Preschool Peer Social Intervention in Autism Spectrum Disorder: Social Communication Growth via Peer Play Conversation and Interaction (Social Interaction in Learning and Development) 3030790797, 9783030790790

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Social Interaction in Learning and Development

Nirit Bauminger-Zviely · Dganit Eytan ·  Sagit Hoshmand · Ofira Rajwan Ben–Shlomo

Preschool Peer Social Intervention in Autism Spectrum Disorder Social Communication Growth via Peer Play Conversation and Interaction

Social Interaction in Learning and Development Series Editors Aleksandar Baucal, Department of Psychology, University of Belgrade, Fac Philosophy, Belgrade, Serbia Francesco Arcidiacono, Research, HEP-BEJUNE, Biel/Bienne, Switzerland Editorial Board Colette Daiute, Graduate Ctr, Psychology, City University of New York, New York, NY, USA Michèle Grossen, Bâtiment Géopolis Bureau 4245, Université de Lausanne Mouline, Lausanne, Switzerland Kristiina Kumpulainen, Faculty of Educational Sciences, University of Helsinki, HELSINKI, Finland Anne-Nelly Perret-Clermont, Institut de Psychologie et Educatio, Universite de Neuchatel, Neuchâtel, Neuchatel, Switzerland Charis Psaltis, Department of Psychology, University of Cyprus, Nicosia, Cyprus Roger Säljö, Department of Education, University Göteborg, Göteborg, Sweden Baruch Schwarz, School of Education, Hebrew University, Jerusalem, Israel Valerie Tartas, Laboratoire CLLE LTC, Bureau C609, Universite de Toulouse Jean Jaures, TOULOUSE CEDEX 9, France

Studying social interaction in human mind and activities is highly relevant for different epistemological and theoretical approaches (e.g., individual constructivism, social constructivism, dialogical approach). Consequently, there is a growing number of social interaction studies in various contexts (family, educational, professional, clinical, institutional, social, political, and cultural settings) which are based on different theoretical perspectives and methodological approaches. This produces a multiplicity of findings which are highly relevant, both theoretically and practically - although weakly interrelated and seldom discussed together.The main aim of this book series is to create a space for continuous and systematic critical reflection of social interaction studies and their integration with a special focus on: (1) a detailed account of actors and processes involved in different types of situated social interaction, (2) situatedness of social interaction within sociocultural and sociomaterial contexts and how social interaction and contexts constitute and transform each other; (3) how properly designed social interactions can provide opportunities for learning and development (in formal, informal, non-formal education), and (4) how the individual person navigates within these social interactions. The book series aims to support an argumentative and productive dialogue among different theoretical and methodological traditions, in order to enable a better understanding of their strengths and weaknesses. For more information on how to submit your proposal, please contact the publisher: [email protected] Direct link: https://www.springer.com/ series/16091

More information about this series at http://www.springer.com/series/16091

Nirit Bauminger-Zviely • Dganit Eytan • Sagit Hoshmand Ofira Rajwan Ben–Shlomo

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Preschool Peer Social Intervention in Autism Spectrum Disorder Social Communication Growth via Peer Play Conversation and Interaction

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Nirit Bauminger-Zviely School of Education Bar-Ilan University Ramat Gan, Israel Sagit Hoshmand Autism Treatment and Research Center, Association for Children at Risk Givat-Shmuel, Israel School of Education Bar-Ilan University Ramat Gan, Israel

Dganit Eytan Alut-The Israeli Society for Children and Adults with Autism Givatayim, Israel School of Education Bar-Ilan University Ramat Gan, Israel Ofira Rajwan Ben–Shlomo Ministry of Education Jerusalem, Israel School of Education Bar-Ilan University Ramat Gan, Israel

ISSN 2662-5512 ISSN 2662-5520 (electronic) Social Interaction in Learning and Development ISBN 978-3-030-79079-0 ISBN 978-3-030-79080-6 (eBook) https://doi.org/10.1007/978-3-030-79080-6 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Those we love don’t go away, they walk beside us every day We would like to dedicate this book to the memory of our loved ones who we lost while working on this project—men who influenced our lives and contributed tremendously to who we are… To my beloved late husband Chico Zviely-Bauminger and my dear father Arie Eilon, who both showed me the path to compassion and growth. Nirit Bauminger-Zviely To my beloved late father Uri Hoshmand, who taught me about the importance of love and friendship during life and their healing power at life’s end. Sagit Hoshmand To my dear late father Abraham Ben-Shlomo for continuously encouraging me to achieve excellence. Ofira Rajwan Ben–Shlomo

Preface

A deficit in the social-communication abilities that enable age-appropriate peer exchanges and relationships is considered a defining characteristic of individuals with autism spectrum disorder (ASD) across the lifespan. Early intervention targeting this core deficit is therefore an urgent need, calling for explicit comprehensive attention at early ages. Simply put, young children with ASD regularly face challenging experiences when trying to spontaneously engage with the peers around them in their preschools and on their playgrounds, which eventually may end in frustration or disappointment. Furthermore, however motivated the nearby typically developing children may be to strike up a conversation or initiate a play encounter, they may find it effortful to engage with these young children with ASD, thereby potentially reducing the success of social inclusion and mainstreaming efforts. Continually exploring basic and applied research on the socioemotional development of children with ASD, Prof. Bauminger-Zviely’s ASD Research and Intervention Laboratory—the ARI Lab—in the School of Education at Bar-Ilan University undertakes systematic investigation of diverse facets characterizing peer relations for individuals with ASD as well as developing wide-ranging theoretically and empirically grounded social interventions. This preface presents a brief introduction on why and how we began this journey of developing a social intervention for preschoolers with ASD, and what to expect in this book. In addition to developing the preschool-based intervention presented in the current book, the ARI Lab has developed two systematic, comprehensive, evidence-based protocols to facilitate peer engagement and its related social-cognitive knowledge in school-age children. One protocol targets school-age children with ASD who are cognitively able (IQ > 70), using the CognitiveBehavioral-Ecological (CBE) intervention model (Bauminger, 2002, 2007a; b, Bauminger-Zviely, 2013). The other protocol targets school-age children with ASD who are minimally verbal, using the School-Based Peer Social Intervention (S-PSI) model to facilitate peer engagement in children with specialized needs who may rely more on nonverbal communication (Bauminger-Zviely et al., 2020). Both the CBE and S-PSI models are carried out primarily in school settings, with the goal of training professionals to become experts in helping students with ASD to enhance their opportunities for and quality of engagement with their peers. The ARI Lab provides assistance and guidance in designing community-based social interventions; training and supervising the implementation of social interventions; and vii

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developing and administering valid assessment measures to evaluate social-emotional functioning and related intervention outcomes. The PPSI project, which is the focus of this book, began after years of operating the CBE intervention model broadly and successfully within the national school system to facilitate peer engagement and social cognition in school-age children with ASD. Although the PPSI model presented here does follows some of the principles and conceptual foundations underlying the CBE model, the school-age intervention could not simply be modified to the younger ages of children in pre-K and kindergarten settings. Young preschoolers with ASD required our Lab’s development of novel interaction, play, and conversation curricula to facilitate the unique age-appropriate social characteristics and needs of children in the 3- to 6-year age range. Especially, the PPSI intervention is unique in its focus on young children’s social play and social pretend play, which are not emphasized in school-age children’s intervention. In addition, the CBE intervention domains of social conversation and social interaction also necessitated age-appropriate adjustments in the PPSI, to meet the differing needs of children younger than school ages. The ARI Lab, under the leadership of Prof. Bauminger-Zviely, began working on developing the PPSI in response to urgent calls from early intervention specialists, preschool educators, child development researchers, government agencies and NGOs, and parents who were seeking constructive, wide-ranging guidance in how to help the young children with ASD in their care to begin to navigate the social world more successfully. Taking up this challenge to create an early intervention, Prof. Bauminger-Zviely formed a group of practitioners and researchers with strong expertise in working with young children with ASD, either through national autism associations in Israel (the Association for Children at Risk, the ALUT Association for Autism) and/or at the Ministry of Education. This new multidisciplinary research group included Prof. Bauminger-Zviely’s three co-authors for this book, doctoral candidates who brought their diverse areas of professional expertise to bear in collaborating on the development, formative evaluation, and empirical validation of the PPSI curricula. Our research team also included three master’s degree students with expertise in ASD, who were masked evaluators of the PPSI observational outcomes. At the heart of our holistic PPSI intervention model, and of this book, are three key interrelated components of peer engagement, which we call the major “building blocks” of social exchange: peer interaction, peer play (both social and social pretend play), and social conversation or peer talk. To develop the three core curricula comprising the holistic PPSI protocol (interaction, play, and conversation), our research team first undertook an extensive literature review, which provided the conceptual basis underlying the PPSI intervention and led us to redouble our efforts to develop and validate our intervention model in view of the specific need we identified for early social intervention targeting peer engagement in this population. Before looking systematically at young children with ASD, we initially delved into the characteristics of peer engagement that occur during the typical

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development of preschoolers. We found fascinating developmental trends in social interaction, play, and conversation. For example, regarding the playing “building block,” young children gradually progress from less interactive forms of communication (e.g., playing in parallel) to more coordinated and co-regulated peer-to-peer play exchanges that include planning and meta-communicating over scripts, roles, and topics. This higher level in the “building block” of peer conversation may include preschoolers’ discussion of a topic from several viewpoints as well as verbal interpersonal sharing and talk that is centered around games or activities. In the “building block” of social interaction, we found that typically developing preschoolers share thoughts, feelings, and objects as well as exhibiting a variety of prosocial behaviors such as comforting, encouraging, showing empathy, and providing help. They demonstrate a gradually growing ability to coordinate one’s own behavior with that of another child, in a progressively more complicated way, including advance planning of social acts. We found significant literature indicating that these early, rich, fruitful peer exchanges are important not only for the child’s social development but also for cognitive, linguistic, and even motoric development, as well as for the child’s everyday well-being. Our extensive literature review next explored if and how all of these “building blocks” of peer engagement may develop differently among young children with ASD. We found that, indeed, all three domains of social engagement pose considerable challenges for preschoolers with ASD, who may show atypical and unusual forms of peer interaction, play, and conversation. As just some examples, understanding of various points of view, planning of social games and activities, sharing emotions or thoughts with peers, arguing to stand up for oneself during conflict or resolving conflict—may all require significant effort and may not succeed for the young child with ASD. Despite the overwhelming evidence that identified the developmental importance of fruitful peer engagement during preschool and the substantial social challenges faced by young children with ASD, we were surprised to discover a striking scarcity of evidence-based intervention protocols that aimed to empower these young children in peer-to-peer interaction, play, and conversation. Thus, we four authors began our systematic intervention planning in earnest (for more on our team, see About the Authors below). Led by Prof. Bauminger-Zviely, Dr. Dganit Eytan (an expert in psychology and applied behavior analyses) developed the PPSI “peer interaction” curriculum; Dr. Sagit Hoshmand (a special education expert) developed the PPSI “social play and social pretend play” curriculum; and Dr. Ofira Rajwan Ben-Shlomo (a senior speech therapist) developed the PPSI “social conversation” curriculum. Then, the ARI Lab team collaborated in conducting the rigorous empirical research (randomized controlled trial) that provided evidence to validate the effectiveness of the holistic PPSI preschool intervention, followed by the model’s further dissemination and implementation into preschools around the country. To provide readers with the necessary conceptual background, empirical evidence, and series of practical tools for implementing the PPSI program in their own educational settings around the world, this book is organized to present the PPSI’s

