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Autism Inclusion Research Papers

The current systematic review of the literature examined studies on improving social communication skills for children with ASD in inclusive preschool classrooms. To target studies that were aimed at increasing the skills of children in inclusive classrooms, each of the 16 included studies featured a typically developing or more experienced peer, either as an intervention agent or during a generalization or maintenance assessment phase of the study. This review identified a range of effective interventions to improve the social communication skills for children with ASD in inclusive preschool classrooms. We discuss our findings and provide suggestions for future research on the following: (a) efficacy of interventions, (b) implications for practice and policy, and (c) limitations and future research.

Efficacy of Interventions

There is a current push in the field for formation, research, and implementation of evidence-based practices (Horner et al. 2005; Odom et al. 2003; Reichow et al 2008). The first research question of this literature review was to establish what portion of the sizable body of research on social communication interventions for children with ASD was directly applicable to young children served in inclusive settings. Results showed a range of acceptable interventions, representative of the larger body of literature on social communication and ASD. The second research question of this review looked to determine the effectiveness (i.e., effect size) of the identified interventions and draw conclusions from these results. Effect size was reported for all studies, but given the small number of studies meeting stringent inclusion criteria, further conclusions need to be drawn about the relevancy, stability, and generalizability of the included interventions.

The current review examined a range of interventions in differing social communication targets. Dependent variables in the reviewed studies generally addressed peer engagement (e.g., play with peers), peer initiation (e.g., invitations to play), and early social pragmatics (e.g., greetings and sharing). While the understanding that children with ASD face difficulty interacting socially seems valid, further research is needed to examine different topographies of social behavior in young children with ASD. While basic social skills like sharing, turn taking, and inviting to play are critical for success in preschool, participants may benefit from training on more advanced, higher order pragmatics such as telling jokes to obtain peer attention. In typically developing preschool populations, social competency extends beyond the ability to perform discrete prosocial behaviors and extends towards less discernible skills like forming friendships, reading subtle social cues, and observing social norms (Bauminger-Zviely et al. 2013; Stanton-Chapman et al. 2012).

In addition, social behavior is also just one component of success in an inclusive preschool classroom. Other barriers for children may include challenging behavior, functional communication needs, and information processing (Crosland and Dunlap 2012; Ravet 2011; Von der Embse et al. 2011). Interventions that combine social skills training with secondary variables of challenging behavior or functional behavior are promising. For example, Jung and colleagues (2008) addressed a secondary variable of the reduction of challenging behavior. The intervention on initiations to peers used in this study included redirections of challenging behavior and reported levels of challenging behavior as a secondary variable. Nelson and McDonnell (2007) used a peer-mediated intervention to increase social interactions, but also tracked functional language use by target participants. Results from these studies indicate that secondary variables (e.g., challenging behavior) may in some cases be important for child progress on social dependent variables such as social initiations. Future research should focus on pairing secondary variables that may interfere with positive interaction with peers with social communication interventions in order to increase responding.

Results of this review showed mixed ability of interventions to be applied effectively in an inclusive setting. Additionally, the consistency of results varied across interventions and between different studies using the same intervention. Of the articles included in this analysis, visuals (i.e., visual schedules, social stories, and social cue cards) and scripts had the most consistently positive result on dependent variables, with PND ranging from 97 to 100 %. The interventions with the most variability across studies, which points to inconsistency of effect, are peer-mediated interventions (26–100 % PND) and video modeling (46–91 % PND). Because of the stringent nature of the inclusion criterion for this review, there is no clear representation of studies with poor effect size, but the variability of success with popular interventions illustrates the necessity of both fidelity of implementation and consideration of participant populations. Further research is needed to determine critical components of interventions that allow them to fit well in inclusive preschool settings.

Two of the included intervention types had highly variable results. As is represented in the larger body of ASD research, a significant portion of these studies included use of video modeling. Past research supports the use of video modeling to address the core symptoms of ASD, including challenging behavior and social communication delays (Bellini and Akullian 2007). These positive effects have been shown to generalize across settings and maintain over time (Bellini and Akullian 2007). Video modeling has also had a good effect for the modeling of complex social interactions such as sharing a toy (e.g., Marzullo-Kerth et al. 2011). Video modeling is a topical area of research however in this review has shown mixed results. The finding that video modeling has varied results for interventions could point to barriers to use of this intervention in inclusive settings. Further analysis of participant characteristics should be undertaken to determine when and for whom video modeling interventions are effective.

