a systematic review of peer-mediated interventions …

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Theses and Dissertations--Early Childhood, Special Education, and Counselor Education

Early Childhood, Special Education, and Counselor Education

2020

A SYSTEMATIC REVIEW OF PEER-MEDIATED INTERVENTIONS A SYSTEMATIC REVIEW OF PEER-MEDIATED INTERVENTIONS

AND TOPIC MAINTENANCE FOR INDIVIDUALS WITH AUTISM AND TOPIC MAINTENANCE FOR INDIVIDUALS WITH AUTISM

SPECTRUM DISORDER SPECTRUM DISORDER

Alyssa Colston University of Kentucky, [email protected] Digital Object Identifier: https://doi.org/10.13023/etd.2020.162

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Recommended Citation Recommended Citation Colston, Alyssa, "A SYSTEMATIC REVIEW OF PEER-MEDIATED INTERVENTIONS AND TOPIC MAINTENANCE FOR INDIVIDUALS WITH AUTISM SPECTRUM DISORDER" (2020). Theses and Dissertations--Early Childhood, Special Education, and Counselor Education. 91. https://uknowledge.uky.edu/edsrc_etds/91

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REVIEW, APPROVAL AND ACCEPTANCE REVIEW, APPROVAL AND ACCEPTANCE

The document mentioned above has been reviewed and accepted by the student’s advisor, on

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Alyssa Colston, Student

Dr. Justin Lane, Major Professor

Dr. Melinda Ault, Director of Graduate Studies

A SYSTEMATIC REVIEW OF PEER-MEDIATED INTERVENTIONS AND TOPIC MAINTENANCE FOR INDIVIDUALS WITH AUTISM SPECTRUM DISORDER

________________________________________

THESIS ________________________________________

A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Education in the

College of Education at the University of Kentucky

By Alyssa Colston

Lexington, Kentucky Director: Dr. Justin Lane, Professor of Education

Lexington, Kentucky 2020

Copyright © Alyssa Colston 2020

ABSTRACT OF THESIS


The purpose of the study was to evaluate the current literature on the use of peer mediated instruction to address topic maintenance for individuals with autism spectrum disorder (ASD). A literature review using the standards recommended by the What Works Clearinghouse was conducted. The studies included in the review met the following criteria: (a) use of SCRD; (b) inclusion of at least one participant with ASD as defined by the Diagnostic and StatisticalMental Disorders, 4th edition, Text Revision (American Psychiatric Association, 2000) or DSM-5 diagnosis of ASD; (c) examination of the use of peer instruction containing any of thefollowing words: PMI, peer training, peer networks (d) examination of the use of PMI on at leastone of the following dependent variables: topic maintenance, response to initiation on topic,reciprocity, sustaining conversation on topic, or response clearly contingent on the initiation; and(e) published in a peer reviewed journal in English in the last 10 years. This review highlightsfour main results: (a) the growing need for future research in topic maintenance interventions forindividuals with ASD; (b) the critical that future research is conducted to evaluate if PMI iseffective in all settings and level of communication needs in participants; and (c) it adds to theliterature that systematic intervention is needed to address social communication needs forindividuals with ASD.

KEYWORDS: Peer-mediated instruction, autism, topic maintenance

Alyssa Colston

May 11, 2020


By Alyssa Colston

Dr. Justin Lane Director of Thesis

Dr. Melinda Ault Director of Graduate Studies

May 11, 2020 Date

iii

ACKNOWLEDGMENTS

I would like to extend my most sincere gratitude to my thesis chair, Dr. Melinda Ault. I

cannot thank you enough. I am incredibly thankfrul for your guidance and support throughout

not only this paper, but also academically throughout my entire graduate school program. Thank

you for sharing your passion and dedication to achieving meaningful outcomes for those we

serve. To the rest of my thesis committee, Dr. Amy Spriggs and Dr. Justin Lane, thank you for

your continuous support and flexibility to help me complete my masters program. You all

provided unique and invaluable perspectives. I am grateful for your contributions both to this

project and also to my graduate school experience. I am also eternally grateful for my family and

friends, especially to my husband Kenny and my precious dog named Juno. Juno completed

graduate school classes as well because he was with me every step of the way. Kenny, thank you

for putting up with me when I was ridiculously stressed. The unwaivering support that you have

provided me throughout this process has meant the world to me.