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theoretical benchmarks (in Part I), its rationales, techniques, and full protocol (in Part II), its design procedures and empirical validation, and its practical psychoeducational implementation (in Part III). To begin, Chap. 1 details the characteristics and development of the three major interrelated components that form the “building blocks” of adaptive peer relations as they emerge in typical development during the preschool years. Thus, in this first chapter of Part I, we provide the description of early peer relations in the form of peer interactions, peer play (both social and social pretend play), and social conversations. Chapter 2 describes the unique characteristics and challenges of young children with ASD in forming, developing, and maintaining peer relations—focusing again on their abilities to interact, play, and converse with their peers. In the concluding chapter outlining the PPSI’s theoretical underpinnings, Chap. 3 reviews former interventions that attempted to enhance peer interaction, play, and conversation in ASD, focusing on their contents, principles, techniques, and main results. Part II of this book discusses the holistic PPSI model’s conceptual basis, main principles, and underlying rationales (Chap. 4), followed by systematic presentation of the full intervention protocol in Chaps. 5, 6 and 7. Each of the three curricula making up the complete PPSI protocol is presented in detail: the PPSI peer social interaction curriculum (Chap. 5), the PPSI social play and social pretend play curriculum (Chap. 6), and the PPSI peer social conversation curriculum (Chap. 7). Each content curriculum includes details on lessons and is accompanied by supplementary visual aids that support the learning and practice stages of the PPSI and make the learned topics and concepts more concrete. Part III of the book will conclude by providing the empirical basis validating the PPSI’s effectiveness (Chap. 8) as well as providing extensive practical guidelines for adapting the intervention to each child and preschool (Chap. 9). Thus, in Chap. 8, we thoroughly describe the PPSI’s planning, development via formative evaluation, and empirical evaluation processes. We review our evaluations of the PPSI’s efficacy in facilitating the social engagement of preschoolers with ASD, including both our rigorous randomized controlled trial and our examination of its social validity and social impact in general and in view of its clinical uses. The book’s final chapter delineates how to implement the psychoeducational PPSI in the child’s natural ecological environment (preschool, kindergarten), from start to finish, to fit each child’s own peer engagement needs. Thus, in Chap. 9 practical guidelines are provided starting from the PPSI facilitator recruitment and training stage, through the child evaluation and corresponding intervention personalization stages, and all the way to the final follow-up, maintenance, and generalization stages. These implementation guidelines for the on-site PPSI facilitator (educator or therapist) include practical tools for conducting child evaluation procedures to serve as the basis for an individualized intervention plan that incorporates social goal setting, curricular adaptations (e.g., delivering the three curricula fully or partially, sequentially or simultaneously), ongoing monitoring of gains, and methods for promoting the transfer of learned social skills to the child’s other natural social environments—the broader preschool activities and the home (e.g., via the PPSI facilitator’s open communication with other preschool psychoeducational staff and

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with parents to share intervention goals and contents and model new activities and techniques). It is our hope that readers will find our holistic PPSI psychoeducational intervention program to be straightforward and user-friendly, while appreciating its theoretically grounded, evidence-based, ecological merits. Our ongoing clinical experience in applying this program to over 100 preschool children has shown us the vast potential for the PPSI “language” and “culture” to easily trickle down into all aspects of the child’s everyday life. This has been our impetus to share the PPSI with you, as we have seen how implementation of the personalized PPSI protocol into the young child’s natural setting can lead the entire preschool community— peers, educational staff, therapeutic staff, parents, siblings—to gradually begin sharing a common vocabulary and supporting one another’s efforts to provide safe, consistent, and rewarding social experiences to the child with ASD. Even more so, this creates a positive feedback loop offering a win-win situation—where confidence- and skill-building occur in parallel both for the target child with ASD and for the preschool staff. We believe that the PPSI intervention—with its versatility, ease of administration, and potential for diffusion into all circles of the child’s life—could benefit many young children with ASD and should eventually become part of preschool early intervention programs and individual educational plans, in order to foster not only these children’s current social lives but also their future well-being. We hope that educators, practitioners, researchers, parents, and policymakers will take up the mantle of this call to intervene early in the peer engagement of preschoolers with ASD, and we look forward to receiving your feedback as you implement the PPSI model, disseminate your results with the rest of the community, and establish international validation.1 Ramat Gan, Israel December 2020

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Nirit Bauminger-Zviely Dganit Eytan Sagit Hoshmand Ofira Rajwan Ben–Shlomo

Researchers who are interested in receiving information about collaborative research options are invited to contact Prof. Nirit Bauminger Zviely at [email protected]. For additional information, see the ARI Laboratory website: https://www2.biu.ac.il/BaumingerASDLab/index. html

Acknowledgements

We would like to express our deep gratitude and appreciation to those who made this book possible. We are grateful to the Autism Treatment and Research Center, Association for Children at Risk for their support of our randomized controlled trial that validated the PPSI program, and especially to Prof. Nathaniel Laor and Tzipi Nagel-Edelstein and Udi Rigai. Our appreciation also goes to the Ministry of Education for opening up the preschools to our interventionists. Additionally, we would like to thank the dedicated PPSI facilitators who undertook this novel intervention by implementing it across their 23 preschools during our empirical study. Especially we would like to express our deep gratitude to the participating young children with ASD and their peers with typical development, who taught us so much about successful social inclusion, as well as to their parents for their recognition of the importance of joining in on our research and intervention efforts. Our research project required very intensive coding procedures of the PPSI observations’ outcome measures. We would like to express our appreciation to the three master’s students with expertise in ASD—Yaelle Fink-Rosenberg, Merav Shalom-Zehavi, and Moran Bernstein—who were masked coders of our observational data. We also would like to thank the Shnitzer Foundation, which supports research efforts benefiting the development of society and the economy in Israel, for their support of our book publication. Special thanks are extended to Dee B. Ankonina for her professional editorial contribution, which helped us to put the most accurate words to our thoughts. We also would like to thank Linda Yechiel for her translation of our PPSI protocol. Last, but not least we would like to express our personal appreciation to our family members for being there for us all along the way… To you Hagar, for walking with me through life with your exceptional wisdom and huge heart; to Ben for our special empowering bond; to Ari for filling my life

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with joy and happiness; and, lastly to my mother, Zemira, for teaching me to smile even in stormy weather. Nirit Bauminger-Zviely To my dear children, Adi, Matan, and Itai: You are, and always will be, “the wind beneath my wings.” With you in my life, everything makes sense. Dganit Eytan To my dear mother, Shulamit Hoshmand, who planted the seeds of confidence and love in my heart, and to my loves Maayan, Elad, Idan, and David—the lights of my life. Sagit Hoshmand To my dear mother, Varda Ben-Shlomo, thank you for always being an empowering role model. To my loves Doron, Tomer, Maya, and Sagi, thank you for your endless support in this journey. Ofira Rajwan Ben–Shlomo

Contents

Part I

Conceptual Basis for the PPSI: Typical and Atypical Peer Relations and Interventions 3 3 3

1 Early Peer Relations in Typical Development . . . . . . . . . . . Why Look First at Typical Development? . . . . . . . . . . . . . . . The Importance of Peer Relations During the Preschool Years Development and Characteristics of Peer Relations in Typical Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Peer Interaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Social Play and Social Pretend Play . . . . . . . . . . . . . . . . . . Social Conversation and Peer Talk . . . . . . . . . . . . . . . . . . . Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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2 Specific Challenges in Peer Relations for Young Children with ASD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Social Participation in ASD . . . . . . . . . . . . . . . . . . . . . . . . . Social Interaction in ASD . . . . . . . . . . . . . . . . . . . . . . . . . . Social and Social Pretend Play in ASD . . . . . . . . . . . . . . . . Peer Talk in ASD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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3 Research on Interventions Promoting Social Interaction, Play, and Conversation in Preschoolers with ASD . . . . . . . . . . . . . . . What Can We Learn from Prior Peer Interventions? . . . . . . . . . . . Research on “Social Interaction” Interventions in Preschoolers with ASD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Research on “Social Play and Social Pretend Play” Interventions in Preschoolers with ASD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Research on “Social Conversation” Interventions in Preschoolers with ASD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Part II

Contents

Principles, Techniques, and Contents of the PPSI Protocol: Interaction, Play, and Conversation Interventions

4 Conceptual Basis, Principles, and Rationales for the PPSI . . . . . . The Conceptual Basis Underlying the PPSI . . . . . . . . . . . . . . . . . . . Ecological Naturalistic Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CBT-Based Psychoeducational Model . . . . . . . . . . . . . . . . . . . . . . . Developmentally Appropriate Contents and Activities . . . . . . . . . . . . Two-Stage Integrative Structure: Skill Acquisition via Adult Mediation (Conceptual Learning Stage) and Skill Practice with Peers (Experiencing and Performing Stage) . . . . . . . . . . . . . . . . . . . . . . . . Skill Acquisition (Learning) Stage . . . . . . . . . . . . . . . . . . . . . . . . Skill Practice (Experiencing and Performing) Stage . . . . . . . . . . . . Emphasis on Peer-Peer Modeling . . . . . . . . . . . . . . . . . . . . . . . . . . Adult Mediation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mobilization of the Visual Strengths of Children with ASD to Support Social Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Holistic Model Configured as Three Content Areas to Foster Professional Expertise, Skill Assessment, and Intervention Personalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 The PPSI Peer Social Interaction Protocol . . . . . Introduction to the “Social Interaction” Curriculum . Outline for “Social Interaction” Protocol. . . . . . . . . Full “Social Interaction” Intervention Protocol . . . .