Additionally, a large number of reviewed studies made direct use of peers, such as in peer coaching or peer modeling. Involving the peer in implementation of the intervention is thought to be effective in reducing two barriers to peer inclusion, social interactions with peers and peer acceptance (Betz et al. 2008; Ganz and Flores 2008; Kohler et al. 2007). Peer acceptance is largely missing from this body of research as a primary variable. Some information about the effect of the interventions on peer acceptance comes from social validity ratings. For example, Woods and Poulson (2006) measured typically developing peer attitudes about peers with ASD with a pre-post questionnaire. Involving a typical peer variable in the research question would allow researchers to embed questions of ecological social validity within interventions.

As has been noted in several topical literature reviews, it is difficult to generalize across studies because of the heterogeneity of behaviors and delays in children with ASD (Schreibman 2000; Goldstein et al. 2014). ASDs are a broad range of developmental disabilities that can differ widely in characteristics, behavioral topographies, and outcomes (Fombonne 2003; Newschaffer et al. 2007). Methodologies are needed to decipher goodness of fit of evidence-based interventions to distinct sub-populations in ASD. This barrier is well noted in this review, as several of the included studies show largely different effect size between participants receiving the same or similar treatment (e.g., Leaf et al. 2012; Nelson and McDonnell 2007). Those studies most successful across participants had both a fairly small subset of individuals with ASD in their study and a high level of systemization of intervention. Future research should focus on determining characteristics of participants and environments that dictate the likelihood of the success of current interventions for specific participant subsets.

Additional issues pertaining to the heterogeneity of children with ASD come from the classroom setting. Across studies there was a wide range of classroom makeup, teacher training, classroom size, philosophy, and dosage of interventions. Further research is needed to investigate preschool classroom characteristics that may contribute to success for children with ASD. There are key needs of classrooms to be able to provide effective settings for interventions on social skills. Teacher training in particular is a barrier for the successful inclusion of children with ASD (Morrier et al. 2010). Individuals who were highly trained in working with children with ASDs, which may not be representative of early childhood educators, implemented over half of the studies included in the present review. Additionally, a majority of the studies completed training or intervention in a clinical or isolated setting and either introduced intervention into a peer setting or assessed participant skill generalization to a peer setting. A few of the included studies assessed generalization to peers, but had only one familiar peer available for generalization of skills. In the typical classroom, there are other factors controlled for in these studies such as classroom noise, teacher/child ratio, and unpredictability of peers that may influence responding. Future research that is embedded in the natural classroom environment and that promotes sustainability of teacher use of interventions in the natural classroom environment is critical.

Implications for Practice and Policy

Research has established that social communication is critical for success in the preschool classroom and has direct correlates with later academic achievement (McClelland and Morrison 2003; Odom et al. 2006). Additionally, for children with special needs, participation in preschool classrooms alongside typically developing peers has been shown to increase opportunities to develop important social and pre-academic skills (Guralnick et al. 1996; Ferraioli and Harris 2011). Current research has also established that for children with autism to successfully participate in inclusive settings, additional supports are often needed. For educators in inclusive settings, results of this review indicate suggestions for applicable interventions. Early childhood teachers working with preschoolers with ASD should access interventions that have shown a good effect in inclusive settings. Results of this review indicate several interventions that can be integrated into classroom routines and that show a good effect on a variety of desired behaviors.

Evidence that the need for effective social communication interventions for this population had increased due to changes in legislation and typical child placement decisions provided much of the impetus for this review. Findings indicate that interventions exist that, when implemented with fidelity, have a positive effect on meaningful engagement in preschool classrooms for children with ASD. Results of this review have implications for policy. Primarily, the range of efficacy of interventions included in this review indicates the need for inclusive settings to include access to evidence-based practices on social communication for children with ASD. Furthermore, teacher training and parent involvement should continue to include strategies for reducing barriers to meaningful interactions with peers in the preschool classroom including communication, challenging behavior, and peer acceptance.