iv

TABLE OF CONTENTS

ACKNOWLEDGMENTS iii

LIST OF TABLES v

CHAPTER 1. Introduction 1

CHAPTER 2. Literature Review 3 2.1 Peer Mediated Instruction 3

2.2 Topic Maintenance 3

CHAPTER 3. Methodology 9

3.1 Search Procedure 9

3.2 Inclusion Criteria 9 3.3 What Works Clearinghouse Indicators 10

3.4 Descriptive Analysis 12 3.5 Interrater Reliability on Quality Indicators and Study Characteristics 12

3.6 Data Collection 13 CHAPTER 4. Thesis Research 14

4.1 Participants 14 4.2 Settings 15

4.3 Dependent Variables 15 4.4 Independent Variables 16

4.5 Results 17 4.6 Student Social Outcomes 18

CHAPTER 5. Discussion 19 5.1 Conclusion 20

APPENDICES 22 APPENDIX 1. RIGOR DATA SHEET 23

APPENDIX 2. DESCRIPTIVE CODING KEY 27 APPENDIX 3. PEER MEDIATED INSTRUCTION PRESENTATION 31

REFERENCES 60

VITA 65

v

LIST OF TABLES

Table 1 Evaluation of Studies using What Works Clearinghouse Guidelines 22 Table 2 Descriptive Analysis 7

1

CHAPTER 1. INTRODUCTION

The prevalence of autism spectrum disorder (ASD) has increased in the last two decades,

alongside a heightened focus on interventions for those affected by the disorder (Leonard et al.,

2010). In 2018, the Centers for Disease Control (CDC) determined that approximately 1 in 59

children is diagnosed with ASD. Individuals diagnosed with ASD are characterized as having

deficits in social communication and displaying repetitive patterns of behavior or perseverative

interests in activities (American Psychiatric Association, 2013). These deficits impact individuals

with ASD, especially in their ability to take advantage of social experiences or opportunities for

social interactions in the classroom, community, and at home (Eaves & Ho, 1997). Practitioners

often identify social behaviors as target skills for intervention because of the potential to

positively affect individuals’ long-term social interactions, and in turn, reduce the likelihood of

loneliness, isolation, and peer rejection (Bollmer et al., 2005; Parker & Asher, 1993). In addition,

acquiring social skills can lead to meaningful employment in real-world settings that are tied to

many quality of life indicators (Trainor et al., 2008).

A number of evidence- and research- based practices for promoting socio-communicative

skills are available in the literature. Skills that have been taught successfully include, but are not

limited to, initiating and responding to compliments, appropriate question asking and responding

to questions, elaborating on topics, maintaining topics during conversation, joining in

appropriately and maintaining conversation, and appropriate comments during conversations.

(Sng, Carter, & Stephenson, 2013). Interventions shown to be effective in teaching these skills

include pivotal response training (Koegel et al., 2013), echoic and textural prompts, prompt

fading (Swerden & Rosales, 2017), video self- modeling (Charlop et al., 2010), social stories,

and social skills groups (Tierney et al., 2014), and peer mediated instruction (Bambara et al.,

2

2016). Of these, the approach proven to be the most established is peer mediated instruction/

intervention (Wong et al., 2014).

3

CHAPTER 2. LITERATURE REVIEW

2.1 Peer Mediated Instruction

Peers providing instruction is known as peer-mediated instruction (PMI) and involves

interventions in which peers are taught to systematically provide instruction to students with

disabilities. In a PMI intervention, peers are trained to implement elements of behavioral

interventions (McFadden et al., 2014). PMI has several advantages for students with ASD

(Bambara et al., 2018). First, PMI is an evidence-based practice for students with ASD across all

age groups (Wong et al., 2015). Second, PMI can be individualized for any scenario or situation

to meet the target behavior (Huber & Carter, 2016).

PMI social skills interventions involve training peers to model, initiate, prompt, and/or

reinforce social behavior and interactions with target children (Kamps et al., 2002). Thus, the

third advantage is that PMI can take place during naturally occurring social opportunities with

typically developing peers, who are the natural experts of an age- appropriate conversation

(Bambara et al., 2018). Additionally, training peers using direct instruction on how to interact

with students with ASD is effective in increasing tolerance for individuals who have special

needs, as reflected by an affirming atmosphere, filled with positive reinforcement and equal

engagement in tasks (Sperry et al., 2010). Consideration for PMI’s effectiveness is important, as

a study by Bass and Mulick (2007) indicated that PMI is the most supported social intervention

for students with ASD.

2.2 Topic Maintenance

Deficits in social-emotional reciprocity, including using turn taking during conversation,

is a deficit for individuals with ASD. These deficits involve restricted, repetitive patterns of

behaviors, interests, or activities (American Psychological Association, 2013). These two deficits

4

together create a challenge for individuals with ASD which can be referred to as an inability to

maintain a topic during a conversation, also known as topic maintenance (Wanska et al., 1986).

Topic maintenance can be defined as maintaining the flow of the conversation by monitoring the

communication partner’s input, adapting to the partner’s talking, being logically consistent with

the current topic of the conversation, and choosing the topic of the conversation for their

conversation turn (Wanska et al., 1986). Conversations in which the communication partners

maintain the topic indicates that the communication partners are aware of their communication

partner’s initiations, responses, comments, or follow up questions (American Psychiatric

Association, 2013).