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6 The PPSI Social Play and Social Pretend Play Protocol . . . . . Introduction to the “Social Play and Social Pretend Play” Curriculum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Outline for “Social Play and Social Pretend Play” Protocol . . . . . Full “Social Play and Social Pretend Play” Intervention Protocol .

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PPSI Empirical Basis and Psychoeducational Implications

8 The PPSI’s Planning, Development, and Empirical Evaluation How Did We Develop and Empirically Test the PPSI? . . . . . . . . . Stage 1: Extensive Literature Review . . . . . . . . . . . . . . . . . . . . . . Stage 2: Survey of Active Practitioners . . . . . . . . . . . . . . . . . . . . Stage 3: Protocol’s Initial Design Stage . . . . . . . . . . . . . . . . . . . . Stage 4: Protocol’s Formative Evaluation Through Pilot Study and Focus Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Stage 5: Full Protocol’s Empirical RCT Evaluation . . . . . . . . . . Study Aims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Intervention Setting and Structure . . . . . . . . . . . . . . . . . . . . . Multi-Method Assessment of Intervention Efficacy . . . . . . . . . Study Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Discussion of Empirical RCT Findings . . . . . . . . . . . . . . . . . Stage 6: Evaluation of PPSI’s Social Validity and Social Impact . Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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9 Implementation of the PPSI in Psychoeducational Settings . . . . . . How Can We Begin to Implement the PPSI Protocol in Our Educational Setting? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Intervention Facilitators’ Recruitment and PPSI Training . . . . . . . . . Evaluation Procedures to Assess the Child’s Social-Communicative Functioning Profile Related to Peer Engagement . . . . . . . . . . . . . . . . Evaluation of Peer-Interaction Behaviors . . . . . . . . . . . . . . . . . . . Evaluation of Social Play and Social Pretend Play Behaviors . . . . Evaluation of Social Conversational Behavior . . . . . . . . . . . . . . . . Constructing the Child’s Social-Communication Profile for Interaction, Play, and Conversation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . How Do We Adapt the PPSI Program to Fit the Specific Child’s Needs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Adaptations for the Child with a Low-Level Social Profile . . . . . . Adaptations for the Child with an Intermediate-Level Social Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Adaptations for the Child with a High-Level Social Profile . . . . . . Setting Explicit Social Intervention Goals for the Personalized PPSI Protocol Constructed to Fit the Child’s Social Profile . . . . . . . . . . . . PPSI Setting, Structure, and Peer Characteristics . . . . . . . . . . . . . . . . Ongoing Evaluation During and After Intervention . . . . . . . . . . . . . . Diffusion of the PPSI Intervention into the Child’s Educational and Home Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Final Words . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257

About the Authors

Prof. Nirit Bauminger-Zviely who led the PPSI project, received her Ph.D. in educational psychology from UCLA and currently is a full professor at Bar-Ilan University’s School of Education. She heads the School of Education’s graduate program specialization in ASD as well as the Autism Research and Intervention— ARI Laboratory. Prof. Bauminger-Zviely is an international expert in evaluation and evidence-based intervention for peer engagement, interrelations, and friendship in ASD. She has been specializing for over two decades in exploring possible precursors, correlates, and characteristics of peer relations in ASD as well developing novel manualized evidence-based social interventions. Her research publications appear in leading scientific journals and include her comprehensive book on the social and academic abilities of high-functioning children with ASD (Bauminger-Zviely, 2013). She was honored as a 2021 INSAR Fellow (International Society of Autism Research) for her sustained international research contribution to autism science. The PPSI project and research also received Bar-Ilan University’s 2021 Rector Prize for scientific innovation. Dr. Dganit Eytan who developed the PPSI “peer interaction” curriculum, was trained at UCLA where she received her B.A. in psychology and worked at the UCLA Young Autism Project since 1993, gaining expertise in applied behavior analysis. For the past 20 years, she has served as the clinical director of Alutaf, a chain of early intervention rehabilitation daycare centers for toddlers with ASD. She received her doctoral degree in 2018 from Bar-Ilan University’s School of Education, examining the facilitation of peer interaction skills among preschoolers with ASD. Dr. Eytan is also a lecturer in the School of Education’s graduate program specializing in ASD. Dr. Sagit Hoshmand who developed the PPSI “social play and social pretend play” curriculum, was trained at Tel Aviv University, where she received her M.A. in early childhood educational counseling. In 2018, she received her Ph.D. in special education from Bar-Ilan University’s School of Education, examining peer social intervention for the development of social play skills among children with ASD. Dr. Hoshmand is the professional director of an autism treatment and research center under the auspices of the Association for Children at Risk, the largest organization in Israel providing early intervention for toddlers with ASD in xix

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childcare centers. She also serves as a lecturer at the graduate program specializing in ASD at the Bar-Ilan University School of Education. Dr. Ofira Rajwan Ben–Shlomo who developed the PPSI “social conversation” curriculum, is a certified speech, communication, and language pathologist who specializes in treating individuals with ASD. She received her doctoral degree in 2018 from Bar-Ilan University’s School of Education, examining facilitation of peer conversational skills among preschoolers with ASD. Dr. Rajwan Ben-Shlomo is a coordinator and counselor for speech therapists at the Israeli Ministry of Education. She is also a lecturer at the Ono Academic College and at Bar-Ilan University.

Part I

Conceptual Basis for the PPSI: Typical and Atypical Peer Relations and Interventions

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Early Peer Relations in Typical Development

Why Look First at Typical Development? Before embarking on the evidence-based peer engagement intervention at the center of this book that targets our population of interest—young preschoolers ages 3–6 years with autism spectrum disorder (ASD)—readers should first deepen their conceptual understanding of the complex relevant processes and phenomena involved in children’s interpersonal development. ASD is a neurodevelopmental disorder characterized by impairments in social interaction and communication and by restricted and repetitive behaviors (Diagnostic and Statistical Manual of Mental Disorders—DSM-5; American Psychiatric Association, 2013). Specifically, peer relations comprise a core social-communicative challenge for young children with ASD, who do not appear to show the same peer patterns as their typically developing counterparts (e.g., American Psychiatric Association, 2013). The current book aims to comprehensively address peer social-communication in preschoolers with ASD (including pre-K and kindergarten) because, without intervention, these early challenges may not only limit their early peer relationship experiences before they enter school but also may reduce later peer engagement across development (Manning & Wainwright, 2010; Schuler & Wolfberg, 2000). As a backdrop for understanding the major challenges in peer relations facing young children with ASD, the current chapter describes how children with typical development engage with their peers.

The Importance of Peer Relations During the Preschool Years Perched at the edge of a carpet, one child says to another, pointing to two plastic hoops and a long rectangular block: “Let’s pretend there’s a big river in front of us and we need to cross it together without falling into the water. All we have are these two big leaves and this piece of wood. Let’s think: How can we cross over safely?” © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 N. Bauminger-Zviely et al., Preschool Peer Social Intervention in Autism Spectrum Disorder, Social Interaction in Learning and Development, https://doi.org/10.1007/978-3-030-79080-6_1

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Preschoolers’ pretend play experiences provide unique opportunities for social learning; for example, the two children in the river-crossing situation above could learn how to collaborate with one another and how to interactively solve a problem. While young children face a social problem together, they learn how to coordinate their behaviors and to share goals, attention, and enjoyment. Goal-directed collaboration with a peer who shares a similar development level is much more challenging than working on the same social play problem with an adult, who may be considered a social “expert.” Adults can more easily scaffold the problem-solving exchange and the collaborative social setting for the child, compared to peers of the same age or developmental level. Hence, during child development, peer-to-peer relations offer unique prospects for social, cognitive, and linguistic growth, which may differ from those furnished by child–adult exchanges (e.g., Hay et al., 2009). Increases in social experiences among children have been shown to improve both social play behavior and language skills (Rogers, 2000; Wolfberg & Schuler, 1993). Vaughn et al. (2016) found that peer engagement in early childhood is an important index of adaptive functioning for the general population. Namely, when young children engage less with their peers during their early years, they demonstrate poorer social adaptation. Likewise, according to longitudinal evidence, individual variations in social behavior and in responding to peers’ behavior at early ages were found to predict later social competence (e.g., Rose-Krasnor & Denham, 2009; Sette et al., 2017).

Development and Characteristics of Peer Relations in Typical Development From very young ages, children interact, play, and talk amongst themselves, with such exchanges becoming gradually more reciprocal and coordinated over the preschool years (Coplan & Arbeau, 2009; Hay et al., 2009). Conceptually, to help tease apart the important “building blocks” that comprise these peer exchanges, three major interrelated components can be pinpointed: peer interaction, peer play (both social and social pretend play), and social conversation or peer talk. We next present these three building blocks of peer engagement in detail, separately, although these interaction, play, and conversation abilities are in fact interconnected within any holistic perspective on peer relations.