Limitations and Future Research

The studies in this review with the strongest results were often those with the most experimental rigor. Many of these studies used a teaching-package or self-written intervention that was formed out of evidence-based components (e.g., Leaf et al. 2009, 2012; Nelson and McDonnell 2007). Strong studies often used components of ABA such as reinforcement schedules or fading of scripts or stimuli (e.g., Jung et al. 2008). Studies that did not directly intervene using an ABA principle still often used ABA components indirectly. For example, Deitchman et al. (2010) used a systematic preference assessment to identify potential reinforcers and used reinforcement principles throughout the intervention. ABA has been shown to be effective for intervention on many components of ASD; however, it is consistently noted in the literature that the dosage required of early intensive ABA sometimes is not possible in a naturalistic environment like that of an inclusive preschool classroom (Jones et al. 2007; Rispoli et al. 2013; Tiger et al. 2006). Although the interventions reviewed here were focused, rather then comprehensive ABA intervention, future research should examine ways to support teacher use of such evidence-based strategies in inclusive preschools.

Differences in effect size between participants on the same intervention may also be related to participant characteristics. Dosage or intensity of intervention may need to be modulated based on participant functioning, for example, higher intensity interventions may be required for lower functioning participants (Hus and Lord 2013; Reichow 2012). Only 30 % of the included studies reported measured cognitive or language levels, with 47 % of the studies noting observational information about functioning. This missing information in the literature may point to a need for researchers to be more explicit about participant characteristics in order to allow for correct dosage and intensity of intervention, as well as to provide information to the consumers about the utility of the intervention to particular populations. Another characteristic of research participants not specified in this body of research is prior treatment. A majority of the included articles did not specify what sort of treatment the participant had been exposed to prior to participation in the study. For participants that may have been receiving intensive ABA therapy, transfer of these skills may have changed outcomes.

In a meta-analysis on social validity ratings for social skill interventions for preschool aged children, authors reported a 27 % rate of studies reporting social validity from 1970–2008 (Hurley 2012). The current study represents a similar trend. Only 31 % of the included studies measured social validity. The addition of social validity measures strengthens the conclusions that can be made about utility of the studies, predicts the likelihood that teachers adapt studies to everyday classroom practices, and provides feedback to researchers about perceived effects of intervention (Goldstein et al. 2014; Hurley 2012). When researching interventions that are novel in the classroom setting, but well established clinically, social validity is especially important because it speaks to the practitioner’s perceptions of goodness of fit. Further research is needed on the role of social validity in intervention research and the extent to which social validity measures are completed in a valid manner. The presence of social validity measures listed by Reichow and colleagues (2008) as a secondary indicator for rigor of design, and Goldstein and colleagues (2014) noted the importance of social validity when they form their framework for the evaluation of interventions for this particular population.

Social Involvement of Children with Autism Spectrum Disorders in Elementary School Classrooms

Erin Rotheram-Fuller, Ph.D.,*Connie Kasari, Ph.D.,**Brandt Chamberlain, Ph.D.,*** and Jill Locke, M.A.**

The publisher's final edited version of this article is available at J Child Psychol Psychiatry

See other articles in PMC that cite the published article.

Abstract

Background

Children with autism spectrum disorders (ASD) are increasingly included in general education classrooms in an effort to improve their social involvement.

Methods

Seventy-nine children with ASD and 79 randomly-selected, gender-matched peers (88.6% male) in 75 early (K-1), middle (2nd–3rd), and late (4th–5th) elementary classrooms across 30 schools completed social network surveys examining each child’s reciprocal friendships, peer rejection, acceptance, and social involvement.

Results

Across grade levels, peers less frequently reciprocated friendships with children with ASD than students in the matched sample. While children with ASD were not more likely to be rejected by peers, they were less accepted and had fewer reciprocal friendships than matched peers at each grade level. Although 48.1% of children with ASD were involved in the social networks of their classrooms, children with ASD were more likely to be isolated or peripheral to social relationships within the classroom across all grade levels, and this difference is even more dramatic in later elementary grades.

Conclusions

In inclusive classrooms, children with ASD are only involved in peers’ social relationships about half of the time, and appear to be even less connected with increasing grade level. Promoting children with ASD’s skills in popular activities to share with peers in early childhood may be a key preventive intervention to protect social relationships in late elementary school grades.

