequately reflect the types of sharing-related problem behaviors in which Iris engaged, the most important of which was Iris’s leaving the play area and refusing to return. This problem behavior was responsible for ending the majority of probe sessions for both toys. Second, the types of sharing opportunities that Richelle presented to Iris varied considerably from those that Hannah presented Elliot, largely due to differences in the toys themselves. While dependent variables that focused on the social and verbal aspects of toy sharing (e.g., responding to requests and offers) were important for Elliot, it was developmentally inappropriate to expect the same of Iris, who was nonverbal. The types of sharing that were most important for Iris were related to allowing her sister to play in a 74  parallel fashion with the same toy. Unfortunately, the need to accommodate individual differences with changes in the dependent variables limit the comparisons that could be made across participants. Baseline Variability  While Iris’s baseline for the puzzle toy displayed a stable, decreasing trend with regard to both the latency to problem behavior and the frequency of positive sharing behaviors, the baseline for magnet board showed more variability. The first factor that contributed to this was that Iris displayed much more rigidity with regard to the order in which the puzzle pieces were inserted as well as much more difficulty allowing others to touch pieces of the puzzle. This resulted in a low threshold for engagement in sharing situations and fewer chances for Richelle to create sharing opportunities during the puzzle toy. In contrast, Iris showed less rigidity around the magnet board and there were more magnets with which the sisters could play. In combination, this meant that Richelle was able to create more sharing opportunities with the magnet board and Iris displayed a higher threshold for sharing engagement with this toy. Video Modeling  When video modeling for the puzzle toy was introduced, Iris watched the videotape once per day. On days when a sharing probe was scheduled, Iris viewed the videotape 30-60 minutes before the session began. However, this did not result in any meaningful increase in the latency to problem behavior or in the frequency of positive sharing behavior. Iris’s mother reported that, when video modeling had been used effectively with Iris in the past, she had been shown the videotapes immediately before she was expected to display the target 75  skill. Thus, a decision was made to have Iris view the video modeling tape immediately before sharing probe sessions rather than 30-60 minutes before.  In previous video modeling research related to play skills, the time between video modeling viewing and probe sessions has varied widely. Some studies stipulated a delay of 30-60 minutes (D’Ateno et al., 2003; Maione & Mirenda, 2006), others had no delay (MacDonald et al., 2005), and still others were unclear about this issue (Charlop-Christy et al., 2000; Nikopoulos & Keenan 2003, 2004). Success in previous studies was achieved with both immediate and delayed viewing. In the present study, immediate video model viewing was associated with immediate and substantial changes in both latency to major problem behavior and frequency of positive sharing behaviors. These results are the first to suggest that, for some children, it may be necessary to view the video immediately prior to the expected demonstration of the target skills.  In the second session after Iris began viewing the video modeling tape immediately prior to the sharing probes (session 11), data collection ended after approximately 3 minutes of play. This occurred because Iris displayed a major sharing-related problem behavior in the form of a tantrum (i.e., loud whining noises accompanied by thrashing her arms and legs). However, Iris was able to quickly recover from this tantrum and she and Richelle then engaged in shared play with the puzzle for 9 minutes until the puzzle was completed. Because the research protocol required that data collection be terminated if a major problem behavior occurred, this improvement in Iris’s sharing behavior was not reflected in the data. However, this anecdote serves as an additional demonstration of positive changes in Iris’s sharing behaviors after introduction of the alternative video modeling intervention. 76  Multiple Treatment Interference  After the substantial gains that were seen in both Iris’s latency to problem behavior and her frequency of positive sharing behaviors across sessions 10-11, an immediate and dramatic decrease in both of these areas was seen in session 12. This was the result of Iris’s parents securing and implementing the advice of a professional who was not associated with the current study. This professional, who worked within a sensory integration treatment model (see Dawson & Watling, 2000), suggested that they provide Iris with massage and/or hugs when she showed signs of protest or agitation while engaged in a non-preferred activity or when she refused to engage in an activity, toward the goal of calming her. During session 12, which occurred after they had implemented this advice for 3 days, Iris left the toy play area within 6 seconds of beginning play with her sister, ran to her mother, and laid down on her back with her feet elevated to receive a massage. Her mother paired the massage with verbal attention and soothing verbal statements. These behaviors by both Iris and her mother continued for all sessions until the study was terminated. It is useful to examine Iris’s leaving behavior from an applied behavior analytic perspective. Throughout the study, leaving the play area resulted in termination of a probe session and thus allowed Iris to escape the supposed aversiveness of a sharing opportunity. Thus, escape may have maintained Iris’s leaving behavior during probe sessions prior to the introduction of the alternative video modeling (AVM) procedure. However, the AVM procedure appeared to be associated with mitigating the reinforcing effect of leaving the play situation, as evidenced by the abrupt change in Iris’s behavior during the first two sessions in this phase. Subsequently, it appeared that Iris’s leaving behavior was reinforced by both massage and by attention from her mother, which was known to be a powerful reinforcer for 77  her. It appears that, while leaving might have been an escape-motivated behavior initially, it changed to an attention- and tangible-motivated behavior once massage and attention were available. The functional properties of massage and hugs were more relevant to the pattern of behavior that Iris displayed than was the “calming” effect that was the intended goal. Previous research on the impact of sensory integration therapy (SIT) on problem behavior in individuals with ASD and other developmental disabilities has primarily focused on self-injurious behavior (SIB), and the findings have been mixed. Sandler and McLain (2007) found that SIT was effective at reducing SIB in a child with mental retardation and cerebral palsy that was maintained by non-social reinforcement, although no comparison was made with other types of interventions. However, in one of the first studies to examine the relative impact of SIT and a behavioral intervention, Mason and Iwata (1990) reported that noncontingent access to SIT had either a detrimental impact or no impact on SIB, regardless of the function of the SIB (i.e., escape, attention, or automatic reinforcement). These authors were also able to show that behavioral interventions introduced subsequent to SIT were effective in decreasing participants’ SIB. More recently, Devlin, Leader, and Healy (2009) again found that SIT delivered at fixed intervals and contingent on SIB was less effective than a behavioral intervention in reducing escape-maintained SIB. Thus, previous research supports the contention that the availability of contingent, SIT-based activities to Iris (i.e., massage and hugs) acted as reinforcers for her leaving behavior and, in fact, strengthened it to the point that she was unwilling to participate in the study activities at all. Clinical Implications  When clinicians use video-based interventions in their applied work with individuals with ASD who demonstrate sharing-related problem behavior and lack appropriate positive 78  sharing behaviors, there are a number of important considerations. The first is the selection of appropriate confederates. Both confederates in the current study were able to create a number of different sharing opportunities independently following initial instruction, with only brief reminders prior to each probe session. Confederates selected in applied settings will need to be at least as skilled in creating sharing opportunities so that the individual who is learning to share has sufficient opportunities to practice. Selected confederates should themselves be skilled at sharing if they are going to help facilitate the learning of another individual, since they provide a form of in vivo modeling. If they are not able to engage in appropriate sharing behavior themselves, there is the potential for the target individual to model the confederate’s inappropriate behaviors rather than those that are desired.  