Topic maintenance has also been referred to as any verbal response that is related to a

communication partner’s prior conversational act (Bambara et al., 2018). A communication act

that either refers to, or is on topic with, recent initiations or responses of other group members or

one that refers to ongoing events, items, or actions is on topic (McFadden et al., 2014). However,

given that the research evidence on PMI as it pertains to topic maintenance is not well-

established, researchers should conduct additional examinations of the evidence-base to provide

recommendations based on findings studies using rigorous research methods.

The current review will compile the literature and determine rigor on PMIs by focusing

on studies that used single case research designs (SCRD) for individuals with ASD that targeted

topic maintenance, either as a primary dependent variable or as defined in the response

definitions. Specifically, the current review summarizes the descriptive information and rigor for

all articles found in the search. The purpose of this comprehensive literature review was to (a)

collate and present the components of SCRD studies conducted on topic maintenance, and (b)

determine the rigor of the studies based on WWC guidelines on single case research. All of the

5

studies reviewed have been published in the last 10 years. Reviewing research in the last 10

years was done as advised by the thesis committee.

6

CHAPTER THREE

METHODOLOGY

3.1 Search Procedure

The existent literature was reviewed to evaluate the evidence-base for using PMI to

increase topic maintenance for children with ASD. The following search terms were used: ASD,

topic maintenance, PMI, communication, and responses within an electronic search of the

following search engines: PsycInfo, ERIC, Academic Search Complete, Psychology and

Behavior Sciences Collection, and MasterFile Premier. A hand search also was done in the

following journals: Research in Autism Spectrum Disorders, Journal of Communication

Disorders, Research in Developmental Disabilities, and Journal of Autism and Developmental

Disorders, and the reference lists of the studies were examined to hand search for articles whose

titles referred to topic maintenance, PMI, social communication, or peer training in the last 10

years. A total of 2, 201 articles were found using this keyword search. Those journals were

selected as recommended by my thesis chair. Titles and abstracts were examined for the

inclusion in the literature review. All articles published before 2010,literature reviews, and

rarticles that did not use a SCRD were then removed. Twenty-three articles remained but only 6

studies met the inclusion criteria.

3. 2 Inclusion Criteria

The studies included in the review met the following criteria: (a) use of SCRD; (b)

inclusion of at least one participant with ASD as defined by the Diagnostic and Statistical

Mental Disorders, 4th edition, Text Revision (American Psychiatric Association, 2000) or DSM-

5 diagnosis of ASD; (c) examination of the use of peer instruction containing any of the

following words: PMI, peer training, peer networks (d) examination of the use of PMI on at least

7

one of the following dependent variables: topic maintenance, response to initiation on topic,

reciprocity, sustaining conversation on topic, or response clearly contingent on the initiation; and

(e) published in a peer reviewed journal in English in the last 10 years. Unpublished dissertations

did not qualify for inclusion. For the purposes of this review, topic maintenance was considered

to be a verbal communication act in response to an initiation by a typical peer. In the reference

list, a single asterisk will be used to identify studies included in the review and two asterisks will

be used to identify studies rated as meets evidence standards or meets evidence standards with

reservations and retained for further analysis.

The inclusion criteria were applied to the manuscripts that were obtained from the search.

I scanned the abstracts and determined if yes-they did meet the inclusion criteria, no-they did not

meet the inclusion criteria, or maybe- they might meet the inclusion criteria. I sorted them into

different piles based on my determination. At this point, I had three in the yes-these studies meet

my criteria for inclusion pile and 20 in the maybe-they might meet the criteria for inclusion pile.

For the articles that might meet inclusion criteria, I read each in more detail to make a permanent

determination. After reading, I determined four of these articles met the inclusion criteria. After I

finalized all of the studies that met the inclusion criteria, I then looked at their reference lists to

pull studies based on the title of the article referred to topic maintenance, peer mediated

instruction, social communication, or peer training in the last 10 years and found one more

article that qualified for inclusion.

3.3 What Works Clearinghouse Indicators

A member of the thesis committee created a data sheet that was used to determine the

presence or absence of each indicator to evaluate rigor of the SCRD (J. Lane, personal

communication, September 23, 2019). The data sheet is shown in Appendix A. Each study was

8

evaluated using these categories, based on the What Works Clearinghouse (WWC) Standards

Handbook, version 4.1 (2020). The eight categories were: (1) systematic manipulation of the

independent variable (IV), (2) adequate attempts to demonstrate the effectiveness of the IV (2)

collection of interobserver data for at least 20% of all sessions in each condition, (3) at least three

data points per condition, (4) if not, at least three data points per condition, (5) interobserver

agreement of at least 80% of all sessions, (4) procedural fidelity of at least 20% of sessions in

each condition (5) procedural fidelity of at least 80% and (6) rating (i.e. meets design standards,

meets design standards with reservations, does not meet design standards).