Keywords: Autism, Social involvement, Inclusive education, Social networks

Introduction

Both parent requests and legislative mandates have increased the number of children with Autism Spectrum Disorders (ASD) included in general education classrooms, regardless of their developmental readiness or environmental adaptations (Fuchs & Fuchs, 1994; Kasari, Freeman, Bauminger, & Alkin, 1999). By definition, children with ASD have difficulties with social relationships at all ages and functioning levels, including failures in effective communication, sharing enjoyment and interest, and emotional reciprocity (APA, 2000). Given these specific social challenges, many parents of children with ASD have advocated integrating these children into general education classrooms to improve children’s social functioning as well as expose them to the traditional curriculum (Gallagher et al., 2000; Hunt & Goetz, 1997; Kasari, Freeman, Bauminger, & Alkin, 1999; Ryndak, Downing, Jacqueline, & Morrison, 1995). However, it is unclear how effective inclusion has been at socially integrating children with ASD into the social structure of typical classrooms, and none have looked at differences in social involvement across grade levels. Our goal was to examine the patterns of social involvement of children with ASD in inclusive classrooms from kindergarten to fifth grade relative to a matched sample of typical peers to evaluate the social involvement of both groups across grade levels.

The benefits of social relationships are well documented among typically developing children. Having friends has been shown to be associated with pro-social skills (Gest, Graham-Bermann, & Hartup, 2001; Ladd, 2005), as well as increased academic achievement, reduced school dropout, and reduced risk of later adjustment problems (Brendgen, Wanner, Morin, & Vitaro, 2005; Farmer et al., 2008; Middleton, Zollinger, & Keene, 1986). Increased social interactions among children have also been shown to improve both social play behavior, as well as language skills (Wolfberg & Schuler, 1993; Rogers, 2000).

Early reports on inclusive classrooms have been encouraging, showing that children with ASD who are included in typical classrooms show improvements in their social initiations, and the ability to generalize learned social skills in school (Carr & Darcy, 1990; Harrower & Dunlap, 2001). In inclusive classrooms, typical peers can be social role models, encouraging the maintenance and generalization of social skills that are often not achieved when using an adult role model in a clinical intervention (Carr & Darcy, 1990; Roeyers, 1996; Shearer, Kohler, Buchan, & McCullough, 1996).

The efficacy of inclusion alone on the social development of children with ASD is not entirely clear. Some parents report their child’s inclusive experience as characterized by peer acceptance, and even being able to form meaningful friendships with their non-disabled classmates (Ryndak et al., 1995; Staub et al., 1994). However, other studies have shown inclusion to be insufficient to truly integrate children with ASD into the social networks of their typical peers (Burack, Root, & Zigler, 1997; Chamberlain, et al., 2007), and may even be to their social detriment (MacMillan, Gresham, & Forness, 1996; Ochs, Kremer-Sadlik, Solomon, & Gainer Sirota, 2001; Sale & Carey, 1995). For older children and adolescents, especially, inclusion alone does not predict the presence of a reciprocal social relationship (Orsmond, Krauss, & Seltzer, 2004). It is unclear, however, whether differences seen across studies are a result of children’s level of social involvement, or an artifact of measurement practices. Parent and teacher reports are indirect, as they may not be privy to children’s activities and associations at school (especially play time). Thus, aggregated student reports were used in this study to get cross-validated impressions from multiple students on the social structure of each classroom.

There are substantial shifts within social relationships throughout elementary school. Children at the kindergarten level are more accepting of differences than their elementary school counterparts, and often associate with peers of all types, based primarily on proximity in the same classroom (Rubin, Chen, Coplan, & Buskirk, 2005; Rubin, et al., 1983). Friendships in late elementary school, however, begin to show more companionship with peers than in earlier grades, as children develop feelings of intimacy through self-disclosure as well as play activities (Freeman & Kasari, 2002; Rubin et al., 2005). The size of friendship groups also increase with grade in elementary school (grades 1–4), peaks during the middle school years, and then declines in adolescence (beginning in 8th grade; Berndt & Hoyle, 1985; Neckerman, 2006; Rubin et al., 2005). However, these developmental shifts in friendships remain unexplored among children with ASD.