Another important consideration when trying to teach sharing behaviors in applied contexts pertains to stimulus control and the availability of reinforcement. Stimulus control occurs when a specific antecedent event elicits a behavior that is more reliably reinforced than not (Cooper et al., 2007). In the context of sharing, stimulus control develops when an opportunity to engage in sharing is reliably followed by a reinforcing event. However, sharing by its very nature often involves giving up something without getting anything in return. Thus, in clinical practice, it may be necessary to provide some type of external reinforcement when an individual engages in successful sharing behavior. In the current study, Elliot did not receive any external reinforcement for engaging in sharing behavior while engaged in play with Hannah during the video modeling phase. However, the video feedback sessions did provide Elliot with external reinforcement for engaging in positive sharing, in the form of earning stickers for previously displayed behaviors. This might account, at least in part, for the relative success of video feedback over video modeling for 79  Elliot. Explicit in vivo reinforcement may be necessary for other children who are learning to share as well. Contributions to the Existing Literature  The current study makes a number of important contributions to the existing literature on video-based interventions and their use with individuals with ASD. This study is only the second to examine the use of video-based interventions to affect sharing behaviors. Simpson et al. (2004) used computer-embedded video models to teach sharing of art materials by four children with ASD who already displayed some sharing behaviors. This makes the current study the first to attempt to use video modeling to teach toy sharing specifically and to examine the impact of this type of intervention not only on positive sharing, but also on sharing-related problem behavior.  For Iris, the temporal relationship between video model viewing and the expected demonstration of the behavior was manipulated in an attempt to achieve the desired treatment outcomes. This was the first attempt to examine this issue empirically and the results, while incomplete, suggest that this temporal relationship may be an important consideration, at least for some individuals. In previous research, positive effects were seen regardless of the temporal relationship (e.g., D’Ateno et al., 2003) or occurred after modifications that were unrelated to the timing of video model viewing were implemented (e.g., Maione & Mirenda, 2006).  This study also provides the first emerging evidence that video feedback interventions may be effectively applied to teach positive sharing behaviors and reduce sharing-related problem behaviors. Previous research on the impact of video feedback interventions has 80  examined only social communicative behaviors (Embregts, 2000; Maione & Mirenda, 2006) and daily living skills (Lasater & Brady, 1995). Limitations and Implications for Future Research  The primary limitation of this study is that it did not demonstrate a functional relationship (i.e., experimental control) between video-based interventions and sharing behavior. Demonstration of experimental control requires a minimum of three demonstrations of the experimental effect at three different points in time across different participants (Horner et al., 2005). Unfortunately, for both participants, only two toys were identified as reliably resulting in sharing-related problem behavior, and attempts to recruit a third participant were unsuccessful. In addition, a reversal of the basic effect of video feedback for the circus toy was not attained for Elliot, and his second toy showed evidence of baseline drift in the desired direction. For Iris, a treatment not associated with the study interfered with the potential success of the video modeling intervention and resulted in her refusal to engage with any of the toys selected for intervention and termination of her participation in the study.  Another limitation is that it was not possible to standardize the number or type of sharing opportunities that the confederates (Hannah and Richelle) presented to the participants. This variability was addressed by converting Elliot’s data to the percentage of opportunities that resulted in either positive sharing or sharing related problem behavior. However, the types of sharing opportunities that Hannah presented were not controlled and thus fluctuated across sessions. For Iris, the frequency of positive sharing behavior per session was recorded but, as was the case for Elliot, the number, timing, and type of opportunities presented were not controlled across sessions. Subsequent research should 81  examine the types of sharing opportunities that are more and less likely to result in problem behavior for a specific child, prior to intervention. For example, for some children, problem behavior may be more likely after a request for a toy is issued; while for others, problem behavior may occur more often when a toy is offered.  The present study raises a number of questions for future research. The first of these is to examine the relative effectiveness of video modeling in individuals with ASD across a range of ability levels. In Elliot’s case, it appeared that video modeling was not an appropriate method of teaching play skills based on his ability level. Alternatively, there is some suggestion that video modeling immediately prior to a target activity might have been an appropriate match based on Iris’s abilities. In addition, the results for Iris suggest that the temporal relationship between viewing a video modeling example and demonstrating the skill may be important for some individuals. Future research should examine the relative effectiveness of immediate versus delayed modeling across a variety of activities and participants, and the extent to which a delay can be lengthened once a skill is established in an individual’s repertoire. Conclusion  Despite its limitations, the present study makes a number of contributions to the existing literature relating to video-based interventions for individuals with ASD. The results suggest that video feedback can be used to teach play skills such as sharing, with improvements that are maintained over several weeks, generalize to novel materials, and are considered to be socially valid. 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Fostering communication and shared play between mainstream peers and children with autism: approaches, outcomes and experiences. British Journal of Special Education, 31, 215-222. 96  Williams, E., Costall, A., & Reddy, V. (1999). Children with autism experience problems with both objects and people. Journal of Autism and Developmental Disorders, 29, 367-378. Williams, E., Reddy, V., & Costall, A. (2001). Taking a closer look at functional play in children with autism. Journal of Autism and Developmental Disorders, 31, 67-77. 97  APPENDICES Appendix A: Behavioral Research Ethics Board Certificate   98  Appendix B: Research Ethics Board Certificate – Amendment  99  Appendix C: Participant Initial Letter of Contact  OPPORTUNITY TO PARTICIPATE IN A RESEARCH PROJECT TO TEACH SHARING BEHAVIORS TO CHILDREN WITH AUTISM!!!!!  