Peer Interaction The first of the three “building blocks” of peer engagement is preschoolers’ peer social interaction. For the purpose of this book, by peer “interaction” we refer to the reciprocal process in which children effectively initiate and respond to social stimuli presented by their peers in diverse social settings and situations (Shores, 1987). Ample verbal and nonverbal socio-communicative behaviors are important

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ingredients of effective peer interaction during preschool (e.g., Mundy, 2018; Rice et al., 2016; Siposova et al., 2018; Soto-Icaza et al., 2015). Typically developing preschoolers use eye contact frequently to regulate their interactions. They also gesture often toward peers to communicate desires and share interests, for example when showing, pointing, waving goodbye, nodding for “yes,” or shaking the head side-to-side for “no.” Children also frequently use the combination of eye contact and pointing to communicate intentions and needs, sometimes termed “joint attention” (Mundy, 2018). In addition, young children often imitate or mirror their peers’ behavior during the interaction as a means of social learning. Peer interactions evolve gradually over the preschool years (e.g., Hay et al., 2009, Rose-Krasnor & Denham, 2009). The earlier stages include more basic, functional interactive behaviors such as merely maintaining close proximity to peers, making verbal or nonverbal requests, offering objects to peers, and receiving objects from peers. Gradually, preschoolers develop more complex social interactive behaviors such as suggesting joint activities or sharing thoughts and feelings. Eventually, preschoolers exhibit prosocial behaviors such as acknowledging another’s distress, showing empathy, providing comfort and encouragement, and offering help. Abilities like joining a group, collaborating with peers, initiating and responding to others, coping with conflict situations while using social problem-solving strategies to solve conflicts, and demonstrating the ability to develop prolonged coordinated interactions with peers are all important interactive skills that lead to adaptive peer engagement during preschool (Coplan & Arbeau, 2009). Complex, efficient interactions with peers require competency in basic “social-cognitive” processes. Social cognition is how children make sense of the social world, including the interplay between the self and others (Beer & Oschsner, 2006). Children’s social cognition includes social-emotional knowledge and a variety of abilities such as spontaneously reading and correctly interpreting verbal and nonverbal social and emotional cues, as well as recognizing which social and emotional information is central and which is peripheral in a given peer interaction. In addition, social cognition entails knowledge of a repertoire of different social behaviors, including what their consequences might be if applied in diverse social tasks. In preschoolers, this repertoire may include familiarity with behaviors like how to initiate a conversation, how to negotiate with a peer to get what one wants, and how to enter a group of children who are already interacting with one another. An important social-cognitive aspect of peer interaction is the ability to appropriately understand others’ mental states, termed “theory of mind” attributions (Crick & Dodge, 1994). During typical development, alongside preschoolers’ gradual development of actual social interactive behaviors, they also gradually develop the ability to infer a range of mental states in others, such as beliefs, desires, intentions, imagination, and emotions that cause different behaviors (Wellman & Liu, 2004). Theory of mind implies an awareness that peers have a mind of their own and may be experiencing mental states, information, and motivations that differ from one’s own. This understanding allows children to effectively communicate and interact socially. Social-cognitive capabilities are important for

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all forms of peer relations, including social and social pretend play, as described next.

Social Play and Social Pretend Play Playing—the second “building block” of peer engagement—is young children’s primary occupation in life. The ability to engage in social play and imaginary play with peers in early childhood contributes significantly to young children’s development of the social skills that they can utilize to communicate in social contexts (Coplan & Arbeau, 2009). In typically developing children, enjoyable peer play motivates children’s social engagement. Social play sets the foundation for peers’ social engagement and communication, providing a framework in which children can construct representations of everyday life situations and can attain knowledge of the social world (Toth et al., 2006). Social forms of play involve active and enjoyable engagement on the part of at least two children. Such play is characterized as spontaneous and voluntary rather than imposed externally. As social play is an end, in and of itself, it is free of means-end directiveness. It is also nonliteral and often imaginative rather than strictly realistic, and it should be flexible and dynamic (Bauminger-Zviely, 2013). During toddlerhood and the preschool years, typically developing children gradually develop their capabilities for both “social play” and “social pretend play,” learning to form complex, reciprocated peer play based on peers’ shared concrete and abstract play acts (Coplan & Arbeau, 2009; Howes, 2011). To better understand how typically developing children progress in their play abilities, Carollee Howes and her colleagues presented a useful model for tracing the different developmental stages of social play in general and of social pretend play in particular, as seen in Table 1.1 and as described next. Social play’s developmental stages. As seen in Table 1.1, in social play according to Howes’s model (Howes, 1980; Howes & Matheson, 1992), toddlers initially engage in parallel play activities, which occur separately but in close proximity to a peer (within 3 feet). In parallel play, the two toddlers engage in a similar or identical activity such as both playing in the sandbox or both pushing cars Table 1.1 A summary description of social play and social pretend play development stages (Howes, 1980; Howes & Matheson, 1992; Howes et al., 1992) Age (years)

Social play

Social pretend play

1.0–1.3 1.3–1.6 1.6–2.0 2.0–2.5 2.5–3.0 3.0–5.0

Parallel Parallel aware Simple

Solitary Solitary directed to a partner Coordinated Simple social and associative Cooperative Complex

Interactive-complementary Reciprocal

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on the floor, side by side. At first, parallel play occurs without the toddlers acknowledging each other (e.g., without eye contact). Next, toddlers begin a developing awareness of the other’s play, including the object that the peer is using and the acts that the peer is performing. When parallel play is aware, initial social behaviors start to evolve, like eye contact as well as imitating, observing, and adapting to the other’s activity. Next, simple social play emerges (1.6 to 2.5 years), which involves direct social behavior with peers comprising mainly turn-taking and object-exchange activities. During this stage, children engage in the same or similar activities while talking, smiling, and offering and receiving objects. The exchange between the children revolves mainly around sharing objects and being responsive to each other, but with limited collaborative play, and the other child is not yet an essential social partner for the play. At this stage, children’s ability to establish a common focus with the peer partner is evolving. Common focus emerges through social behaviors such as sharing toys, providing help, asking questions, giving instructions, and discussing the play activity. Gradually, children’s play progresses to interactive-complementary play (2.5 to 3 years), including role reversals in social games such as run-and-chase and ball games. In this stage, the other child becomes an essential social partner for the play. Children engage in games requiring reciprocal and complementary actions, while comprehending each other’s roles and distinct contributions to the game (e.g., catcher and escaper in run-and-chase). They also understand that roles may be reversed. During this stage, awareness about the existence of social rules is emerging. During the preschool years (ages 3–5 years), social play becomes reciprocal and involves joint planning in order for the pair's actions to become integrated in joint activity that has a common plan. Thus, preschoolers’ play involves organizing, planning, and playing in complex social exchanges such as joint construction of a wooden block structure or playing games with rules (“Let's play hide-and-seek”). In social play at this stage, the activity or game is organized in advance and in cooperation with other children, and the use of language is more extensive. Play with social partners involves assigning roles and taking on identities and becomes reciprocal when the children display an ability for taking on roles and reversing them among themselves. In a social game with rules, such as hide-and-seek, for example, the children organize a group, assign roles, and play according to social rules. Social pretend play’s developmental stages. As seen in Table 1.1, according to Howes’s model (Howes & Matheson, 1992; Howes, Unger & Matheson, 1992), while engaging in social pretend play children learn to share meanings of imaginary social acts, to negotiate and resolve conflicts, and to meta-communicate (talk over roles, scripts, and themes). Initially, in the first half of their second year, toddlers engage in solitary pretend play acts (e.g., dressing a doll, using a banana as a telephone) and then move to solitary pretend play acts directed toward a partner, which are enacted through simple unnamed scripts, with or without complementary roles (e.g., listening to a peer’s heart with a stethoscopes). Coordinated pretend

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play is next, when toddlers nearing age 2 years start acknowledging each other (e.g., making eye contact) while involved in the same or similar symbolic activities in a parallel way (e.g., each feeding a doll). At this stage, reciprocity with the play partner and common meaning making begin. The toddlers learn that they can coordinate their play, not just by using the same objects but also by sharing the symbolic meaning that they attribute to those objects. For example, when two children run, each holding a stick and making shooting sounds, or when each child pushes a toy car on the floor while making “vroom” sounds, they are not yet playing with each other, but they are playing make-believe in a coordinated manner based on their attribution of an identical meaning to their objects. Thus, their make-believe action now occurs in a social setting, which leads to the development of more complex social pretend play stages. During the third year of life, children exhibit simple and associative social pretend play, where they are involved in simple unnamed pretend play scripts (e.g., shared cooking) but do not yet take on complementary roles. During such “simple” social pretend play, children pretend while playing with each other, mostly by attributing identical symbolic meanings to objects. Such play mainly involves object-focused exchanges, where children perform imaginary acts with toy tools and real-life accessories according to familiar everyday scripts that relate to children's personal world, enacting situations from their daily life (e.g., getting up in the morning, eating family dinner, showering). The children gradually start to play together but do not yet communicatively organize play, and at this stage, it is an adult who assigns meaning and context to the pretend play. For example, two children “cook” in the kitchen next to each other and watch each other's toy food and pots, but the interaction is mainly focused on the objects. The adults may shape the setting as a “kitchen” or a “restaurant.” The simple communication exchanges revolving around these everyday pretend play situations are termed “associative” imaginary social play. For example, the aforementioned two “cooks,” each cooking their own dish in the make-believe kitchen side by side, may talk about what they are cooking or suggest to the other what to cook, showing that they have agreed on the situation’s definition as a “restaurant/kitchen” and on shared meanings for the activity’s accessories, but they have not yet undertaken make-believe simulated roles as restaurant employees or family members. In simple associative social pretend games, children start using meta-communication that revolves around the game, but this talk mainly informs one another what to do and how to act without integrating the play partners’ actions. The most complex development of pretend play reached during the child’s third year is the cooperative social pretend play stage. At this point, children integrate dramatic acts into their play, which attests to their enactment of complementary roles within the game, for example, one child pretends to cook and the other pretends to eat their make-believe dish. At this stage, the child’s and partner’s complementary roles are not necessarily spoken or announced explicitly in advance but are clearly understood from children's actions (e.g., one cooks, the other eats). During the preschool years (3–5), children learn to engage in complex social pretend play, where they meta-communicate about their play, assign and name

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roles, propose play scripts, and discuss play themes. Examples might be: “Let's say we went to the forest and we saw a lion;” “You'll be the dad, I’ll be the mom, and you’ll be the baby;” “Let's play doctor.” At this stage, shared planning precedes the actual game. During the preschool years, children also communicate meanings as a way to investigate and cope with emotional issues such as learning control and compromise, developing trust and intimacy, and experiencing the delicate balance between the needs of oneself and others. Through their play, children develop the ability for self-control while negotiating their own needs and taking others’ needs into consideration. Thus, reciprocity becomes evident to the child. The meta-communication that occurs during complex play includes announcing activities’ themes (“let's play doctor”), taking on and assigning roles while debating them (“no, you’ll be the father and I’ll be the doctor, she’ll be the baby patient”), and suggesting scenarios for the game (“she has chicken pox”). In terms of thematic topics, children initially take on roles that are related to their most familiar everyday family experiences, reflecting their desire to play real-life situations. Later on, they try out other roles and relationships outside the family (driver-passengers, waiter-diner). Towards the ages of 4–6, the contents become imaginary and abstract, including fictional human and non-human characters to which the child was exposed only via communication media (such as aliens, monsters, or sorcerers). These preschoolers jointly create a world of imaginary stories in which they spontaneously integrate these characters, with no specific schemes, while constructing play contents and scripts as they go along.