Children with ASD show a desire for friendships (Bauminger & Kasari, 2000), but remain at an increased risk of social problems in regular classroom settings. High-functioning children with ASD in included classroom settings are more often neglected and rejected than their typical classmates (Ochs et al., 2001), as well as have fewer friendships, poorer friendship quality with their friends, and more loneliness at school compared to their typical peers (Bauminger & Kasari, 2000). These children initiate interactions less often with peers, are less proximal and engaged with peers, show more non-social behaviors, and are more often rated as having poor social behaviors by their teachers (Koegel, Koegel, Frea, & Fredeen, 2001; McConnell, 2000). Additionally, children with ASD have been shown to be less accepted by peers and are viewed as less central members of their classroom social structure as compared to typical classmates (Chamberlain, et al., 2007). Despite delays in developmental shifts in social involvement for children with ASD, these changes are important to explore in manners similar to the literature on typically developing populations. Including information on the age and grade of participants throughout research studies is critical, and studies that group children across grades looking at social involvement should be interpreted with caution.

Based on this existing literature, we hypothesized that children with ASD may be able to form and maintain social relationships at earlier grades, but have more trouble with these relationships in later elementary school. Thus, we studied differences in the social involvement of children both with and without autism at different grade levels. Each child’s friendships, levels of peer acceptance and rejection, and position within the classroom social networks (e.g., centrality) were examined.

Method

Families of children with ASD were recruited from participating local area schools, as well as self-referrals based on outreach activities and community agencies. Families wishing to participate were asked to contact the study investigator and provide written informed consent.

Schools and classrooms

Voluntary informed consent for participation was obtained from the principals of 30 schools, 79 parents of children with ASD and 1063 parents of typical peers in 75 classrooms in the greater Los Angeles County area. Child assent was also required from all participating children; both children with ASD and typical peers (n=1,142). As study measures assessed classroom level social networks, participating students reported on all classroom peers. Therefore, an additional 1106 peers whose families did not sign consent were anonymously listed as ‘other peers’ within the classroom, but did not complete study measures. Class sizes averaged 30.08 students (sd=14.36), with a minimum of 50% of children in each classroom participating to ensure reliability of data. Only four of classrooms contained two children with ASD, whereas all other classrooms contained one. No other information was obtained about the diagnostic status of any other children in the classroom. Classrooms were grouped into three levels of elementary school: 1) early: kindergarten and 1st grade (n=19 classrooms, n=20 children with ASD; 456 typical peers); 2) middle: 2nd and 3rd grade (n=36 classrooms, n = 38 children with ASD, n = 853 typical peers; and 3) late: 4th–5th grade (n=20 classrooms; n = 21 children with ASD, n = 860 typical peers).

Once data was collected from all children within these classrooms, we randomly selected one gender-matched participating peer from within the same classroom of each child with ASD to be included in the comparison group. This resulted in a matched sample of 79 typical peers: 20 in early elementary; 38 in middle elementary; and 21 in late elementary classrooms.

Child participants

For each grade grouping, children with ASD were overwhelmingly male (88.6%; n = 70), and diverse in ethnicity, with 38.0% Caucasian, 19.0% Latino, 13.9% Asian, 5.1% African American, and 6.3% of other ethnicities. Overall, the average age of children with ASD was 8.11 years (sd=1.57). All diagnoses were confirmed by an independent evaluation of the child prior to participation. Participants who had recent evaluations (within one year prior to participation) were not required to attend the Autism Evaluation Clinic to receive an additional assessment. Of the 65 children for which we obtained a full differential diagnosis, the majority of children had a diagnosis of autism (75%, n = 49), with the remaining participants being identified as having Asperger’s disorder (25%, n = 16). The remaining 14 participants were only identified as having “ASD.” California schools do not use IQ in their assessments of children, so files provided by parents often did not include IQ. IQ was not used to include or exclude children within this study, but only as a demographic descriptor for those children who did attend the Autism Evaluation Clinic. A total of 65 of the children with ASD were administered the Weschler Intelligence Scale for Children-III (WISC-III), which yielded an average full scale IQ of 91.4 (sd = 17.3; range = 52–129). Children’s IQ did not differ based on age or grade level, but did differ as a function of diagnosis. As expected, children with a diagnosis of autism had a significantly lower average IQ (M=85.36, sd =14.21) compared to children with Asperger’s disorder (M=102.31, sd= 19.41, t(59) =−3.71, p<.001).

Among the 79 typical peers, 88.6% were male, as they were matched to the children with ASD, however, we do not have information on ethnicity. Given the high rate of similar ethnicity within each classroom, however, we anticipate that the random selection of gender-matched controls resulted in a sample similar in ethnicity to the children with ASD.