My name is Landa Mark and I am a graduate student at the University of British Columbia. I have worked in ABA programs with children with autism for 4 years, and I have noticed that many children have difficulty in play situations where they are expected or asked to share toys and other favorite items with other children. For my graduate thesis, I will be conducting a study to determine the effectiveness of a video modeling intervention for increasing sharing behaviors in children with autism spectrum disorders with their siblings or peers. The intervention is also aimed at decreasing problem behaviors related to sharing during toy play. The intervention will involve having the child with autism watching short videotapes/DVDs at home, once every day for 6-8 weeks. In the videos/DVDs, adult models will engage in play interactions in which they share their favorite toys. In addition, the child with autism will play with a sibling (brother or sister) or friend a few times per week at home, using the same toys as in the videotapes. I will videotape the play sessions and use the videotapes to record data on sharing and problem behavior. The play sessions will occur for approximately 5-15 minutes, 2-3 times per week for approximately 8 weeks.  I am hoping to recruit two children who are at least 4 years old who have been diagnosed with autism, autism spectrum disorder, Asperger’s Syndrome, or pervasive developmental disorder. To qualify for this study, a child with autism must: • Be able to watch television or videos at home for at least 15 minutes at a time • Be able to engage in a preferred play activity for at least 10 minutes at a time • Have difficulty sharing toys or other items with other children • Engage in problem behavior (e.g., screaming, verbal protests, tantrums, grabbing, etc.) when asked to share toys with others, at least some of the time • Have a parent/guardian at home who is willing to supervise daily video viewing sessions according to a written protocol • Have a sibling or peer who is available for intervention play sessions  There are no foreseeable risks to the participants with autism. Potential benefits include improved play skills with siblings or peers and information about the effectiveness of video modeling as an intervention for children with autism spectrum disorders.  If you are interested in having your child participate, please contact me directly. Alternatively, you may contact my advisor, Dr. Pat Mirenda. I hope that you will assist me in my study. Thank you for your time!  Regards, Landa Mark  100  Appendix D: Participant Pre-Study Observation Consent Form    Pre-Study Observation Informed Consent Form (Participant) Teaching Children with Autism to Share Using Video Modeling  Principal Investigator Pat Mirenda, Ph.D., Professor (Faculty Advisor) Department of Educational & Counseling Psychology, and Special Education (ECPS) Faculty of Education, University of British Columbia  Co-investigator Landa Mark, Graduate Student (Masters) Department of Educational & Counseling Psychology, and Special Education (ECPS) Faculty of Education, University of British Columbia  Research is being conducted for the fulfillment of degree requirements for the Master of Arts degree. Ms. Mark will use the data from this project for her thesis (public document).  Purpose of the Study and Pre-Study Observation The purpose of the study is to investigate the effects of a video modeling intervention designed to improve verbal and physical toy sharing behaviors and reduce sharing-related problem behaviors in children with autism spectrum disorders. The purpose of the pre-study observation is to determine if the potential participant with autism meets the following inclusion criteria: • Engages in little or no toy sharing with other children • Exhibits problem behavior (e.g., screaming, verbal protests, tantrums, grabbing, etc.) when asked to share toys with others  Pre-Study Observation Procedures and Time Commitment The observation will take place during a 10 minute play session in your home with a sibling or peer whose parent/guardian consents to his or her participation. If necessary, a second, 10 minute observation may be scheduled. Toys belonging to your child will be used during the observation session.  There are no foreseeable risks to your child during the observation period. An adult will be present during the observation play session to insure the safety of all children. If your child indicates, through his/her behavior or verbally, a desire not to participate in the observation play session or to terminate a session, this will occur immediately.    101  Confidentiality All information from this research study will be kept strictly confidential. Your child will not be identified by name in any reports of the completed study. All data records will be kept on a password-protected computer disk or in a locked file cabinet and destroyed 5 years after the end of the study.  Contact If you have any questions or would like more information about this project, you may contact either Landa Mark at or Dr. Pat Mirenda.  If you have any concerns about your child’s treatment or rights as a research participant, you may contact the Research Subject Information Line in the UBC Office of Research Services.  Consent I understand that my child’s participation in this pre-study observation is entirely voluntary. I may refuse to have him/her participate or withdraw from the pre-study observation at any time without jeopardy to my current or future relationship with the University of British Columbia.  Please check  below:  I have received a copy of the pre-study observation consent form.  Please check  one box below:  I consent to my child’s participation in this pre-study observation.  I do not consent to my child’s participation in this pre-study observation.  If you consent to having your child participate in this pre-study observation, please print your child’s name, print your name, and sign the appropriate section below.   Child’s name (please print)     Date   Parent/Guardian’s name (please print)   Date   Parent/Guardian’s signature     Date  102  Appendix E: Confederate Pre-Study Observation Consent Form   Pre-Study Observation Informed Consent Form (Confederate) Teaching Children with Autism to Share Using Video Modeling  Principal Investigator Pat Mirenda, Ph.D., Professor (Faculty Advisor) Department of Educational & Counseling Psychology, and Special Education (ECPS) Faculty of Education, University of British Columbia  Co-investigator Landa Mark, Graduate Student (Masters) Department of Educational & Counseling Psychology, and Special Education (ECPS) Faculty of Education, University of British Columbia Research is being conducted for the fulfillment of degree requirements for the Master of Arts degree. Ms. Mark will use the data from this project for her thesis (public document).  Purpose of the Study and Pre-Study Observation The purpose of the study is to investigate the effects of a video modeling intervention designed to improve verbal and physical toy sharing behaviors and reduce sharing-related problem behaviors in children with autism spectrum disorders. The purpose of the pre-study observation is to determine if your child meets the following criteria for inclusion in the study as a play partner for the child with autism: • Able to communicate vocally using at least short sentences • Able to engage in primarily positive interactions with another child during toy play • Absence of episodes or problem behavior related to refusal/reluctance to share  Pre-Study Observation Procedures and Time Commitment The observation will take place during one or two 10-minute play sessions in the home of the participant with autism. During the observation(s), your child and the child with autism will play together with toys that belong to the other child. Since your child will be interacting with a young child with autism who may exhibit some unusual or disruptive behaviors, there may be some risk. However, an adult will be present at all times to ensure your child’s safety. If your child indicates, through his/her behavior or verbally, a desire not to participate in the observation session or to terminate the session, this will occur immediately. Your child may or may not be invited to participate in the study following this observation session.  Confidentiality All information from this research study will be kept strictly confidential. Your child will not be identified by name in any reports of the completed study. All data records will be kept on a password-protected computer disk or in a locked file cabinet and destroyed 5 years after the end of the study. 103   Contact If you have any questions or would like more information about this project, you may contact either Landa Mark or Dr. Pat Mirenda.  