Social Conversation and Peer Talk Any visitor to a preschool can see that young children talk to each other quite often and even gossip! Indeed, early peer talk—the third “building block” of peer engagement—is crucial for pragmatic language development. Children use language “pragmatics” to communicate effectively in the given social context, which requires them to know whether the situation calls for them to greet, request, show interest, tell, attend to, or show another conversational act toward the social partner, verbally or nonverbally (Adams, 2002; Clark, 2008). Peer talk offers children a wide range of opportunities for mutual learning of social-communicative and linguistic skills (Blum-Kulka & Snow, 2004; Garvey, 1984). The situational embeddedness of preschoolers’ talk varies greatly, differing in the degree to which it is tied to the activity at hand and generating different conversational types (genres) within various social settings. Such talk may include “interpersonal sharing” of personal experiences and feelings, “argumentative discussion” of a topic from different viewpoints, and “activity talk” that focuses on current activity (e.g., Blum-Kulka et al. 2004). Although developmental sequences in typical pragmatic linguistic development are not well established, accumulating literature has shown that typically developing children’s early social exchanges revolve mainly around joint attention toward objects and adults, followed by rapid development of the ability to

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communicate intents (see review in Adams, 2002; Clark, 2008; Garvey, 1984). Infants use preverbal paralinguistic skills like gestures, eye contact, vocalization, and pointing to attract adults’ attention to their interests and needs (Adams, 2002; Clark, 2008). Speech acts—the primary illocutionary values conventionally conveyed by utterances as acts—are a crucial component of children’s conversational capabilities (Dore, 1986). Expressed in real-life social interactions, speech acts require knowledge of language as well as appropriate use of that language within the given situation, such as turn taking, requests for clarification, and making clarifications (Adams, 2002). The first speech acts appear in babies in their first year. During toddlerhood, speech acts such as questioning, claiming, and stating intentions evolve (Snow et al., 1996). By the age of 3–5 years, typically developing children can already express various speech acts like remarking, requesting, responding to a question, protesting, and asking WH (what, where, when) and yes/no questions, but advanced speech acts like promising and persuading may not be fully mastered until age 9 or later (Hoyle & Adger, 1998). Moreover, 3- to 5-year-olds can already correctly identify and produce rules of conversational turn-taking, start to understand inference, use discourse markers according to context, and generate narratives (Adams, 2002). Typical preschoolers can also match discourse to listener characteristics, identify linguistic cues, repair unclear messages, and understand hidden meaning. A study on typical preschoolers’ topic initiations in peer talk during snack time (age 3:5– 5:4 years) demonstrated that most initiations were person-related; most conversations began by commenting on something or directing the listener’s attention to look at or do something rather than asking questions; and conversation initiations were as often on topics relevant to listeners as to speakers (O’Neill, et al., 2009). Thus, children as young as preschool ages can adapt the topic of the conversation that they suggest to their conversational partner. Moreover, almost one third of initiations were related to mental states (i.e., beliefs) in self and peers, suggesting that children as young as 3.5 years can already adapt their utterances to listeners’ perspectives. As they grow, children’s talk becomes increasingly sophisticated and frequent with regard to two main conversational mechanisms: turn taking and dialogic cooperation (Hamo & Blum- Kulka, 2007). Turn-taking skills help build participation in a social conversation, supporting the conversation’s structure and continuity, including skills for initiating, maintaining, and ending the conversation while taking turns and accounting for timing. In typical development, the turn-taking mechanism begins emerging at preverbal stages and continues to develop until the age of 4–5 years (Ninio & Snow, 1996). Dialogic cooperation skills permit common meaning construction between interlocutors and support the conversation’s topic continuity and functionality. Such skills comprise supplying relevant responses in conversation; adjusting the content, amount, and form of speech; and adapting to the rhythm of the conversation. This mechanism is more complex than the turn-taking mechanism; therefore, it continues developing for longer across childhood. Only in the school years do children begin to master conversations (Clark, 2008) in terms of topic development, listening

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responses, and discourse markers (see review in Hoyle & Adger, 1998). Some skills continue to develop into adolescence, such as meta-pragmatic reflection on one’s own and others’ communicativeness, acquisition of idiomatic language, narrative competence, and use of polite forms (Adams, 2002; Clark, 2008; Rajwan & Sela, 2021). Nonetheless, children as young as preschool age can already demonstrate fairly complex forms of listener-directed peer talk.

Conclusions As this chapter showed, typically developing preschoolers demonstrate gradually increasing sophistication in their overall peer engagement, as manifested in their interaction, play, and conversational skills. The rapid growth experienced during the preschool years in the domains of social cognition, language, and cognitive executive functioning enables these young children to gradually develop more complex, coordinated, and reciprocal social exchanges with peers. Meta-communication regarding peer play and peer interaction reveals increasingly sophisticated forms of peer talk, including negotiations of needs and desires; arguing over scripts, themes, and roles; and planning the social activity at hand. Importantly, the development of peer engagement is bidirectional. On the one hand, during participation in interaction, play, and conversation exchanges with peers, children have opportunities to experience, practice, and develop more complex linguistic, cognitive, and social skills. On the other hand, they need those very skills as prerequisites in order to engage effectively with peers. Those children who are deprived of plentiful and fruitful interactions with peers because they struggle to achieve developmentally appropriate peer engagement behavior, such as children with ASD, may be caught in a cycle of social isolation. The key challenges in peer engagement exhibited by children with ASD are described in the next chapter.

References Adams, C. (2002). Practitioner review: the assessment of language pragmatics. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 43, 973–987. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Bauminger-Zviely, N. (2013). Social and academic abilities in children with high-functioning autism spectrum disorders. New York: Guilford Press. Beer, J. S., & Ochsner, K. N. (2006). Social cognition: a multi-level analysis. Brain Research, 1079, 98–105. Ben-Shlomo, O. R., & Sela, T. (2021). Conversational categories and metapragmatic awareness in typically developing children. Journal of Pragmatics, 172, 46–62. Blum-Kulka, S., & Snow, C. (2004). Introduction: The potential of peer talk. Discourse Studies, 6, 291–306.

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Blum-Kulka, S., Huck-Taglicht, D., & Avni, H. (2004). The social and discursive spectrum of peer talk. Discourse Studies: Peer Talk and Pragmatic Development, 6(3), 307–328. https://doi.org/ 10.1177/1461445604044291 Clark, H. H. (2008). Pragmatics of language performance. In L. R. Horn & G. Ward (Eds.), The handbook of pragmatics (pp. 365–382). Oxford: Blackwell. Coplan, R., & Arbeau, K. A. (2009). Peer interactions and play in early childhood. In K. H. Rubin, W. M. Bukowski, M. William, & B. Laursen (Eds.), Handbook of peer interactions, relationships, and groups: social, emotional, and personality development in context (pp. 143– 161). New York: Guilford Press. Crick, N. R., & Dodge, K. A. (1994). A review and reformulation of social-information processing mechanisms in children’s social adjustment. Psychological Bulletin, 115, 74–101. Dore, J. (1986). The development of conversational competence. In R. L. Schiefelbusch (Ed.), Language competence assessment and intervention (pp. 3–60). San Diego: University of Kansas College Hill Press. Garvey, C. (1984). Children’s talk. Cambridge: Harvard University Press. Hamo, M., & Blum-Kulka, S. (2007). Apprenticeship in conversation and culture: emerging sociability in preschool peer talk. In J. Valsiner & A. Rosa (Eds.), The Cambridge handbook of sociocultural psychology (pp. 423–443). Cambridge: Cambridge University Press. Hay, D. F., Caplan, M., & Nash, A. (2009). The beginnings of peer relations. In K. H. Rubin, W. M. Bukowski, & B. Laursen (Eds.), Social, emotional, and personality development in context: handbook of peer interactions, relationships, and groups (pp. 121–142). New York: Guilford Press. Howes, C. (1980). Peer play scale as an index of complexity of peer interaction. Developmental Psychology, 16, 371–372. https://doi.org/10.1037/0012-1649.16.4.371 Howes, C. (2011). Social play of children with adults and peers. In A. D. Pellegrini (Ed.), The Oxford handbook of the development of play (pp. 231–244). Oxford: Oxford University Press. Howes, C., & Matheson, C. C. (1992). Sequences in the development of competent play with peers: Social pretend play. Developmental Psychology, 28, 961–974. https://doi.org/10.1037/ 0012-1649.28.5.961 Howes, C., Unger, O. A., & Matheson, C. C. (1992). The collaborative construction of pretend: Social pretend play functions. State University of New York Press. Hoyle, S. H., & Adger, C.T. (1998). Kids talk: Strategic language use in later childhood. Oxford University Press. Manning, M. M., & Wainwright, L. D. (2010). The role of high level play as a predictor social functioning in autism. Journal of Autism and Developmental Disorders, 40(5), 523–533. https://doi.org/10.1007/s10803-009-0899-9 Mundy, P. (2018). A review of joint attention and social-cognitive brain systems in typical development and autism spectrum disorder. European Journal of Neuroscience, 47, 497–514. https://doi.org/10.1111/ejn.13720 Ninio, A., & Snow, C. (1996). Pragmatic development. Boulder: Westview Press. O’Neill, D. K., Main, R. M., & Ziemski, R. A. (2009). I like Barney: preschoolers’ spontaneous conversational initiations with peers. First Language, 29, 401–425. Rice, C. E., Adamson, L. B., Winner, E., & McGee, G. G. (2016). A cross-sectional study of shared attention by children with autism and typically developing children in an inclusive preschool setting. Topics in Language Disorders, 36(3), 245–265. https://doi.org/10.1097/ TLD.0000000000000099 Rogers, S. J. (2000). Interventions that facilitate socialization in children with autism. Journal of Autism and Developmental Disorders, 30, 399–409. Rose-Krasnor, L., & Denham, S. (2009). Social-emotional competence in early childhood. In K. H. Rubin, W. M. Bukowski, & B. Laursen (Eds.), Social, emotional, and personality development in context: Handbook of peer interactions, relationships, and groups (pp. 162– 179). New York: Guilford Press.