Procedures

All participating children completed a Friendship Survey (Cairns & Cairns, 1994) in a group administration format, with clear instructions to ensure comprehension and individual assistance provided for any children without good reading/writing skills, or difficulties understanding instructions. This nomination procedure results in a robust picture of the full set of classroom social networks with as few as 50% of the children in a classroom participating (Cairns & Cairns, 1994, p.101), and has been demonstrated to be successfully utilized by children with ASD to rate their social involvement (Chamberlain, et al., 2007; Farmer & Farmer, 1996). On the Friendship Survey, children were asked to nominate students in their classroom in three categories: 1) children that they like to “hang out with” and then circling their three closest friends, and putting a star next to their best friend in the class; 2) children that they did not like to “hang out with” in their class; and 3) list children who “hang out together” in groups. Using this free-recall method indicated each child’s salience in the social structure of the class. From these student reports, multiple measures were calculated.

1. Reciprocal top 3 friendships and best friend

Reciprocal friendships refer to the number of peers who mutually listed each other as their top 3 friends within their class. Best friendships were only counted if they were reciprocal. In the event that a peer listed a child as a friend who did not complete the questionnaire, this information was coded as missing data instead of a non-reciprocal friendship.

2. Acceptance

Acceptance for each child was calculated using a z-score of the total number of friend nominations received from all other peers within the classroom. Thus, this provided a score of relative acceptance for each child within the classroom ranging from −1 to +1. Using this z-score, 0 represented the average level of acceptance within the classroom, and negative scores represented acceptance that was lower than the average, while positive scores represented above average levels of acceptance.

3. Rejection

A sum of the number of peers who listed a child as one that they did not like to hang out with was also transformed into a z-score within the class. This number provided the relative level of rejection within each classroom for each student similar to levels of acceptance.

4. Social Network Centrality

Centrality refers to the prominence of an individual in the overall classroom social structure. Three types of centrality were evaluated, each student’s: 1) “individual centrality,” 2) “cluster centrality,” and 3) “social network centrality” (SNC). Using methods developed by Cairns, and described by Farmer (Cairns, Gariepy, & Kinderman, 1990; Farmer & Farmer, 1996), the first two types of centrality were used to determine the third. Based on Farmer and Farmer (1996, p.437), there are four levels of “social network centrality” that are possible, ranging from isolated to nuclear (0= isolated, 1=peripheral, 2=secondary, and 3=nuclear). Isolated status refers to children without any connections to peers in the classroom, while peripheral status refers to those students who have only tenuous connections to one or two peers. Secondary status describes those children who are involved in the classroom social network, but not the most nominated students in the class, whereas nuclear status represents those students who are most frequently nominated by classmates as having friends. For the purposes of these analysis, this 4-level variable of SNC was further collapsed into a two-level variable, separating those students that were peripheral or isolated (low SNC) relative to students who had secondary or nuclear centrality status (high SNC).

5. Social Connections

The total number of social connections was calculated from the classroom social network map for each child within the classroom. A co-occurrence matrix of all social relationships was developed based on reports from all students completing the survey within the classroom, and any significant correlations (above 0.40) between two students within the classroom were considered social connections (see Cairns & Cairns, 1994 for a full description of analysis procedures).

Data Analysis

The distributions of social network variables met standard statistical assumptions. Analyses were two-tailed, and a level of p < .05 was used as a cutoff to identify significant results. All Friendship Survey outcomes were compared by both autism status and grade level (early, middle, or late). Effects of class size and gender, ethnicity and IQ of children with ASD were controlled within analyses, but produced the same pattern of results across grade groups, thus, original analyses are presented. One exception is noted in the results.

Results

Within the group of children with ASD, there were few differences across grade group levels. Although low across all grade groups, children with ASD were significantly more socially included in early (55.0%) and middle (57.9%) grades than later grades (23.8%; χ2(2)=6.81, p=0.03). However, there were no significant differences by grade level in the amount of top 3 reciprocal friendships, best friendships, acceptance or rejection by peers, or the total number of social connections. Children with ASD did receive nominations as friends (M=1.68, sd=1.84), and often nominated several peers as friends (M=4.19, sd=2.94), however, these nominations often did not match between the typical children and children with ASD, as we see low rates of reciprocal top 3 (21.2%) and best friendships (11.6%). Children with higher (secondary or nuclear) SNC were compared to those who had lower (peripheral or isolated) SNC on demographic characteristics, but no differences were found. Controlling for child factors (gender, ethnicity, and IQ), children with ASD who had at least one reciprocal friendship had significantly higher SNC (M=1.59, sd=0.91), and acceptance (M=−0.29, sd=1.08) relative to children with ASD with no reciprocal friendships (SNC M=1.19, sd=0.74, F(1,53)=4.33, p=0.042; acceptance, M=−0.95, sd=0.75, F(1,53)=8.63, p=0.005).