If you have any concerns about your child’s treatment or rights as a research participant, you may contact the Research Subject Information Line in the UBC Office of Research Services.  Consent I understand that my child’s participation in this pre-study observation is entirely voluntary. I may refuse to have him/her participate or withdraw from the pre-study observation at any time without jeopardy to my current or future relationship with the University of British Columbia.  Please check  below:  I have received a copy of the pre-study observation consent form.  Please check  one box below:  I consent to my child’s participation in this pre-study observation.  I do not consent to my child’s participation in this pre-study observation.  If you consent to having your child participate in this pre-study observation, please print your child’s name, print your name, and sign the appropriate section below.   Child’s name (please print)     Date   Parent/Guardian’s name (please print)   Date   Parent/Guardian’s signature     Date  104  Appendix F: Participant Consent Form  Informed Consent Form (Participant) Teaching Children with Autism to Share Using Video Modeling or Video Feedback  Principal Investigator Pat Mirenda, Ph.D., Professor (Faculty Advisor) Department of Educational & Counseling Psychology, and Special Education (ECPS) Faculty of Education, University of British Columbia  Co-investigator Landa Mark, Graduate Student (Masters) Department of Educational & Counseling Psychology, and Special Education (ECPS) Faculty of Education, University of British Columbia  Research is being conducted for the fulfillment of degree requirements for the Masters of Arts degree. Ms. Mark will use the data from this project for her thesis (public document).  Purpose of the Study The purpose of the study is to investigate the effects of a video modeling or video feedback intervention designed to improve verbal and physical toy sharing behaviors and reduce sharing-related problem behaviors in children with autism spectrum disorders (ASD). Your child is eligible to participate because he or she was diagnosed with ASD and has difficulty sharing favorite toys/items with other children.  Study Procedures and Time Commitment The study will focus on teaching appropriate sharing behaviors to children with autism. The intervention will include video modeling or video feedback and play sessions with another child. Play sessions will be videotaped, and the investigator will use these videotapes to record data on your child’s sharing and non-sharing behaviors. During the study, your child with ASD will watch a 5-10 minute videotape/DVD every day at home, under your supervision. In the video modeling condition, your child will view an adult sharing favorite toys with another adult while they play together. In the video feedback condition, your child will view him- or herself playing with a favorite toy with a sibling or friend, while the researcher points out examples of sharing successes and failures. In addition, 2-3 times per week, your child with ASD will play with a sibling or friend at home, using the same toys as in the videotapes. These play sessions will last for 5-15 minutes each for approximately 8 weeks and will be supervised by Landa Mark. The total time commitment for your child with ASD is estimated at 8-9 hours for video/DVD viewing and 6-8 hours for play sessions over a 2-month period. You will also be responsible for arranging for a peer play partner for each play session. You may arrange for the same play partner for each session, or you may select different partners. 105   There are no foreseeable risks to your child in this study. An adult will be present during all play sessions to insure the safety of both children. If your child indicates, through his/her behavior or verbally, a desire not to participate in video viewing or play sessions or to terminate a session, this will occur immediately. There are potential risks to the peer play partner during interactions with your child who has autism. These risks may include exposure to a child who prefers to play games in specific ways and who engages in problem behaviors such a grabbing and screaming that are related to a reluctance to share. If the peer play partner or his or her parent chooses to withdraw from the study at any time, you will be responsible for identifying another play partner.  The researcher will provide you with another letter of initial contact for the parent of the new play partner. If you are not able to locate a replacement play partner, your child will no longer be eligible for participation in the study. You will be thanked for your participation and you will no longer have any responsibilities related to the research project.  Potential benefits to your child’s participation include improved sharing behaviors with siblings and peers and the ability to play more cooperatively with other children. In addition, this study will help us understand how to teach sharing behaviors to children with ASD who have difficulty in this area.  Confidentiality All information from this research study will be kept strictly confidential. Your child will not be identified by name in any reports of the completed study. All data records and videotapes will be kept on a password-protected computer disk or in a locked file cabinet and destroyed 5 years after the end of the study. Only the principal investigator, the co-investigator, and one research assistant will have access to the data. Videotaped material will not be used in any presentations without your permission.  Contact If you have any questions or would like more information about this project, you may contact either Landa Mark or Dr. Pat Mirenda. If you have any concerns about your child’s treatment or rights as a research participant, you may contact the Research Subject Information Line in the UBC Office of Research Services. 106  Consent I understand that my child’s participation in this study is entirely voluntary. I may refuse to have him/her participate or withdraw from the study at any time without jeopardy to my current or future relationship with the University of British Columbia or any agency providing support to my child.  Please check  below:  I have received a copy of the consent form.  Please check  one box below:  I consent to my child’s participation in this study.  I do not consent to my child’s participation in this study.  If you consent to having your child participate in this study, please print your child’s name, print your name, and sign the appropriate section below.   Child’s name (please print)     Date   Parent/Guardian’s name (please print)   Date   Parent/Guardian’s signature     Date   107  Appendix G: Confederate Consent Form  Informed Consent Form (Confederate) Teaching Children with Autism to Share Using Video Modeling or Video Feedback  Principal Investigator Pat Mirenda, Ph.D., Professor (Faculty Advisor) Department of Educational & Counseling Psychology, and Special Education (ECPS) Faculty of Education, University of British Columbia  Co-investigator Landa Mark, Graduate Student (Masters) Department of Educational & Counseling Psychology, and Special Education (ECPS) Faculty of Education, University of British Columbia Research is being conducted for the fulfillment of degree requirements for the Masters of Arts degree. Ms. Mark will use the data from this project for her thesis (public document).  Purpose of the Study The purpose of the study is to investigate the effects of a video modeling or video feedback intervention designed to improve verbal and physical toy sharing behaviors and reduce sharing-related problem behaviors in children with autism spectrum disorders. Your child is eligible to participate because he or she is the brother, sister, friend, or acquaintance of a child with autism.  