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Schuler, A. L., & Wolfberg, P. J. (2000). Promoting peer socialization and play: The art of scaffolding. In B. Prizant & A. Wetherby (Eds.), Language issues in autism and pervasive developmental disorder: a transactional developmental perspective (pp. 225–227). Baltimore: Paul H. Brookes. Sette, S., Spinrad, T. L., & Baumgartner, E. (2017). The relations of preschool children’s emotion knowledge and socially appropriate behaviors to peer likability. International Journal of Behavioral Development, 41(4), 532–541. https://doi.org/10.1177/0165025416645667 Shores, R. E. (1987). Overview of research on social interaction: a historical and personal perspective. Behavioral Disorders, 12(4), 233–241. https://doi.org/10.1177/ 019874298701200408 Siposova, B., Tomasello, M., & Carpenter, M. (2018). Communicative eye contact signals a commitment to cooperate for young children. Cognition, 179, 192–201. https://doi.org/10. 1016/j.cognition.2018.06.010 Snow, C. E., Pan, B. A., Imbens-Bailey, A., & Herman, J. (1996). Learning how to say what one means: a longitudinal study of children’s speech act use. Social Development, 5, 56–84. Soto-Icaza, P., Aboitiz, F., & Billeke, P. (2015). Development of social skills in children: neural and behavioral evidence for the elaboration of cognitive models. Frontiers in Neuroscience, 9, article 333. https://doi.org/10.3389/fnins.2015.00333. Toth, K., Munson, J., Meltzoff, A. N., & Dawson, G. (2006). Early predictors of communication development in young children with autism spectrum disorder: Joint attention, imitation, and toy play. Journal of Autism and Developmental Disorders, 36, 993–1005. Vaughn, B. E., Santos, A. J., Monteiro, L., Shin, N., Daniel, J. R., Krzysik, L., & Pinto, A. (2016). Social engagement and adaptive functioning during early childhood: Identifying and distinguishing among subgroups differing with regard to social engagement. Developmental Psychology, 52(9), 1422–1434. https://doi.org/10.1037/dev0000142 Wellman, H. M., & Liu, D. (2004). Scaling of theory-of-mind tasks. Child Development, 75, 523– 541. Wolfberg, P. J., & Schuler, A. L. (1993). Integrated play groups: a model for promoting the social and cognitive dimensions of play in children with autism. Journal of Autism and Developmental Disorders, 23(3), 467–489.

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Social Participation in ASD The dynamic development of peer relations during the preschool years poses considerable challenges for young children with ASD, who often struggle with the social-communicative “building blocks” comprising effective peer engagement (American Psychiatric Association, 2013). A defining characteristic for children with this disorder is their atypicality in developing and maintaining interpersonal relationships that are appropriate to their developmental level, beyond their relationships with caregivers (American Psychiatric Association, 2013). In particular, social relationships with peers are a recognizable challenge. Many of the behaviors underlying adaptive peer relations do not develop in a typical way among young children with ASD (American Psychiatric Association, 2013). These may include adjusting one’s own behavior to suit a partner or to suit the social context; maintaining back-and-forth conversation; responding nonverbally (e.g., with eye contact, facial expression) to a partner’s communication; and integrating verbal with nonverbal communication modes (e.g., looking towards and smiling at a peer while responding aloud to that peer’s overture). In fact, some atypical communication behaviors are considered to be early signs for ASD—such as eye contact that is vague and less communicative, communicative gestures that are used predominantly for instrumental purposes, and major problems in achieving joint attention, whether by initiating or responding (Adamson et al., 2017; Mundy, 2018). These unusual early nonverbal communication patterns coincide with such children’s characteristically limited variety of facial expressions, which may also be atypical in their quality because these expressions may appear unclear (mixed) or situationally inappropriate (Chawarska et al., 2014; Costa et al., 2017). All of these early social-communicative tendencies may influence the ability of children with ASD to learn from and jointly engage in their social environment (Rice et al., 2016).

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 N. Bauminger-Zviely et al., Preschool Peer Social Intervention in Autism Spectrum Disorder, Social Interaction in Learning and Development, https://doi.org/10.1007/978-3-030-79080-6_2

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By definition, ASD symptoms may lead to restrictions in social participation and social involvement with peers (Germani et al., 2017). It is not surprising, then, that preschool children with ASD were found to participate less in social activities (e.g., birthday parties), were less likely to engage with or remain within proximity of peers, and demonstrated less regulated behaviors during unstructured free-play situations, in comparison to typically developing children. Children with ASD were also found to be more likely to receive adult support in the classroom and to engage socially with adults more than with peers. Using a timed-interval behavior-coding system, elementary school children with ASD spent approximately 30% of their recess time engaged in solitary activities, whereas their typically developing classmates only spent approximately 9% of recess unengaged. In addition, children with ASD spent only about 40% of the recess period jointly engaged with peers in reciprocal activities, conversations, or games as compared to 70% for matched typical classmates (Locke et al., 2016). Also, research has demonstrated that when young children with ASD do show more social behaviors, they occur during different social contexts compared to their typical age-mates. Namely, typically developing preschoolers generally show more peer involvement in the preschool activity areas related to free play, most commonly when children participate in sociodramatic/pretend play activities in preschool classrooms (Odom & Peterson, 1990; Sontag, 1997). In contrast, preschoolers with ASD show more social behaviors during structured social settings in the classroom that enforce proximity, such as during book-related activities, snack time, or lunch (Innocenti et al., 1986). All in all, for these preschool children with ASD, participation in fewer unstructured social activities and situations reduces their opportunities to develop and practice social engagement skills (e.g., Reszka et al., 2012). A recent study conducted in Bauminger-Zviely’s ASD Research and Intervention Laboratory—the ARI Lab—in the School of Education at Bar-Ilan University, zoomed in on these unstructured social settings in preschools by observing socio-communicative capabilities in preschoolers with ASD who were cognitively high-functioning (with an IQ over 75) versus preschoolers with typical development (Bauminger-Zviely & Shefer, 2021). We examined spontaneous peer engagement during unstructured preschool activities occurring both indoors (e.g., free time, activity corners, mealtime) and outdoors (playground). Major atypicalities were noted among the preschoolers with ASD across various social-communication domains, including prosocial behavior, social conversation, and social and social pretend forms of play, although their functional communication (e.g., giving and requesting information) was more typical. As detailed in the next sections, these findings offer further support for prior research indicating that the three key “building blocks” associated with efficient peer relations—namely, social interaction, play, and conversation skills—do not appear to show the same patterns in young children with ASD as in their typically developing counterparts

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(e.g., Jordan, 2003; Stefanatos & Baron, 2011). Our Preschool Peer Social Intervention (PPSI), presented in detail in Chaps. 5, 6 and 7, derives its theoretical foundation from the body of research investigating these three “building blocks” for peer engagement, to be detailed next.

Social Interaction in ASD Children with ASD often appear to have challenges in peer interaction—the first of the three “building blocks” necessary for successful peer engagement in typical development (as described in Chap. 1). Research has shown that children with ASD tend to have less frequent and often less complex peer interactions compared to their typical peers; namely, they exhibit behaviors that indicate social intention but with minimal social enactment (see review in Bauminger-Zviely, 2013 and also Locke et al., 2016). Among some of the less complex behaviors that children with ASD may demonstrate are close proximity, vague gaze, imitation of others’ social acts, communication for merely “functional” purposes (e.g., asking for a toy), passive observation, and solitary behaviors (see review in Bauminger-Zviely, 2013). The production of complex interactive prosocial behaviors such as sharing, providing help, expressing positive affect, making eye contact, cooperating, and comforting is often challenging for many children with ASD (Hartley & Fisher, 2018; Kasari & Chang, 2014; Locke et al., 2016). They also tend to find the initiation of peer interaction to be substantially more challenging than responding to peer overtures, but their response quality may also be poor (e.g., active but odd), which can preclude the development and maintenance of fruitful or extended social interactions (Locke et al., 2016). A recent study (Germani et al., 2017) explored the essential components and barriers of peer interaction for preschoolers with ASD using stakeholders’ (professionals’ and parents’) perspectives. The following were identified as important components in order to attain successful peer interaction in ASD. First, basic interpersonal skills are needed, for giving and reacting appropriately to the signs and hints that occur in social interactions. Also, children must be able to both initiate and respond during reciprocal social exchanges with peers. They must also be able to develop and maintain social interactions. Regulation of behaviors, emotions, and impulses are important too. Lastly, preschoolers need to be able to enter into social relationships with others while complying with social conventions. The barriers to social participation in peer interaction that Germani et al. (2017) identified in preschoolers with ASD included anxiety and lower social confidence as well as children’s restricted and repetitive interests and behavioral rigidity that narrowed the type and frequency of social activities with peers. As expected, most of these preschoolers’ interactions were reported to be with their therapist or parents rather than with peers, but when spontaneous interactions with peers did occur, they were most likely to unfold with a more mature child who could accommodate the interaction or with a younger child who might better match the child’s social and

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emotional maturity levels. Lack of familiarity and acceptance were reported by stakeholders as important barriers that did not allow the child with ASD to feel safe and gain enjoyment from the peer interaction. A study on elementary school children with ASD evaluated social involvement, reciprocal friendship, rejection, and acceptance from early (K-1) through late (4–5) elementary grades (Rotheram-Fuller et al., 2010). The study’s main findings yielded fewer reciprocated friendships by peers and less acceptance in the classroom social network among students with ASD compared to their counterparts with typical development. Also, students with ASD were more likely to be isolated or peripheral to social relationships within the classroom, across time, with even more robust difference in later elementary grades. The authors concluded that in inclusive classrooms, children with ASD are involved in peer interaction about half of the time as typical students and appear to be less connected as grade level increases. Research has highlighted atypicality in ASD for various social-cognitive capabilities that are important for social interaction. Specifically, researchers identified these children’s unusual development of social perceptions, which are the very basic prerequisites for social interaction, such as challenges in attending to dynamic social stimuli (Klin et al., 2002). Such perceptual challenges found by Klin et al. among children with ASD—for example looking less at others’ eyes and more at the mouth or body region—may lead to less typical encoding of vital social stimuli. For example, children with ASD were found to need more prompts to recall vignettes’ details, and they also added erroneous information that was not in the vignettes (Channon et al., 2001). Researchers also identified atypical development in social understanding among children with ASD, such as limited comprehension of social norms, rules, and constructs (e.g., Nah & Poon, 2011). The abilities for understanding and for recognizing emotions are another aspect of social cognition that often develops unusually in ASD. To be noted, the ability to recognize prototypical basic emotions in others (e.g., happiness, sadness, fear, anger) seems relatively typical in children with ASD who are cognitively high-functioning (IQ > 75); however, an awareness of one's own negative basic emotions and an ability to understand basic emotions’ causes have been less consistently reported (e.g., Begeer et al., 2008). Furthermore, in the more complex social situations in preschool, these children's challenges in understanding other minds (i.e., “theory of mind” attributions; Kimhi et al., 2014) as well as in performing executive functioning skills, especially attention-shifting and flexibility (e.g., Kimhi et al., 2014), compound the heightened social demands. Thus, the social situations that most characterize preschool settings, namely unstructured social situations like recess and interactions that involve a group rather than a dyad (i.e., one-on-one peer interactions), pose the highest social challenges for children with ASD. As a result, the enhancement of peer interaction skills via comprehensive intervention should target these children’s potential areas of difficulty and empower them to engage more often in dyadic and group peer interactions in a growing variety of unstructured naturalistic social situations.