Among the matched sample of typical peers, there were no differences across grade group levels in SNC, reciprocal top 3 or best friendships, or rejection, however, children were significantly more accepted by their peers in the early grades (M=0.63, sd=0.87) than in the middle (M=−0.05, sd=0.63) or later grades (M=−0.06, sd=0.89; F(2)=4.39, p=0.017). Typically developing children also showed significantly higher numbers of social connections in the older (M=5.57, sd=3.01) relative to middle grades (M=4.03, sd=2.05; F(2, 76)= 3.47, p=0.036).

Although approximately half (48.1%) of children with ASD were socially involved in their classrooms (secondary or nuclear SNC), this was significantly lower than the percentage of typically developing peers within the same social network status (91.1%; χ2(1)=34.59, p<.001; see Table 1). Children with ASD were also significantly lower than typical classmates in almost all measures of social involvement, except rejection from peers.

Table 1

Social Involvement of Children with ASD compared to Gender-Matched Typical Peers across all Grade Levels

When separating comparisons within each grade group, results showed a slightly different pattern (see Table 2). Overall, children with ASD were still far below their typical classmates on most measures of social involvement; however, there were fewer differences in the early than in middle and late grade groups. For example, within the early grade group, children with ASD and typical peers had similar rates of reciprocal best friendships, while in the middle and late grade groups, children with ASD showed significantly lower rates of reciprocal best friendships than typical classmates (middle χ2(1) =7.86, p=0.005; older χ2(1)=7.20, p=0.007). Although acceptance was significantly lower for children with ASD than typical peers across all grade groups, rejection by peers remained non-significant regardless of grade.

Table 2

Social Involvement of Children with ASD compared to Gender-Matched Typical Peers at Each Grade Group

Discussion

This study explored the social networks of children with ASD and a matched set of their typical peers in early, middle, and late elementary school. There were three major observations. First, in inclusive classrooms with at least one child with ASD, typical children’s social involvement demonstrated normative, developmental patterns. Across all grade groups, typical students were socially connected to their classmates, with higher numbers of social connections in the higher elementary grades, as would be predicted by previous research (Berndt & Hoyle, 1985; Rubin et al., 1983; Rubin et al., 2005).

Second, children with ASD had significantly fewer reciprocal relationships in all grades relative to typical classmates. Reviewing both student’s reciprocal top 3 and best friendships, results demonstrated that children with ASD looked more similar to classmates in early grades in contrast to middle and late grades, although they have significantly fewer reciprocal top 3 friendships across all grade groups. Given these differences, it appears that social involvement was at its peak for children with ASD in the early and middle elementary school years.

Reciprocity is a key component of friendships that offers bonding, intimacy, and support (Berndt, 1998; Buhrmester, 1998; Freeman & Kasari, 2002). However, children with ASD showed misperceptions of their social involvement, as they listed children as friends who did not consider them within their social group. This replicates earlier findings by Bauminger and Kasari (2000), and Chamberlain and colleagues (2007), who also found that children with ASD did not accurately report their friendships. It is still unclear, however, whether this misrepresentation stems from a misunderstanding of the nature of friendships, or an inability to assess the reciprocal nature of their own relationships. The importance of friendships was highlighted, however, by the finding that children with ASD who had at least one reciprocal friendship were more socially involved in their classroom social networks and more accepted by peers overall. More information is needed to clarify the role of individual reciprocal friendships in assisting children with ASD to become more fully involved in the classroom social structure.