Study Procedures and Time Commitment A child with autism with whom you and your child are acquainted will participate in a research study to investigate the effectiveness of a video modeling or video feedback intervention aimed at teaching sharing behaviors. The video modeling intervention will require your child and the child with autism to watch a short videotape every day of two people playing with and sharing toys appropriately. The video feedback condition will require your child and the child with autism to view videotapes of themselves playing with a favorite toy, while the researcher points out examples of sharing successes and failures. The study will also require your child’s participation in 5-15 minute play sessions with the child with autism, 2-3 times per week for approximately 8 weeks. The play sessions will take place in the home of the child with autism and will be supervised by his or her parent and the research co-investigator. During the sessions, both children will play with interesting and fun toys. All of the play sessions will be videotaped, and the researcher will use these videotapes to record data on the sharing behaviours of the child with autism and your child. The total time commitment for your child is estimated at 6-8 hours for play sessions over a 2-month period.  Since your child will be interacting with a young child with autism who may exhibit some unusual or disruptive behaviors, there may be some risk. These risks may include exposure to 108  a child who prefers to play games in specific ways and who engages in problem behaviors such a grabbing and screaming that are related to a reluctance to share. However, an adult will be present at all times to ensure your child’s safety. If your child indicates either verbally or through his/her behavior a desire to not participate or to terminate any session, it will be discontinued immediately. In addition, you or your child may withdraw completely or decline participation at any point in the study. If you or your child chooses to withdraw from the study, another confederate will be identified by the parent of the child with autism, and there will be no further responsibilities for either you or your child.  Potential benefits to participation include improving your child’s play skills with a child who has autism, improving the sharing ability of a child with autism, and increasing general knowledge about the usefulness of video modeling as an effective intervention.  Confidentiality All information from this research study will be kept strictly confidential. Your child will not be identified by name in any reports of the completed study. All data records and videotapes will be kept on a password-protected computer disk or in a locked file cabinet and destroyed 5 years after the end of the study. Only the principal investigator, the co-investigator, and one research assistant will have access to the data. Videotaped material will not be used in any presentations without your permission.  Contact If you have any questions or would like more information about this project, you may contact either Landa Mark or Dr. Pat Mirenda.  If you have any concerns about your child’s treatment or rights as a research participant, you may contact the Research Subject Information Line in the UBC Office of Research Services. 109  Consent I understand that my child’s participation in this study is entirely voluntary. I may refuse to have him/her participate or withdraw from the study at any time without jeopardy to my current or future relationship with the University of British Columbia.  Please check  below:  I have received a copy of the consent form.  Please check  one box below:  I consent to my child’s participation in this study.  I do not consent to my child’s participation in this study.  If you consent to having your child participate in this study, please print your child’s name, print your name, and sign the appropriate section below.   Child’s name (please print)     Date   Parent/Guardian’s name (please print)   Date   Parent/Guardian’s signature     Date 110  Appendix H: Video Modeling Scripts – Elliot  Elliot – Circus Video Modeling Script  Actor 1 Give Actor 2 umbrella SAY: Here you have the umbrella Actor 2 SAY: Thanks Actor 1 Jump tiger through fire SAY: Jump tiger jump Actor 2 Reach over and help Actor 1 jump tiger SAY: I’ll help him make it through Actor 1 Keep holding on to tiger with Actor 2  Play separately Actor 1 SAY: Do you want a turn with the leopard Actor 2 SAY: sure Play with leopard Actor 1 Pick up trainer and approach Actor 2’s leopard and whip it SAY: get back leopard, get in the cage Actor 2 SAY: ow ow Put leopard in the cage Actor 1 Play with orange elephant on platform SAY: the elephant will now stand on the box Actor 2 Play with purple elephant on balance beam SAY: my elephant is walking the balance beam Actor 2 Reach over and take the fire from Actor 1’s area SAY: I need the fire Actor 1 Let Actor 2 take the fire SAY: ok Actor 1 SAY: can I have the balance beam Actor 2 SAY: yeah here you go Actor 1 SAY: thanks Actor 1 play with tiger and balance beam SAY: can the tiger walk the beam? Actor 2 Play with lion jumping on platforms SAY: my lion can jump across the green stands 111  Actor 1 Reach over and move lion’s legs SAY: you need to put his legs like this Actor 2 Keep holding on to the lion and let Actor 1 move his legs SAY: oh ok, thanks Actor 1 Return to play with tiger make tiger sounds Actor 2 Return to play with lion make lion sounds Actor 2 SAY: do you want the purple elephant too? Actor 1 SAY: oh yeah thanks Actor 1 Play with two elephants Actor 2 SAY: wait they’re hats should be off Reach over and take elephant’s hats off and leave them by Actor 1 Actor 1 Hold on to elephants but let Actor 2 take the hats off SAY: that’s better, thanks Actor 2 Play with girl and leopard SAY: the girl is going to try to train the leopard Actor 1 Play with elephants, pretend to have them eat SAY: the elephants need to eat Actor 1 SAY: here’s the whip for your girl Hand the whip to Actor 2 Actor 2 Put whip in girls hand SAY: that’s awesome Actor 1 Hold out stick towards Actor 2 SAY: would you like the stick too? Actor 2 SAY: no thanks I’ll just have the whip Actor 1 SAY: ok I’ll keep it  Actor 1 Play with the tiger on the balance beam Actor 2 Take the girl and whip Actor 1’s tiger SAY: take that tiger Actor 1 Let Actor 2 whip tiger SAY: good tiger that’s how you walk the beam Actor 2 Return to playing with leopard and fire SAY: I’m teaching the leopard to jump through the fire Actor 1 SAY: can I have a turn with the fire Actor 2 112  SAY: sure here you go Give the fire to Actor 1 SAY: I need the boy Actor 1 Give the boy to Actor 2 Actor 2 play with boy and girl SAY: now the boy and girl can train together Actor 1 Play with trainer, tiger and balance beam Actor 2 Take the orange elephant and hat from Actor 1’s area SAY:  the boy wants the orange elephant Actor 1 Let Actor 2 take the orange elephant SAY: alright I don’t need him Actor 2 Play with orange elephant and boy Actor 1 SAY: Put the boy on the elephant. I’ll help you Reach over and help put the boy on the elephant Actor 2 Work with Actor 1 on putting the boy on the elephant Actor 1 Play with purple elephant Actor 2 Play with lion and girl Actor 1 SAY: here’s the balance beam for the lion put the balance beam by Actor 2 Play with the purple elephant Actor 2 Reach over and put the purple hat on Actor 1’s elephant SAY: he needs his hat on Actor 1 Keep holding the elephant and let Actor 2 put the hat on Actor 1 SAY: do you want the umbrella? Actor 2 SAY: yup Take the umbrella SAY: do you want the horn? Actor 1 SAY: no thanks SAY: can I have the lion and the fire instead? Actor 2 Give Actor 1 the lion and the fire SAY: can I have the purple elephant? Actor 1 SAY: sure you can have him Give the purple elephant to Actor 2 Actor 1 Play with lion tiger and trainer Actor 2 Play with girl and leopard Actor 2 113  Take leopard over and attack Actor 1’s trainer SAY: AHHH leopard attack! Actor 1 Use trainer to fight back Actor 2’s leopard SAY: get back leopard! Get Off! Actor 2 Return to playing with leopard and balance beam Actor 1 Return to playing with trainer and lion Actor 1 Reach over and move the girl’s arm with the whip SAY: you need to whip like this Actor 2 Hold on to the girl and let Actor 1 move the whip arm Actor 1 SAY: try to get them to jump through the fire Give Actor 2 the fire Actor 2 Play with the leopard, fire, and girl Actor 1 SAY: I’ll help you Bring trainer over to the fire SAY: jump jump leopard Actor 2 Make the leopard jump Actor 1 Return to playing with the trainer, lion, tiger Actor 2 SAY: can I try the stick? Actor 1 Give Actor 2 the stick SAY: can I have the elephants and the boy then? Actor 2 Give Actor 1 the elephants and the boy SAY: here you go Actor 1 Play with both elephants Actor 2 Reach over and move one of the elephants onto the platform with Actor 1 SAY: see they can balance on here Actor 1 Allow Actor 2 to move the elephants onto