The definitions for each quality indicator were detailed in the What Works Clearinghouse

Standards Handbook, Version 4.1 (2020). To have a systematic manipulation of the independent

variable, the researcher is able to determine when and how the independent variable conditions

change (e.g. baseline to intervention). Determination was based on (a) data in baseline were

trending low, (b) the data pattern within baseline was consistent enough to predict how the data

would look if there was no phase change (consistent levels), and (c) there was a significant

change between the baseline and intervention (Disord, 2015). Three attempts to systematically

manipulate the independent variable needed to occur to qualify the study as Meets Design

Standards and Meets Design Standards with Reservations. Depending on the design type, phases

met adequate criteria if the design involved a specific number of data points per phase. All of the

studies that met the inclusion criteria were either multiple baseline or probe studies. For multiple

baseline or probe studies, there must have had a minimum of six phases with at least five data

points per phase to be rated Meets WWC Single Case Design (SCD) Standards Without

Reservations, specified as meets design standards (MDS). The studies must have had a minimum

of six phases with at least three data points per phase to be rated Meets WWC SCD Standards

9

With Reservations, specified as meets design standards with reservations (MDwR). Any phases

that had less than three data points will result with the rating Does Not Meet WWC SCD

Standards, specified as does not meet design standards (DNM). Studies were rated as DNM if

they failed to systematically manipulate the independent variable, if there were not at least three

demonstrations of effect, absence of IOA data or IOA data below the acceptable level (at least

20% of sessions with 80% accuracy), absence of PF data or PF data below the acceptable level

(at least 20% of sessions with 80% accuracy) and/or insufficient data points per session. After

the authors evaluated each of the studies, each were characterized as MDS, MDwR, or DNM.

3.4 Descriptive Analysis

For the studies that were rated as MDS or MDSwR, I coded the articles in terms of the (a)

author, (b) design, (c), participants, (d) setting, (e) instructor, (f) dependent variable, (g)

independent variable, (h) name of the independent variable as identified by the author, and (i)

results. The first author was the primary coder for each of the studies. Definitions of the specific

terms for the codes are detailed in Appendix B.

3.5 Interrater Reliability on Quality Indicators and Study Characteristics

Interrater reliability on quality indicators and descriptive characteristics was conducted

by the chair of the thesis committee, the reliability collector, Melinda Ault. Procedures included

the two of us coding one article to serve as training. The two authors reviewed one study and

then discrepancies were then discussed and consulted with one another to determine which

ratings were accurate. After the practice, I coded all of the articles using the quality indicators

and also completed the descriptive characteristics for all of the articles. I then sent all of the

articles to my reliability collector and the articles were put in a randomizer. Using an electronic

randomizer, the reliability collector gave each article a number based on alphabetical order and

10

coded the first two articles that came up (for 20% of the articles). We evaluated only the primary

dependent variables for rigor and were unaware of the first author’s coding and descriptive

characteristics for each study. Interrater reliability was calculated by using a point-by-point

reliability method. The number of agreements of was divided by the number of agreements plus

disagreements (i.e. all variables in the study for descriptive coding, all categories of rigor for

rigor), and the quotient was multiplied by 100 to convert the number into a percentage. Interrater

agreement for the rigor was 92% with 43 agreements, with a possible of 45 responses. Interrater

agreement for the descriptive coding was also calculated, with 94% agreement with 36

agreements, with a possible of 38 responses.

The descriptive information from all of the 7 articles that contained 16 studies can be

found in Table 2. Specifically, the table includes (a) design, (b) participants, (c) setting, (d)

instructor, (e) dependent variable, (f) independent variable, (g) investigation called, and (h)

results.

3.6 Data Collection

Five studies recorded data on the participants through video footage and coded the

responses after the sessions (Bambara et al., 2016; Bambara et al., 2018), three studies recorded

the participant behavior using Noldus Observer XT Software (2009; Kamps et al., 2014) and one

study recoded participants in vivo (Mason et al., 2014). All of the studies measured the

dependent variable using whole interval recording.

11

CHAPTER FOUR

THESIS RESEARCH

4.1 Participants

A total of 14 participants with ASD participated in the studies rated as MDS or MDSwR.

Four of the studies contained three participants (e.g., Bambara et al., 2016; Mason et al., 2014),

and five of the studies contained four participants (e.g., Bambara et al., 2018; Kamps et al.,

2014;). The qualifying studies contained participants ranging from elementary aged to high

school aged (6-20 years). Five of the studies contained participants in the high school setting,

ranging in age from 14-20 years (e.g., Bambara et al., 2016; Bambara et al., 2018), and four of

the studies contained participants in the elementary school setting, ranging from ages 6-8 years

(e.g., Kamps et al., 2014; Mason et al., 2014).