The most dramatic difference between children with ASD and typical peers, however, was in their SNC scores. Across all grades, children with ASD were significantly lower in their social network centrality relative to typical classmates. Only 55.0% and 57.9% of children with ASD were considered nuclear or secondary in classroom social networks at the early and middle grades, respectively, while only 23.8% of children with ASD were in that category in the later grades. These are incredibly low rates of inclusion relative to their typical peers, who were considered to be nuclear or secondary within the classroom at rates of 95.0%, 92.1%, and 85.7% respectively across the grade levels. This dramatic downward shift in the late elementary grades among children with ASD may suggest many changes between the middle to late grade level groups. Peers may begin to not only recognize differences between themselves and the child with ASD, but also become much less tolerant of differences and aberrant behaviors (Santrock, 1997). Peers may also become more aware of and fear stigma that could be linked to them if they associate with a child within the classroom that is otherwise rejected (Major & O’Brien, 2005).

Still, it is encouraging that overall, 48.1% of children with ASD were socially involved within their classroom social networks (secondary or nuclear). These are encouraging results to support classroom inclusion, especially in the younger and middle grade group levels. Unfortunately, there were no demographic variables collected that distinguished these children. Future studies should focus on obtaining more complete demographic and functioning information to be able to identify child level predictors of social involvement. On the other hand, we may also need to look outside of characteristics of the child to environmental factors that were not measured in this particular study, to explore other aspects that might be impacting their social involvement.

One explanation for differences observed in the social involvement of children with ASD across grade groups is in the games played on the playground. In the oldest grade group level, games become more sophisticated, and sportsmanship becomes increasingly important. Solitary play is directly associated with peer rejection (Spinrad et al., 2004), which is a common feature of ASD. Cooperative games that can be played in a parallel or solitary fashion in early grades are replaced by competitive ones in later grades. Children with ASD often lack motor coordination and have difficulty understanding games, especially with complex or changing rules. This puts children with ASD at a significant disadvantage with their peers as children get increasingly competitive in later grades. Especially for boys (which are disproportionately represented at a higher rate within ASD) in the later elementary school years, sports are a considerable source of group identity. Many typically developing boys, when completing the social network questionnaire, listed children according to who played which game on the yard (i.e. basketball group, etc.), and not being a part of one of those groups may leave children with ASD on the periphery.

One of the limitations of this project was the small sample size of children with ASD, especially females. Greater information on female children with ASD could possibly shed light on gender dynamics with peers that cannot be seen with this limited group. In addition, the small sample size of children with ASD allowed a comparison of only three aggregated grade groups of children, which may neglect differences between individual grades. Further exploration with larger numbers of children with ASD would be optimal to more fully evaluate the developmental changes in social involvement in each grade level. Future research may also need to examine relationship quality or loneliness, in addition to the level of social involvement, to get a better understanding of the impact of peer relationships on the child with ASD.

Another consideration for future studies is to use a different comparison group. As parents are often asked to choose between inclusive or separate settings for their child’s education, having more information on differences between these two settings on the involvement of children with ASD in the social group of each type of classroom might be valuable to inform children’s placement.

The cross-sectional design of this study also limits understanding of what changes might occur across grades within the group of children with ASD. Further characterization of the functioning of each child with ASD, as well as the classrooms and peers could provide essential information on the match between children’s abilities and general education classrooms that best promote social involvement. Having longitudinal studies watch well-characterized children over time could help specify the challenges that arise for certain children with ASD that could better explain the drop in social involvement at the oldest grades.

This study represents a first look at differences in social involvement for children with ASD at three elementary school grade group levels. Children with ASD show a considerably different pattern of social network inclusion from their typical classmates. Although inclusion alone may be sufficient to integrate some children with ASD into the social structure of classrooms in the younger and middle elementary school years, more assistance may be needed at the older grades to facilitate true social involvement. Changing demands in both cognitive and physical skills, with emerging and evolving competitive games leave children with ASD significantly less included than their typical classmates. Longitudinal studies are clearly needed to follow children with ASD throughout these elementary school years, and specifically examine the challenges that arise to make social involvement in the later years so much more difficult.

Key Points

  • Across grades, almost half of children with ASD were socially involved in their regular education classroom social networks.

  • The involvement of children with ASD in classrooms is comparable to typical peers in early elementary grades, but lower than peers in older elementary grades.

  • Reciprocal relationships are a considerable challenge for children with ASD within regular education classrooms across grade groups.

  • Common activities and skills building may be necessary to fully involve children with ASD in the social groupings of their peers, beyond current inclusion practices.

Acknowledgments

This work was supported by grant NIH MH 068172 and the Center for Autism Research and Training at UCLA.

Abbreviations

SNC
Social Network Centrality

Footnotes

There are no conflicts of interest by any authors of this manuscript.

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