the platform SAY: wow you’re a great elephant trainer Actor 2 Take the trainer from around Actor 1 to your area SAY: I’m going to use the trainer now Actor 1 Let Actor 2 take the trainer Actor 1 SAY: do you want the trainers stand too? Actor 2 SAY: yea cool   Types of Sharing Featured in Elliot’s Circus Video 114   Type Total Examples A = asks for a toy 7 ARR = appropriate response to a request 7 IC = Initiates co-manipulation 7 AC = allow co-manipulation 7 T = take a toy 3 AT = allows take 3 A/D = accepts toy or politely declines after an offer 9 O = offers a toy 9    Elliot – Egypt Video Modeling Script  Actor 1 Give Actor 2 water container SAY: You need the water container Actor 2 SAY: Thanks Actor 1 Put man on camel SAY: He’s going to search the desert for treasure Actor 2 Reach over and help Actor 1 put reigns in man’s hands SAY: I’ll help you put the reigns on Actor 1 Keep holding on to the man while Actor 2 puts on reigns  Play separately Actor 1 SAY: does you guy want the golden axe? Actor 2 SAY: that would be cool Play with man and axe Actor 1 Take camel and walk over to Actor 2’s man SAY: I bring a message from the queen – you must finish the tomb Actor 2 SAY: yes sir I will work very hard Make man work at tomb Actor 1 Play with boy and blue containers SAY: the secret water goes into the containers Actor 2 Play with Cleopatra and the fan SAY: Cleopatra needs to be fanned Actor 2 Reach over and take a blue container from Actor 1 SAY: Cleopatra needs some water Actor 1 Let Actor 2 take the blue container 115  SAY: ok Actor 1 SAY: can I have the panther Actor 2 SAY: sure I’m not using it Actor 1 SAY: thanks Actor 1 play with boy and panther SAY: what a beautiful panther Actor 2 Play with camel SAY: my camel has been walking for a long time Actor 1 Reach over and move camel’s legs SAY: you can make him lay down Actor 2 Keep holding on to the camel and let Actor 1 move his legs SAY: that helps, thanks Actor 1 Return to play with panther Actor 2 Return to play with camel Actor 2 SAY: do you want one of the golden containers Actor 1 SAY: yes please Actor 1 Start putting the containers in the tomb Actor 2 SAY: I’ll help you put them all in Reach over and take help put the containers in the tomb Actor 1 Let Actor 2 help but the containers in SAY: awesome they all fit! Actor 2 Play with the man, take off hat and tools SAY: the tomb is complete! Actor 1 Play with the tomb SAY: the tomb will now be sealed! Actor 1 SAY: here’s the queen’s chair for Cleopatra Hand the chair to Actor 2 Actor 2 Put Cleopatra in the chair SAY: thank you she is much more comfortable Actor 1 Hold out the tower towards Actor 2 SAY: would you like the tower? Actor 2 SAY: no Cleopatra does not want the tower near her Actor 1 SAY: I’ll just put it up here  Actor 1 116  Put the tower on the tomb Actor 2 Take the fan and fan Actor 1’s boy SAY: boy you must be so hot…..I’ll fan you Actor 1 Let Actor 2 fan the boy SAY: oh thank you…I fell much better, it is so hot Actor 2 Return to playing with camel, stand him up SAY: the camel must continue his journey Actor 1 SAY: can I have the key for the tomb Actor 2 SAY: yeah here it is Give the key to Actor 1 SAY: I need the one of the men to ride the camel Actor 1 Give the man to Actor 2 Actor 2 play with the man and the camel SAY: the camel will guard the tomb for the queen Actor 1 Play with the camel Actor 2 Take the panther from Actor 1’s area SAY:  the tomb needs the panther for extra protection Actor 1 Let Actor 2 take the panther and place by tomb SAY: ok, good luck panther Actor 2 Play with Cleopatra and the chair Actor 1 SAY: Cleopatra should go to the tomb Reach over and help Actor 2 move Cleopatra’s chair into the tomb Actor 2 Work with Actor 1 to move Cleopatra to the tomb Actor 1 Play with the camel and the man Actor 2 The man and the blue container Actor 1 SAY: here’s a basket for your water container Take basket from camel and give it to Actor 2 Play with key and open the tomb Actor 2 Reach over and start closing the doors SAY: keep the doors closed to protect the treasure Actor 1 Close the two doors with Actor 2 Actor 1 SAY: do you want to hold on to the key? Actor 2 SAY: yes Take the key SAY: do you want the fan? Actor 1 117  SAY: no thanks SAY: can I have the camel and his rider? Actor 2 Give Actor 1 the camel and the man SAY: can I have the boy? Actor 1 SAY: yes he can help the man protect the tomb Give the boy to Actor 2 Actor 1 Play with two camels – march around the area Actor 2 Play with the man and boy – march around the tomb Actor 2 Take the boy and approach Actor 1’s camels SAY: help help…enemies are coming to the tomb Actor 1 Stop the camels SAY: oh no…we will come help Actor 2 Return to playing with boy and man Actor 1 Return to playing with camels Actor 1 SAY: the boy should be on top of the top to watch Reach over and help Actor 2 put the boy on the top of the tomb Actor 2 Hold on to the boy and let Actor 1 help move him to the top of the tomb Actor 1 SAY: here is a water container for the boy Give Actor 2 the gold container from the camel Actor 2 Pretend to have the boy drink the water Actor 1 play with camels Actor 2 play with Cleopatra Actor 1 SAY: I will warn Cleopatra of the danger Bring camel over to Cleopatra SAY: Queen you are in danger Actor 2 Make Cleopatra jump SAY: oh no…thank you for warning me! Actor 1 Return to playing with the camels and men Actor 2 SAY: can I have the whip? Actor 1 Give Actor 2 the whip SAY: can I have the knife and the axe then? Actor 2 Give Actor 1 the knife and the axe SAY: here they are Actor 1 Put axe and knife in camel’s bag, play with the camel Actor 2 Reach over and take the sword from the man’s sling SAY: put his sword in there too 118  Actor 1 Allow Actor 2 to move the man’s sword into the bag SAY: thanks, no all the weapons are in one place Actor 2 Take the basket from the other camel SAY: I need this basket for the water bottle Actor 1 Let Actor 2 take the basket Actor 1 SAY: do you want the camel so you can carry it to the tomb Actor 2 SAY: for sure!  Types of sharing featured in Elliot’s Egypt video Type Total Examples A = asks for a toy 7 ARR = appropriate response to a request 7 IC = Initiates co-manipulation 7 AC = allow co-manipulation 7 T = take a toy 3 AT = allows take 3 A/D = accepts toy or politely declines after an offer 10 O = offers a toy 8  119  Appendix I: Video Modeling Scripts - Iris  Iris – Puzzle Video Modeling Script ACTOR 1 Put together 3 puzzle pieces (top with balloons) ACTOR 2 Place another puzzle piece on SAY: “this piece goes right here” ACTOR 1 Allow Actor 2 to place puzzle piece in  Put on 2 more puzzle pieces (including maraca) ACTOR 2 SAY: “you found the maraca” ACTOR 2 Place 2 pieces of Dora’s head on puzzle ACTOR 1 Allow Actor 2 to place Dora pieces in the puzzle Place Dora’s maraca piece and place Dora’s backpack piece by the puzzle ACTOR 2 Move Dora’s backpack into the puzzle SAY “Dora’s backpack goes here” ACTOR 1 Allow Actor 2 to move the backpack ACTOR 2 Place rest of Dora’s maraca and cherry tree SAY “here’s Dora’s hair and some of the tree” ACTOR 1 Allow Actor 2 to place the puzzle pieces in Take a handful of pieces from the pile and set them beside you away from Actor 2 and put in a few more pieces of Dora ACTOR 2 Reach out and take a piece from Actor 1’s pile SAY “I want to put this piece in” and place it in puzzle ACTOR 1 Allow Actor 2 to take the piece and put it in the puzzle Put in some more pieces from both piles ACTOR 2 Place pieces of Boots’ maracas SAY: “I’ll put together Boots” ACTOR 1 Allow Actor 2 to place the pieces of Boots in the puzzle ACTOR 1 Place 2 more pieces in the puzzle ACTOR 2 Push the whole puzzle upwards SAY: “let’s move it so we have more room” ACTOR 1 Allow Actor 2 to move the puzzle ACTOR 2 SAY “can I have Boots’ eyes” ACTOR 1 Give Actor 2 the puzzle piece with Boots’ eyes Put some other pieces in 120  ACTOR 2 Place some more pieces in SAY “we are doing really good” ACTOR 1 Allow Actor 2 to put in the pieces ACTOR 1 Give Actor 2 2 pieces of the puzzle ACTOR 2 Accept pieces from Actor 1 SAY “Thanks for giving me some pieces” Put pieces in puzzle ACTOR 1 Let Actor 2 place pieces in ACTOR 2 Reach over and take a piece from Actor 1’s pile SAY: “This piece goes here” And place it in the puzzle ACTOR 1 Allow Actor 2 to take the pieces and put them in Place another piece in the puzzle ACTOR 2 Place 2 more pieces in the puzzle ACTOR 1 Allow Actor 2 to place the pieces in the puzzle Place a piece by the puzzle but not in ACTOR 2 Move the piece Actor 1 put down and put it in the puzzle SAY: “it goes here” ACTOR 1 Allow Actor 2 to move the piece Finish the last few pieces of the puzzle   Types of sharing featured in Iris’s puzzle video Type Number of Examples ISP – Initiate shared play. Placing puzzle pieces in the puzzle. 