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Chapter 5 in this book will present the PPSI protocol for our recommended evidence-based “social interaction” curriculum that derives from the current conceptual review of explicit areas of challenge in the peer interaction experiences of young preschoolers with ASD. As seen in that chapter, we suggest that the basic ingredients of effective “social interaction” intervention should include aspects such as developing young children’s ability to act jointly with and socially cooperate with peers, entailing skills such as initiating, joining in, responding to, and maintaining an interaction. In addition, we assert that evidence-based intervention to promote peer interactions should foster preschoolers’ ability to interact in prosocial ways such as providing help, comforting one’s partner, and compromising during peer interaction exchanges. Moreover, our peer interaction curriculum incorporates preschoolers’ training to promote skills for sharing objects, emotions, and thoughts with peers and for regulating their behaviors through conflict resolution capabilities —all aspects considered to be complex social interaction behaviors that the literature has pinpointed as great areas of challenge for preschoolers with ASD.

Social and Social Pretend Play in ASD “I would like to play with him, but I don’t know how” – a verbal, cognitively able 5-year-old boy with ASD

Most interactions during early childhood are based on social and social pretend play experiences with peers. Yet, children with ASD often demonstrate atypicality in their peer play—the second of the three “building blocks” enabling effective peer engagement in typical development (as described in Chap. 1). Play skills may be delayed among many children with ASD (Dominguez et al., 2006; Jordan, 2003). While these children may exhibit play at a merely functional level, they frequently demonstrate significantly unusual pretend, social, spontaneous, creative, and enjoyable play (Hobson et al., 2009). The underlying mechanisms that enable creative joint play with peers may already develop atypically in toddlerhood and in preschoolers with ASD (Jordan, 2003). These challenging play mechanisms include representational skills like joint attention or theory of mind; social understanding of “play culture” such as game rules and norms; creativity and imagination, which may entail generativity in pretend play; executive functions like attention shifting; and flexibility and spontaneity rather than repetitive and obsessive interests and actions (Schuler & Wolfberg, 2000). Indeed, without explicit guidance, children with ASD are frequently at risk for being deprived of consistent social play and social pretend play experiences. Social play in young children with ASD differs in quality and quantity compared to that of typical age-mates (Schuler & Wolfberg, 2000). On the playground, children with ASD were found to be involved in solitary nonsocial play activities more often than their contemporaries (Locke et al., 2016). Similarly, compared to

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their typically developing peers, children with ASD were also less often involved in simple social play (comprising mainly turn-taking activities), and they engaged in fewer instances of rough/vigorous play. Most often, their play manifests itself in less diverse and less complex forms and sometimes idiosyncratically (e.g., Campbell et al., 2017; Hobson et al., 2013; Jordan, 2003; Wolfberg, 2016). Social play in ASD may often be highly structured and repetitive and may lack flexibility (Hobson et al., 2009; Jordan, 2003). Play activities in ASD range from manipulating objects and enacting elaborate routines to pursuing obsessive and narrowly focused interests, including high rates of inappropriate and inflexible toy use. The symbolic dimension of social pretend play is often a major challenge in ASD. Compared to typically developing age-mates, many of these children may exhibit more instances of mere repetition of a peer’s pretending actions, fewer novel play acts, and less elaboration on pretend play (e.g., Murdock & Hobbs, 2011). In sharp contrast to the rich thematic variations of play in typically developing children, the restricted range of interests and the obsessive insistence on sameness in many children with ASD often result in pretend play that is repetitive and might seem almost obsessive in its literal repetition of identical acts (e.g., Bass & Mullick, 2007). Play in ASD is sometimes defined as “echoplaliya”—immediate or delayed literal repetition of others’ play behaviors and unimaginative repetitions of play acts —which are analogous to echolalia, the stereotyped repetitions of utterances characterizing this disorder (e.g., Schuler & Wolfberg, 2000; Wolfberg, 1999). Like social play, social pretend play is also characterized by more restricted novel play acts and less elaboration and diversity compared to typically developing age-mates (e.g., Murdock & Hobbs, 2011). Co-regulating one's own play behaviors with those of others has been highlighted as quite challenging for many young children with ASD (Jordan, 2003). This aspect of social play is most pronounced during free-play situations involving peers, where the social setting is less clear. The task of creating joint peer play during free-play situations puts more demands on children with ASD to coordinate their actions, plans, and thoughts with another peer in a vague social situation as well as to create variety and flexibility in the play activity. In such settings, these children’s limited knowledge about “how to play” and how to understand others’ mental states (theory of mind) become much more evident, with rises in confusion and a sense of insecurity often ensuing. As a result, children with ASD may avoid or resist social overtures, passively enter play with little or no self-initiation, or approach peers in an obscure and one-sided fashion (e.g., Wolfberg, 1999). Greater structure in a social environment, involving adults’ scaffolding, was found to elicit higher rates of responsive communication acts, such as more responsiveness or compliance behaviors and increased following of pointing gestures and gaze, in young preschoolers between 2 and 5 years of age (M = 45 months) with a mean nonverbal mental age of 27.5 months (Clifford et al., 2010). Poorer responsiveness was evident in free-play situations with peers that involved various games like jack-in-the-box, modeling clay, birthday cake (with associated materials like candles and a knife), or a soap bubble gun with soapy liquid. In a like manner, during games with clear rules such as hopscotch, children with ASD were

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found to participate at a rate similar to their typical peers even in unstructured free-time situations (Macintosh & Dissanayake, 2006; Sigman & Ruskin, 1999). Knowledge and confidence as well as a sense of security, then, seem to be key components for increasing social and social pretend play behaviors in young children with ASD. This indicates that, overall, “joint engagement” with peers may be deficient in these children but not absent, suggesting that it could be strengthened and developed in safer and more comprehensible social settings. Thus, as seen in Chap. 6 of this book, our recommended evidence-based PPSI “social play” intervention derives from the current conceptual review of explicit areas of challenge in the social and social pretend peer play experiences of young preschoolers with ASD. As seen in that chapter, we advocate that evidence-based intervention specifically targeting “social play” in ASD should promote the complexity and quality of social and social pretend play by gradually moving play complexity towards more coordinated levels of joint peer play. Indeed, the PPSI play curriculum design is systematically grounded in the developmental stages of social and social pretend play characterizing typical development, as described in Chap. 1. Thus, the PPSI play curriculum focuses both on conceptual understanding of play situations, rules, and norms and on the practicing and experiencing of play behaviors in real-time peer-group activities.

Peer Talk in ASD When young children play, they talk about their play. Indeed, activity talk is the most prominent verbal activity during the preschool period that integrates language and play. Yet, peer talk—the last of the three “building blocks” needed to engage successfully with peers in typical development (as described in Chap. 1)—is another area that poses challenges during the early development of children with ASD. Although social conversational style has been shown to be frequently atypical in ASD, there is very little research available exploring naturalistic conversational exchanges between preschoolers with ASD and their peers. This is despite the knowledge that speech addressed directly toward children in their first five years of life is important for early language development (Tomasello, 2000). Two studies have been conducted in Bauminger-Zviely’s ARI Lab that specifically investigated spontaneous peer talk in ASD. We videotaped preschoolers with and without ASD during 10-min. free-play and/or snack time and compared the conversation quality and communicative-pragmatic skills of the two groups of children during their peer talk (Bauminger-Zviely et al., 2014). Our main findings revealed higher conversational quality and a stronger pragmatic profile in typical development than in ASD, with the latter group showing unusual development of a number of pragmatic behaviors such as reciprocity during conversation, responsiveness to the interlocutor, and the context-relatedness of utterances. Beyond these issues related to utterances’ literal meaning, the ASD group also revealed atypical communicativeprosodic aspects of peer talk such as unusual intonation and stereotypic speech. The

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most prominent atypicality in the ASD group versus the typical group was for several paralinguistic skills—not involving words—where the preschoolers with ASD demonstrated unusual eye contact, inappropriate facial expressions, and inappropriate gestures. We also examined the role of the communication partner as possibly contributing to the quality of preschoolers’ peer talk, by comparing conversational exchanges when the partner was a friend (either a child with ASD or with typical development) to exchanges with a partner who was merely an acquaintance from the same preschool (Bauminger-Zviely et al., 2014). Interestingly, when children with ASD spent time in peer talk with an identified friend, they engaged in longer reciprocal conversations and were more responsive to their partner’s emotional state than with non-friends. Moreover, only in the ASD group did the friend dyads demonstrate better social functioning than the non-friend dyads on the following pragmatic capabilities: out-of-context utterances, unresponsiveness to interlocutor, stereotypic speech, and inappropriate facial expression. Also, in both groups, reciprocity of conversation and use of eye contact were better in peer talk exchanges between friends than between acquaintances, but here too the ASD group showed larger effect sizes. Overall, target children showed significantly better pragmatic linguistic behaviors in peer talk with a friend than with a non-friend for 30% of behaviors in the ASD group (n = 9) and for 18.5% of behaviors in the typical group (n = 5). Thus, this study’s intriguing results highlight the beneficial role played by communicating with a familiar friend in providing a better social milieu for preschoolers’ learning of socially complex and co-regulated peer conversations. In another study using a similar methodology to observe peer talk in a 10-min. free-play/snack time with a friend partner versus an acquaintance partner, Bauminger-Zviely et al. (2017) compared ASD and typical groups for preschooler’s speech acts—the communicative intentions conveyed by utterances in specific contexts. Results showed that speech acts’ development in several categories— mainly those with social consequences and those involving relatedness—appeared to be hampered in ASD versus typical development. In contrast, the more basic and less socially oriented speech acts, like merely requesting, appeared to be more preserved. In addition, speech acts such as assertive declarations that children use to describe the world—like reporting facts, sharing experiences, evaluating situations, and establishing rules—were significantly less developed in the ASD group compared to the typical group. Assertive declarations are used to create social facts (“This is a car”), to establish norms and rules (“We don’t do that”), to make claims (“Me first”), to tell jokes or tease (“Told you so”), and to give warnings (“Watch out!”). In general, these declarations are mainly social initiations used to lead a social exchange, rather than to respond to a social act that was already established. Initiating social overtures, rather than responding, is a well-documented challenge for children with ASD across functioning levels (e.g., Kasari et al., 2011; Lord & Magill-Evans, 1995; Sigman & Ruskin, 1999).