Each of the participants had a prior diagnosis of ASD as measured by assessments

administered to each of the participants prior to inclusion of the studies to confirm the

participants met the diagnostic criteria as well as to obtain a measure of severity. This varied

from the Childhood Autism Rating Scale (Bambara et al., 2016; Bambara et al., 2018, Mason et

al., 2014), to the Social Responsiveness Scale (Bambara et al., 2016; Bambara et al., 2018), to the

Vineland Adaptive Behavior Scales- Second Edition and the Peabody Picture Vocabulary Test-

4th edition (Mason et al., 2014), to unspecified clinical assessment and education assessment

(Kamps et al., 2014). Additionally, to qualify for the studies, all participants were able to speak

in two to three word sentences and were responsive to others. From this information, it is

possible that PMI is most effective for higher functioning individuals with ASD and those who

have oral speech. The review did not identify participants who were minimally verbal or used an

augmentative and alternative communication device.

12

All studies included typical peers; five peers were selectedwere via teacher nomination

(Bambara et al., 2018; Kamps et al., 2014), while five were recruited via student interest in

participating in the study (Bambara et al., 2016; Bambara et al., 2018). One study recruited peers

that the participants with ASD already knew (Mason et al., 2014).

4.2 Settings

All of the studies were conducted in public school settings. Five studies took place in

school cafeterias (Bambara et al., 2016; Bambara et al., 2018), one study took place during

regularly scheduled recess times (Mason et al., 2014), and three studies took place in either the

participants’ resource room or speech therapy room (Kamps et al., 2014). All of the data

collection conducted took place during group activities.

4.3 Dependent Variables

All of the studies included topic maintenance within their primary dependent variables.

Of the nine studies retained for descriptive analysis, nine studies measured the frequency of total

conversational acts (Bambara et al., 2016; Bambara et al., 2018; Kamps et al., 2014; Mason et

al., 2014;), nine measured the frequency of initiations (Bambara et al., 2016; Bambara et al.,

2018; Kamps et al., 2014; Mason et al., 2014), six measured the frequency of follow up

questions (Bambara et al., 2016; Bambara et al., 2018; Mason et al., 2014), and one measured the

frequency of on topic responses (Bambara et al., 2018; Kamps et al., 2014;). Increased frequency

of conversational acts and initiations were the most observed dependent measure across all nine

studies. All studies reported operational definitions for each of the behaviors. Five of the studies

included coded definitions for each behavior defined as a conversational act (Bambara et al.,

2018; Kamps et al., 2014). The definitions of the dependent variables are included in Appendix

A.

13

All of the observation measures examined children’s social behavior; however, most of

the studies used different operational definitions. An on-topic social communication act (i.e.

initiation, response, comment, request, follow up question) was recorded correct in different

ways for each study. Three studies examined conversational acts, initiations, and follow up

questions and no communication act was coded if the student used inappropriate or off-topic

verbalizations (Bambara et al.2016), three studies indicated on their coded definitions that for a

response to be coded, it must be in response to, or on topic within 3 s of a previous vocalization

(Kamps et al., 2014). Two studies included in the coded definitions that the follow-up questions

must be about the prior conversational act or the topic of the conversation, and later indicating

that for a comment to be scored correctly, it needed to be about a partner’s statement (Bambara

et al., 2018). One study specified that a verbalization, to be coded as a correct response, needed

to be meaningful and match the current context (Mason et al., 2014).

4.4 Independent Variables

Of the nine studies retained for descriptive analysis, all used daily training sessions to

measure effectiveness (e.g., Bambara et al., 2016; Bambara et al., 2018; Kamps et al., 2014;

Mason et al., 2014), eight of the studies used role play (e.g., Bambara et al., 2016; Bambara et

al., 2018; Kamps et al., 2014), and nine of the studies used daily/ weekly feedback (e.g.,

Bambara et al., 2016; Kamps et al., 2014; Mason et al., 2014). Nine of the studies used text or

visual cues (Bambara et al., 2016; Bambara et al., 2018; Kamps et al., 2014; Mason et al., 2014)

and five of the studies used peer prompting (e.g., Kamps et al., 2014). In addition, one of the

studies used adult prompting (Mason et al., 2014).

All of the studies used a treatment package. For example, three studies used a packaged

intervention of role play, daily/weekly feedback, text or visual cues, and daily training sessions

14

(Bambara et al., 2016). Five studies used role play, peer prompting, text or visual cues, daily

training sessions, and daily/ weekly feedback (Bambara et al., 2018, Kamps et al., 2014). One

study used daily/weekly feedback, adult prompting, text or visual cues, and daily training

sessions (Mason et al., 2014). Eight of the studies used daily training sessions in the form of

scripted materials and then the students were asked to role play using the strategies (e.g., ask

follow up questions, use the text or visual cue card, use phrases such as ‘ask me about it’). The

definitions of the independent variables are included in Appendix A. All of the studies included

in the review examined research questions using SCRDs. Of the nine studies retained for

descriptive analysis, all of them used multiple baseline across participants designs.