7 ASP – Allowing shared play. Allow other to put pieces in the puzzle 7 H – Touching puzzle. Touching and moving pieces. 3 AH – Allow touching of pieces. Allows other to touch or move pieces of the puzzle 3 T – Take puzzle. Taking pieces from other person’s pile. 2 AT – Allow take. Allows other to take piece from their pile. 2    Iris – Magnet Board Modeling Script ACTOR 2 121  Place wagon magnet on the Magnet Board SAY: “the wagon goes on the path” ACTOR 1 Allow Actor 2 to place the wagon magnet  Place Max magnet on wagon ACTOR 2 SAY: “You put Max in the wagon” ACTOR 2 Place Mr. Huffington and Airplane on Magnet board ACTOR 1 Allow Actor 2 to place magnets Put Ruby and fire truck on magnet board ACTOR 2 Move Ruby Magnet to the chair on picture SAY “Ruby can sit on the chair” ACTOR 1 Allow Actor 2 to move the Ruby magnet ACTOR 2 Place Grandma magnet by wagon SAY “Grandma can pull the wagon” ACTOR 1 Allow Actor 2 to place the magnet on the magnet board Place some magnets on the board ACTOR 2 Reach out and take the “Max & Ruby” logo magnet from Actor 1’s pile SAY “I want to put on the house” and put it on the magnet board ACTOR 1 Allow Actor 2 to take the Magnet and put it on the board Put some magnets on the board ACTOR 2 Place Ruby and friend as Doctors magnet on sandbox on the magnet board SAY: “Ruby and her friend can play in the sandbox” ACTOR 1 Allow Actor 2 to place the ruby and friend magnet on the board ACTOR 1 Place Max and snake on the living room scene ACTOR 2 Move the snake magnet to the outside scene SAY: “the snake can’t be inside. I’ll put him in the backyard” ACTOR 1 Allow Actor 2 to move the snake ACTOR 2 SAY “can I have the book” ACTOR 1 Give Actor 2 the book magnet Put some magnets on the board ACTOR 2 Place the book and the book and the robot in the living room ACTOR 1 Allow Actor 2 to put on the book and robot magnets ACTOR 1 Give Mrs. Huffington and watering can magnets to Actor 2 ACTOR 2 Accept magnets from Actor 1 122  SAY “Thanks for giving me the magnets” Put magnets on board ACTOR 1 Let Actor 2 place magnets ACTOR 2 Reach over and take the truck magnet from Actor 1’s pile and put in the sandbox SAY: “The truck goes in the sandbox” ACTOR 1 Allow Actor 2 to take the truck magnet Place some magnets on the board ACTOR 2 Place helicopter and parachute magnets in the tree ACTOR 1 Allow Actor 2 to place the magnets on the tree Place Ruby magnet in living room ACTOR 2 Move the Ruby magnet to a different part of the living room SAY: “put Ruby here” ACTOR 1 Allow Actor 2 to move the Ruby magnet  Sharing types featured in Iris’s magnet board video Type Number of Examples ISP – Initiate shared play. Placing puzzle pieces in the puzzle. 6 ASP – Allowing shared play. Allow other to put pieces in the puzzle 6 H – Touching puzzle. Touching and moving pieces. 3 AH – Allow touching of pieces. Allows other to touch or move pieces of the puzzle 3 T – Take puzzle. Taking pieces from other person’s pile. 2  AT – Allow take. Allows other to take piece from their pile.  2  123  Appendix J: Probe Session Protocol - Elliot   Date: _____________________________   Child: Elliot  Time Start: ________   Time End: ___________  Toys in baseline phase to be probed (check):     Circus            Egypt  Toys in intervention phase to be probed (check):       Circus               Egypt  Order of toy presentation (check):   Circus, Egypt  Egypt, Circus  Preparation    Write in date and check the toys that are to be probed for the day    Set up video camera on tripod. Focus camera on the play area, zoomed appropriately to see both children    Prepare toy materials • Locate toys scheduled to be probed. • Determine presentation schedule • Place the first toy in the play area • Remove all other toys from the area.   Remind Hannah to ask, take, offer and touch toys that Elliot is playing with   Toy Play Probe    Tell Elliot and Hannah you are ready for them to come and play. Say “first we will play with  ________”.    Ensure that the camera is focused and is recording    Say “Play Together”    Do not give any prompts to the target child during the play session (other than to defuse escalation of problem behavior).   124       When approximately 10 minutes has passed stop the current toy play by saying “We are all done playing with _____, let’s take a break” and Stop Recording     Direct children to neutralizing activity    Remove first toy from the play area and move it out of view of the children. Set up second toy in the play area    Check camera to ensure it is focused on the play area and turn on    Bring the children from neutralizing activity to the toy play area and say “Now we will play with _______ (Toy name)”   Say “Play Together”.    Repeat for all target toys that are required for the session.    If either child leaves the play area during the toy play, redirect to the play area and say “Keep playing with _____ (sibling).” If either child leaves the play area a second time consider the play session over and introduce neutralizing activity then next toy.   Final Steps:    Stop recording and turn off the video camera    Clean up play area.    Transfer the session video to hard drive and label with date and start/end times    Charge video camera for next session              125  Appendix K: Probe Session Protocol – Iris  Date: _____________________________   Child Code:  Iris  Time Start: ________   Time End: ___________  Toys in baseline phase to be probed (check):     Magnet Board        Puzzle  Toys in intervention phase to be probed (check):      Magnet Board         Puzzle  Order of toy presentation (check):      Magnet Board, Puzzle      Puzzle, Magnet Board    Preparation    Write in date and check the toys that are to be probed for the day    Set up video camera on tripod. Focus camera on the play area, zoomed appropriately to see both children    Prepare toy materials • Locate toys scheduled to be probed. • Determine presentation schedule • Place the first toy in the play area • Remove all other toys from the area.   Toy Play Probe    Tell Iris you are ready for her to come and play with her toys. Say “first we will play with ________.    Ensure that the camera is focused and is recording    Say “play with _______” (first toy).     Tell Richelle to join Iris and play with the toy.    Do not give any prompts to the target child during the play session. Except to return to play area after a “leave”.  126       When the puzzle is finished or all magnets are on the magnet board say “we are all done playing with _______” OR if Iris “leaves” the play area and does not return with in 1 minute     Direct children to neutralizing activity    Remove first toy from the play area and move it out of view of the children. Set up second toy in the play area    Check camera to ensure it is focused on the play area and turn on    Bring Iris from neutralizing activity to the toy play area and say “Now we will play with _______ (Toy name)”   Say “Play with _______” and start the camera recording. Allow Iris to play for approximately 1 minute.     Tell Richelle to join Iris and play with the toy.    Repeat for all target toys that are required for the session.   Final Steps:    Stop recording and turn off the video camera    Clean up play area.    