Challenges in peer interaction are commonly associated with autism, both within research literature and through first-person accounts. Related intervention studies have tended toward a skills-based approach that emphasizes remediating perceived social deficits in the autistic individual, with most of the literature focusing on children who are classified as “high functioning” due to their verbal skills and/or typical IQ scores. Limitations in this skills-based approach have led to the development of a supports-based approach—based largely on a distributed model of communication—as an alternative way to facilitate peer interactions involving autistic students (Vidal, Robertson, & DeThorne, 2018). This supports-based approach prioritizes egalitarian interactions, participation in shared activities, and flexible access to multimodal communicative resources.
The present mixed methods study was designed to examine the communication profile and peer interactions of John, a 9-year-old autistic child with inconsistent access to speech and concomitant diagnoses of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) and apraxia. In addition to behavioral assessments of John, data collection included interviews of John and 8 other adult and peer participants as well as 20 video-taped observations during art class. An ABAB design was employed to assess the functional relation between the social supports provided during art class and differences in peer interaction, measured via communicative offers and interpersonal synchrony between John and one of his non-autistic peers.
In regard to key findings, John’s speech-language profile was characterized by use of single words, emergent word combinations, some conventional gestures, concomitant language comprehension challenges, and poor intelligibility associated with motor speech impairment.
His sensory-motor profile included fine motor impairments, gross motor strengths, and sensory differences across visual, hearing, and tactile modalities. John’s peer interactions at the beginning of the study were relatively limited and characterized as single-turn and non- egalitarian with a prominence of eye gaze. The implementation of social supports during art class was associated with increased peer interactions characterized by increases in shared eye gaze, eye contact, shared activity, turn-taking, and emergent egalitarian interactions. In addition, peers and other adults were noted to adopt routines and strategies introduced by the examiner.
The present study is pioneering in providing a detailed description of the communicative profile and peer interactions of an autistic child with limited speech. It also contributes to the evidence base for use of a supports-based approach to facilitating peer interaction for autistic students in the classroom. Additional considerations for clinical practice and future research are also discussed