4.5 Results

A total of seven SCRD articles were found that met the inclusion criteria, with a total of

16 independent experiments within the seven articles. As per WWC recommendation, each

experiment was evaluated as a “study” with a total of 16 studies reported in the results. Of the

16, 5 (31%) of them were rated MDS, 4 (25%) were rated MDSwR, and 7 (43%) were rated

DNM. The reasons that studies did not MDS standards or MDSwR was because five of the

studies (31%) did not have at least 5 data points per phase (Bambara et al., 2018, Bambara et al.,

2016, Kamps et al., 2014). Four of the studies (25%) did not collect procedural fidelity (Barber et

al., 2015, McFadden et al., 2014), three studies (18%) did not have adequate attempts to

manipulate the independent variable, and two studies (12%) did not have at least 80% agreement

for IOA data in all phases (Banda et al., 2010). Table 1 shows the results from each study

analyzed.

15

4.6 Student Social Outcomes

All of the nine studies showed positive effects with a low percentage of overlap, and an

immediacy of effect to support the use of peer mediated instruction to increase on-topic social

communication acts. Nine studies indicated strong improvements in focal students’

conversational skills, including an increased number of conversational acts (Bambara et al.,

2016; Bambara et al., 2018; Kamps et al. 2014; Mason et al., 2014), eight studies showed

improvements in initiations (Bambara et al., 2016; Bambara et al., 2018; Kamps et al. 2014), and

three studies showed improvements in responses (Kamps et al, 2014). Five of the studies showed

improvements in comments (Bambara et al., 2016; Bambara et al., 2018) and five studies showed

improvements in follow up questions (Bambara et al., 2016; Bambara et al., 2018).

16

CHAPTER FIVE

DISCUSSION

The current review expands on previous literature on PMI in four ways. The purpose of

this literature review was to examine the findings in the research about subjects related to PMI

and its relationship to topic maintenance for individuals with ASD. First, This review highlights

the growing need for future research in topic maintenance interventions for individuals with

ASD. Although many of the response definitions included topic maintenance, it was not a

primary dependent variable in any of the studies included in this review. In the researcher’s

initial search, 25 articles were found. Of the 25 articles, only 8 (32%) contained information

regarding topic maintenance. One article was removed from the review completely because it did

not have a graphic display.

Second, it is possible that PMI is most effective for higher functioning individuals with

ASD and those who have oral speech. The review did not identify participants who were

minimally verbal or used an augmentative and alternative communication device . All of the

studies included students who could speak in two to three word phrases or in complete sentences.

Without comparable data on the majority of children with ASD who are not represented in

research, it is possible that PMI is effective for individuals who are able to communicate in 2-3

word sentences based on the research that I have. However, it is not possible to evaluate the

effects of PMI for participants who are unable do speak in 2-3 word sentence (Bambara et. al.,

2016). In addition, although this review evaluated the effects of PMI for elementary- aged and

high school- aged, it did not evaluate the effects for young adults with ASD as they transition to

the workplace. Because the social landscape changes drastically as young adults transition to

17

post-school, it is critical that future research is conducted to evaluate if PMI is also effective in

these settings (Miller et al., 2014).

Third, this review adds to the literature about the need for systematic intervention is

necessary, as proximity to peers alone does not necessarily result in the social interaction

(Bambara, 2016). All of the studies deliberately created opportunities for the individuals with

ASD to interact with their typical peers. Unlike other PMI studies (e.g. Hochman et al., 2015,

Hughes et al, 2013), where the only intervention provided to peer participants was proximity and

communication books for the children with ASD, a form of peer mediated instruction was

delivered to the peers affiliated in the studies included in the review. Peer models was proven to

be change agents for improving social behaviors (Kamps et al., 2014).

Although experimental control was obtained for all of the studies included in the review,

many of the studies used multiple components in an intervention to have an impact on student

behavior. For example, Bambara and fellow researchers (2016) used a packaged intervention of

peer prompting, role play, daily/ weekly feedback, text or visual cues, and daily training

sessions. It is unknown which procedure is having the most effects. Further analysis of removal

and addition of variables is needed to establish a clear role in each of the intervention

components.

5.1 Conclusion

Future research should be done to evaluate the strength of the evidence which was

outside the scope of my review. This can be done after the articles have been determined MDS or

MDSwR, then evaluated the studies using the quality indicators recommended by Kratochwill et

al., (2010), by conducting a visual analysis of each dependent variable to determine evidence

effectiveness. Establishing a reliable pattern of responding is something that needs to be done in

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the future for better rigor of intervention. In addition, more research on topic maintenance can be

done across age levels and across the entire spectrum of ASD, specifically including participants

in middle school (ages 12 to 14) and participants post- graduation as they attempt to gain

meaningful employment (after age of 21), and to include Asperger’s. I would have found more

articles if I had changed the search terms to include peer networks and Asperger’s.