Transfer the session video to hard drive and label with date and start/end times    Charge video camera for next session     127  Appendix L: Probe Session Data Collection Form – Elliot  Toy:  ___________________                       Date: ____________________        # opportunities presented by sibling  _________  % opportunities resulting in positive sharing _________  % opportunities resulting in problem behaviors _________           PSO Time Presented Sharing Opportunity (PSO) Positive Sharing Behavior (PSB) Sharing-Related Problem Behavior (SRPB)  A       IC     T     O ARR      AC     AT     A/D G        RR     RAC   RAT     RO   A       IC     T     O ARR      AC     AT     A/D G        RR     RAC   RAT     RO   A       IC     T     O ARR      AC     AT     A/D G        RR     RAC   RAT     RO   A       IC     T     O ARR      AC     AT     A/D G        RR     RAC   RAT     RO   A       IC     T     O ARR      AC     AT     A/D G        RR     RAC   RAT     RO   A       IC     T     O ARR      AC     AT     A/D G        RR     RAC   RAT     RO   A       IC     T     O ARR      AC     AT     A/D G        RR     RAC   RAT     RO   A       IC     T     O ARR      AC     AT     A/D G        RR     RAC   RAT     RO   A       IC     T     O ARR      AC     AT     A/D G        RR     RAC   RAT     RO   A       IC     T     O ARR      AC     AT     A/D G        RR     RAC   RAT     RO   A       IC     T     O ARR      AC     AT     A/D G        RR     RAC   RAT     RO  128  Appendix M: Probe Session Data Collection Form – Iris  SESSION DATE & NUMBER: ________________  TOY 1: ____________________    (INT    BL ) Latency (sec) of Play before first minor PB Frequency of Positive Sharing Behaviors (before first major PB)   Type of PB: ________ A M/H AT ASP Total ALL PSBs: Latency (sec) of Play before first major PB   Type of PB: ________  TOY 2: _____________________     (INT    BL ) Latency (sec) of Play before first minor PB Frequency of Positive Sharing Behaviors (before first major PB)   Type of PB: ________ A M/H AT ASP Total ALL PSBs: Latency (sec) of Play before first major PB   Type of PB: ________ 129  Appendix N: Initial Video Viewing Script - Elliot   Date  Time  Toy featured in video  Supervised by  Explanation of target behaviors  Explanation of playing and talking  Latency of Video  Number of times child left area  Number/type of prompts needed to watch          Have child sit in comfortable location (chair in front of T.V.)  Say, “Time to watch a video. We are going to watch people sharing with a toy”  Said this: Y or N  Turn on video.  Point out people sharing. Say, “Look they are sharing.”  Said this: Y or N  Point out  1 occasion of  each type of targeted allowed sharing: 1. AC   Y or N 2. ARR Y or N 3. AT Y or N 4. A/D Y or N  When video is finished, say “You can copy the people and share your toys.” Said this: Y or N        130   Appendix O: Initial Video Viewing Script – Iris    Date  Time  Toy featured in video  Supervised by  Explanation of target behaviours  Explanation of playing and talking  Latency of Video  Number of times child left area  Number/type of prompts needed to watch          Have child sit in comfortable location (chair in front of tv/computer.)  Say, “Let’s watch a video of your puzzle! We can watch people sharing the puzzle and having fun”  Said this: Y or N  Allow Iris to watch the video uninterrupted  Did this: Y or N  When video is finished, say “You can play with the puzzle and share just like those people did” Said this: Y or N        131  Appendix P: Video Viewing Protocol - Elliot   Date: ____________________________  Child: Elliot  Sharing Videos to be shown (check if videos that will be shown and write order number beside.   ___ Circus        ___ Egypt    Probe Days: Show the tape 30 – 60 minutes before the beginning of the probe session.   Probe Days: engage Elliot in neutral activity after the videos are complete.   Non-Probe Days: show the video(s) at a convenient time.    Get the CD from the study materials kit and put in a computer    Check the videos that will be shown (above) and write in the order they will be shown  Check previous days sheet to determine order.  When there is 1 video show only that video 1 time  When there are two videos follow this schedule: Day 1: Circus, Egypt Day 2: Egypt, Circus Repeat    Call Elliot and tell him to sit comfortably in front of the computer. Tell him, “time to watch your videos.”   Play the correct CD    Do not talk with Elliot while the tape is playing but stay in the room to monitor viewing    If Elliot attempts to interact with you during the viewing, point to the computer, and say “keep watching your video”    If Elliot gets up from where he is sitting, verbally prompt him to sit down and watch the video.    If Elliot leaves the viewing area, pause the video, tell him to return and resume the video    When all scheduled videos have been watched, tell Elliot, “you’re done watching the videos”  132    Probe Days: engage child in neutralizing activity not related to the study or the target toys before the probe session.    Stop the CD and remove it from computer    Place CD in the study kit    Complete video viewing data sheet    133  Appendix Q: Video Viewing Protocol – Iris  VIDEO VIEWING PROTOCOL  Child: Iris    Probe Days: Show the tape one time 30 – 60 minutes before the beginning of the probe session   Probe Days: engage Iris in neutral activity (not related to the study toys) after the videos are complete.   Non-Probe Days: show the video(s) one time per day at a convenient time.    Get the CD from the study materials kit and put in a computer    Check the videos that will be shown and write in the order they will be shown on the Video Viewing Data sheet  Check previous day’s data sheet to determine order.  When there is 1 video show only that video 1 time  When there are two videos follow this schedule: Day 1: Puzzle, Magnet Board Day 2: Magnet Board, Puzzle Repeat    Call Iris and tell her to sit comfortably in front of the computer. Tell her, “time to watch your sharing videos.”   Play the correct DVD/CD    Do not talk with Iris while the video is playing but stay in the room to monitor viewing    If Iris attempts to interact with you during the viewing, point to the computer, and say “keep watching your video”    If Iris gets up from where she is sitting, verbally prompt her to sit down and watch the video.    If Iris leaves the viewing area, pause the video, tell her to return and resume video    When all scheduled videos have been watched, tell Iris, “you’re done watching the video(s)”    Probe Days: engage Iris in neutralizing activity not related to the study or the target toys before the probe session. 134     Stop the CD and remove it from player    Place CD in the study kit    Complete video viewing data sheet 135  Appendix R: Video Viewing Data Sheet                         Date  Time  Videos Watched (circle)  Supervised by  Total viewing session time  Number of times child left area  Number of time video stopped  Number of prompts needed to watch    1      2   1      2   1      2   1      2   1      2    1      2  136  Appendix S: Social Validity Questionnaire   Please circle the rating that best applies how you felt about the video feedback intervention in which your children participated.  1.  Sharing was an important social skills behavior for my child with autism to learn  1                          2                             3                             4                              5        Agree                                                   Neutral                                                Disagree   2.  I understood the procedures used during the video feedback intervention  1                          2                             3                             4                              5        Agree                                                   Neutral                                                Disagree   3.  The video feedback intervention was an appropriate intervention for my child with autism 1                          2                             3                             4                              5        Agree                                                   Neutral                                                Disagree   4.  The video feedback intervention was disruptive to our family’s daily routines  1                          2                             3                             4                              5        Agree                                                   Neutral                                                Disagree   5.  After the intervention my son had a meaningful increase in his sharing behavior  1                          2                             3                             4                              5        Agree                                                   Neutral                                                Disagree  6.  After the intervention my son had a meaningful decrease in his sharing-related problem behavior   1                          2                             3                             4                              5        Agree                                                   Neutral                                                Disagree  

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