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Table 1

Evaluation of Studies using What Works Clearinghouse Guidelines

Authors (Design) Systematic Manipulation of IV

Adequate Attempts to Demonstrate Effectiveness of IV

At least 5 Data Points in each Condition

If not, at least 3 Data Points per Condition

IOA Collected at 20% of sessions in each Condition

IOA was at least 80%

PF Collected at least 20% of sessions in each Condition

PF was at least 80%

Classification of Design Standards

Bambara et al. (2016) Fig. 1

Y Y Y n/a Y Y Y Y MDS

Bambara et al. (2016) Fig. 2- Initiations


Bambara et al. (2016) Fig. 3- follow up questions

Y Y N n/a Y Y Y Y MDSwR

Bambara et al. (2018) Fig. 1- initiations


Bambara et al. (2018) Fig. 1- follow up questions

Y N N n/a Y Y Y Y DNM

Bambara et al. (2018) Fig. 2- Conversational Acts


Banda et al. (2010). Fig.1 initiations

Y N Y n/a Y N Y Y DNM

Banda et al. (2010) Fig.1 responses

Y N Y n/a Y N Y Y DNM

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Barber et al. (2015) Fig. 1 initiations

Y Y Y n/a Y Y N n/a DNM

Barber et al. (2015) Fig. 2 responses

Y Y Y n/a Y Y N n/a DNM

Kamps et al. (2014) Fig. 3 total communication acts

Y Y N Y Y Y Y Y MDSwR

Kamps et al. (2014) Fig.4- initiations


Kamps et al. (2014) Fig.5-responses


Mason et al. (2014) Y Y Y n/a Y Y Y Y MDS

Mcfadden et al. (2014) Fig. 1- Total communications (focus student)

Y Y Y n/a Y Y N N DNM

Mcfadden et al. (2014) Fig. 1- Total communications (peer)

Y Y Y n/a Y Y N N DNM

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Table 2

Descriptive Analysis

Authors Design Participants Setting Instructor Dependent Variable

Independent Variable

Investigation Called

Results

Bambara et al. (2016)

Multiple baseline across participants

3 participants with ASD

School cafeteria

Researcher, parapro. speech therapist

Increased conversational acts, initiations, follow up questions

Role play, daily/weekly feedback, text or visual cues, daily training sessions

Peer mediated intervention

Follow up questions, initiations, and total conversation acts improved for all students from baseline.

Bambara et al. (2018)

Multiple baseline design across participants


School cafeteria

3 doctoral research assistants


Role play, peer prompting, text or visual cues, daily training sessions, daily/weekly feedback


Follow up questions, initiations, and total conversation acts improved for all students from baseline.

Banda et al. (2010) Multiple baseline design across participants


General education classroom

researcher Initiations, responses

Daily training sessions and adult prompting

Direct instruction Initiations and responses improved for all participants from baseline.

Barber et al. (2015) Multiple baseline design across participants


Autism clinic

researcher Topic maintenance, initiations, responses

Role play, daily feedback, adult prompting, text or visual cues, daily training sessions

“Stay, Play, Talk” No improvements for initiations from baseline for four participants. Total responses improved

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for all participants from baseline.

Kamps et al. (2014) Multiple baseline across participants


Resource classroom or speech therapy room

Researcher trained school staff and peers

Initiations and on and off topic responses, increased conversational acts

Peer prompting, role play, daily/weekly feedback, text or visual cues, daily training sessions

Peer networks Communication acts, initiations, and responses improved for all students from baseline.

Mason et al. (2014) Multiple baseline design across participants


School recess

Researcher, parapro, speech therapist


Daily/ weekly feedback, adult prompting, text or visual cues, daily training sessions


Communication acts for all target students improved from baseline

Mcfadden et al. (2014)

Multiple baseline design across participants


School recess

Pararpro, speech therapist

Initiations, responses

Peer prompting, role play, daily/ weekly feedback, adult prompting, daily training sessions

Peer network recess intervention package

Initiations for target student and peer improved from baseline

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APPENDIX 1: DATA RIGOR SHEET

Article:

Evaluation of Rigor

Code for each design within an article

Design Systematic Manipulation of IV

Adequate attempts to demonstrate effectiveness of IV

At least 5 data points in each conclusion

If not, at least 3 data points in each condition

IOA collected at 20% of sessions in each condition

IOA was at least 80%

PF collected at least 20% of sessions in each condition

PF was at least 80%

Rating: Meets, Meets with Reservations, Does not Meet

Notes for Evaluating Designs and Studies Design Standards

• Meets standards when all criteria when met.• Meets with reservations when all criteria are met except when there are fewer than 5 data points in one

or more conditions• Does not meet/is a failure to meet criteria for the above ratings

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APPENDIX 2: DESCRIPTIVE CODING KEY

ASD At least one participant with ASD as defined in the article

0-5 years old Chronological age as detailed on article



Elementary and younger 12 years or younger

Middle and older 13 years or older

Mix 2+ participants in a variety of age classes: (e.g. one participant that is 4, one participant that is 16.)

Educational classroom Resource room OR general education classroom

Therapy room Occupational, Speech, Physical therapy room

Clinic/ hospital Clinic not associated with a school (e.g. autism clinic).

Recess Outside or inside a playground containing standard recess equipment (e.g. swings, blacktop/gravel fields, basketball courts, slides, beams, etc.)

Combined Behavior being measured in 2+ settings (e.g. therapy room AND resource room, or if the rooms change throughout the study to 2+ settings).

Teacher This will be marked if the participant’s general or special education teacher is providing direct instruction to the participant with ASD, even if someone else is collecting the data based on responses for the purpose of the study.

researcher/ experimenter This will be marked if the researcher/ experimenter provides direct instruction to the individual with ASD even if someone else is collecting the data based on responses for the

25

purpose of the study.

Parapro This will be marked if a paraprofessional that works with students with ASD or general education students as a teacher assistant is providing direct instruction to the participant with ASD even if someone else was collecting data based on responses for the purpose of the study.

Peer This will be marked if a peer aged within 2 years of the participant with ASD is providing direct instruction to the participant with ASD, even if someone else was collecting data based on responses for the purpose of the study.

Researcher train peer This will be selected if a researcher provided direct instruction to the peer and then the peer provided direct instruction to the participant with ASD, even if someone else was collecting data based on the responses for the purpose of the study.

Speech therapist This will be selected if the school, community, or home-based speech therapist provided direct instruction to the participant with ASD, even if someone else was collecting data based on responses for the purpose of the study.

Topic maintenance Participant making a statement, asking or answering a question posed by another peer or participant, which pertained to the previous statement or question.

Increase conversational acts Frequency of total conversational acts (i.e. initiation response follow up questions + commenting)

Initiations Any verbal utterance that (a) begins a conversation or (b) introduces a new topic (i.e. is unrelated to the partner’s immediate prior conversation act or the topic of the conversation).

Follow up questions A verbal response in question form that

26

requests information about the partner’s prior conversational act or the topic of the conversation. Must be on topic or related to prior conversational act.

Longer conversational episodes Increased duration of time that the conversational partners engaged in a conversation

Commenting A verbal response that is not contingent upon (or solicited by) a partner’s prior communication act (e.g. describe or report events, label, deny assertions, and remark about a personal statement).

Nonverbal communication acts Eye contact, directional gaze, maintaining close proximity (e.g. standing within an arm’s length away), waving, looking at peers, shoulder tapping, winking, gesturing toward an object or person.

Responses Any verbal utterance that or nonverbal gesture following a question or request to a peer.

Peer- Mediated Intervention (PMI) Lessons are provided to the peers about how to interact with individuals with ASD.

Multi-component PMI PMI with added interventions (e.g. PMI + Role Play, PMI +

Direct instruction Scripted or unscripted direct instruction by the implementer with the interventionist sitting across from the participant and teaching the skill for 2-6 weeks.

“Stay, Play, Talk” Typically developing children are taught to stay with their friends, play with their friends, and talk to their friends across the day.

Peer Prompting Peers prompted participants throughout a social experience (e.g. providing gestural, verbal, visual performance

Role Play Participants engaged in scripted and unscripted conversational scenarios as part of a training.

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Daily/ Weekly feedback After the session, the interventionist provided specific feedback to the participants about their performance.

Adult prompting Adults prompted participants throughout a social experience (e.g. providing gestural, verbal, visual prompts.

Text or visual cues Cues that are used throughout sessions for the participants to utilize if needed. Provided by the interventionist.

Pivotal response training Structured play and monitoring and various specific interventions to build motivation while socializing with peers.

Daily training sessions Daily training immediately before the sessions to remind participants of the strategies that they can utilize during sessions.

Results Strong Evidence: all participants increased from baseline levels No evidence: no participants increased from baseline

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APPENDIX 3. PEER MEDIATED INSTRUCTION PRESENTATION

As part of my thesis completion, I conducted a professional development to other teachers in the

district. The powerpoint and the notes are shown below.

60

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Vita

1. University of Kentucky Bachelors in Science- Special Educaiton- Moderate to Severe

Disabilities

2. University of Kentucky Masters in Science- Special Education Teacher Leadership-

Moderate to Severe Disabilities

3. Alyssa Colston

a systematic review of peer-mediated interventions …

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