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The preschoolers with ASD showed also lower performance on organizational devices compared to their typically developing peers (Bauminger-Zviely et al., 2017). Organizational devices include meta-linguistic speech acts that aim to regulate conversational flow using boundary markers, attention getters, and so on during peer talk. These devices to achieve social consequences like focusing attention, initiating, and leading social routine—rather than instrumental consequences such as responses that satisfy physical wants or needs like requesting objects. Thus, it is unsurprising that preschoolers with ASD faced challenges in establishing social routines or in using devices to maintain ongoing social conversations. Taken altogether, when looking at group differences (ASD vs. typical), this research study indicated that preschoolers with ASD may show adequate levels of the more basic, less socially oriented speech acts (e.g., requesting), while other speech acts (e.g., attaining joint attention, leading and maintaining conversation flow, sharing experiences) may be delayed or may present differently in the ASD group compared to the typical group. Interestingly, friend dyads outperformed non-friend dyads not only in the variety of speech acts that they exhibited in both groups but also in the total frequency for most of those acts that they did demonstrate (such as assertive declarations, requesting acts, and organizational devices). It appears, then, that peer friendships offer an important route for the development of more complex peer conversations in young children with ASD. Another recent study has also emphasized the role of the partner and setting as influencing the conversation behaviors of such young children. Ferguson et al. (2020) compared conversational behaviors of children with ASD in special and mixed educational settings versus inclusive settings. They found that children in the inclusion classrooms produced more speech, received significantly more verbal input from their peers, and were exposed to a similar amount of teacher talk compared to children in the ASD-only or mixed-disability classrooms. Additional studies have noted the marked conversational challenges facing young children with ASD. For example, in Jones and Schwartz’s (2009) study of family dinner experiences, cognitively high-functioning young children with ASD (IQ > 70; chronological age = 3.5–7.0 years) initiated fewer bids for communication exchanges, commented less often, continued ongoing exchanges through fewer conversational turns, and responded less often to family members’ communication, in comparison to age-mates with typical development. In addition, children with ASD were found to more frequently “walk away” from conversations without coherently ending them with friendly closures that accounted for others’ perspectives (e.g., Rubin & Lennon, 2004). What seem to be especially challenging are some of these children’s abilities to initiate, develop, or expand a peer exchange by taking turns within an ongoing conversation or by switching between topics to accommodate the conversational partner’s perspective (Paul et al., 2009). Overall, research has documented atypicality in most components of conversational behaviors for young preschoolers with ASD. Thus, as seen in the PPSI protocol in Chap. 7 of this book, our recommended evidence-based “social conversation” curriculum derives from the current conceptual review of the explicit

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areas of challenge characterizing these children’s peer talk experiences. As seen in that chapter, we designed our “social conversation” intervention curriculum to include important basic conversational ingredients for promoting young children’s ability to effectively initiate, develop, expand, and terminate conversations, including skills such as taking turns within an ongoing conversation, switching between topics to accommodate the conversational partner, and ending a conversation in an adaptive way.

Conclusions As seen throughout the chapter, young children with ASD face comprehensive and extensive challenges in peer relations, spanning the way children play with each other, talk with each other, and interact. Several components were also identified that influence the nature of peer relations in ASD, including the nature of preschoolers’ social environment (segregated vs. integrated), the structure of their social activities (free-play vs. semi-structured vs. structured), as well as the role of the peer partner (friend vs. acquaintance; ASD vs. typical). Taken altogether, direct targeted social learning processes seem necessary to enhance these young children’s skills for peer interaction, play, and conversation. However, intervention planning should carefully consider more than just the targeted skills, by taking into consideration children’s need to feel safe while experimenting with unfamiliar behaviors and children’s desire to feel accepted and worthy of social connection, as prerequisites for successful intervention design. Thus, helping preschoolers with ASD to develop stronger and more efficient interactive, play, and conversational abilities with peers may not only render a substantial impact on these children’s immediate interpersonal experiences but also offers vast potential for improving their future social competence, which relies on these early building blocks. This is the major aim of our PPSI intervention spanning three areas that pose peer engagement challenges in ASD: to help these young children stack up the major building blocks to construct more adaptive peer interactions, social play experiences, and social conversations. In order to understand the unique contribution of the PPSI protocol, the next chapter provides extensive review of previous intervention studies that have endeavored to promote peer engagement in ASD.

References Adamson, L. B., Bakeman, R., Suma, K., & Robins, D. L. (2017). An expanded view of joint attention: Skill, engagement, and language in typical development and autism. Child Development, 90(1), e1–e18. https://doi.org/10.1111/cdev.12973 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Bass, J. D., & Mulick, J. A. (2007). Social play skill enhancement of children with Autism using peers and siblings as therapists. Psychology in the Schools, 44, 727–735.

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Bauminger-Zviely, N. (2013). Social and academic abilities in children with high-functioning autism spectrum disorders. New York: Guilford Press. Bauminger-Zviely, N., & Shefer, A. (2021). Naturalistic observation to evaluate preschoolers spontaneous peer interaction: The Autism Peer Interaction Observation Scale (APIOS). Autism, 25(6), 1520–1535. Bauminger-Zviely, N., Karin, E., Kimhi, Y., & Agam-Ben-Artzi, G. (2014). Spontaneous peer conversation in preschoolers with high-functioning autism spectrum disorder versus typical development. Journal of Child Psychology and Psychiatry, 55(4), 363–373. https://doi.org/10. 1111/jcpp.12158 Bauminger-Zviely, N., Golan-Itshaky, A., & Tubul-Lavy, G. (2017). Speech acts during friends’ and non-friends’ spontaneous conversations in preschool dyads with high-functioning autism spectrum disorder versus typical development. Journal of Autism and Developmental Disorders, 47, 1380–1390. Begeer, S., Koot, H. M., Rieffe, C., Terwogt, M., & Stegge, H. (2008). Emotional competence in children with autism: Diagnostic criteria and empirical evidence. Developmental Review, 28, 342–369. Campbell, S. B., Mahoney, A. S., Northrup, J., Moore, E. L., Leezenbaum, N. B., Brownell, C. A., & Abnorm, J. (2017). Developmental changes in pretend play from 22-to 34-months in younger siblings of children with autism spectrum disorder. Journal of Abnormal Child Psychology, 46(3), 639–654. Channon, S., Charman, T., Heap, J., Crawford, S., & Rios, P. (2001). Real-life-type problem-solving in Asperger’s syndrome. Journal of Autism and Developmental Disorders, 31, 451–469. Chawarska, K., Macari, S., Volkmar, F. R., Kim, S. H., & Shic, F. (2014). ASD in infants and toddlers. In F. R. Volkmar, S. J. Rogers, R. Paul, & K. A. Pelphrey (Eds.), Handbook of autism and pervasive developmental disorders: Diagnosis, development, and brain mechanisms (Vol. 1, pp.121–147). Hoboken: John Wiley & Sons. Clifford, S., Hudry, K., Brown, L., Pasco, G., Charman, T., & The PACT Consortium. (2010). The modified-classroom observation schedule to measure intentional communication (M-COSMIC): Evaluation of reliability and validity. Research in Autism Spectrum Disorders, 4(3), 509–525.https://doi.org/10.1016/j.rasd.2009.11.008 Costa, A. P., Steffgen, G., & Samson, A. C. (2017). Expressive incoherence and alexithymia in autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(6), 1659–1672. https://doi.org/10.1007/s10803-017-3073-9 Dominguez, A., Ziviani, J., & Rodger, S. (2006). Play behaviours and play object preferences of young children with autistic disorder in a clinical play environment. Autism, 10(1), 53–69. https://doi.org/10.1177/1362361306062010 Ferguson, E. F., Nahmias, A. S., Crabbe, S., Liu, T., Mandell, D. S., & Parish-Morris, J. (2020). Social language opportunities for preschoolers with autism: Insights from audio recordings in urban classrooms. Autism, 24(5), 1232–1245. Germani, T., Zwaigenbaum, L., Magill-Evans, J., Hodgetts, S., & Ball, G. (2017). Stakeholders’ perspectives on social participation in preschool children with Autism Spectrum Disorder. Developmental Neurorehabilitation, 20, 475–482. Hartley, C., & Fisher, S. (2018). Do children with autism spectrum disorder share fairly and reciprocally? Journal of Autism Developmental Disorders, 48(8), 2714–2726. Hobson, R. P., Lee, A., & Hobson, J. A. (2009). Qualities of symbolic play among children with autism: A social-developmental perspective. Journal of Autism and Developmental Disorders, 39(1), 12–22. Hobson, J. A., Hobson, R. P., Malik, S., Bargiota, K., & Calo, S. (2013). The relation between social engagement and pretend play in autism. British Journal of Developmental Psychology, 31, 114–127.

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Innocenti, M. S., Stowitschek, J. J., Rule, S., Killoran, J., Streifel, S., & Boswell, C. (1986). A naturalistic study of the relation between preschool setting events and peer interaction in four activity contexts. Early Childhood Research Quarterly, 1, 141–153. Jones, C. D., & Schwartz, I. S. (2009). When asking questions is not enough: An observational study of social communication differences in high functioning children with autism. Journal of Autism and Developmental Disorders, 39, 432–443. Jordan, R. (2003). Social play and autistic spectrum disorders: A perspective on theory, implications and educational approaches. Autism, 7, 347–360. https://doi.org/10.1177/ 1362361303007004002 Kasari, C., & Chang, Y. (2014). Play development in children with autism spectrum disorders: Skills, object play, and interactions. In F. R. Volkmar, S. J. Rogers, R. Paul, & K. A. Pelphrey (Eds.), Handbook of autism and pervasive developmental disorders: Diagnosis, development, and brain mechanisms ( Vol. 1, pp. 263–277). Hoboken: John Wiley & Sons. Kasari, C., Locke, J., Gulsrud, A., & Rotheram-Fuller, E. (2011). Social networks and friendships at school: Comparing children with and without ASD. Journal of Autism and Developmental Disorders, 41(5), 533–544. Kimhi, Y., Shoam-Kugelmas, D., Agam Ben-Artzi, G., Ben-Moshe, I., & Bauminger-Zviely, N. (2014). Theory of mind and executive function in preschoolers with typical development versus intellectually able preschoolers with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 44, 2341–2354. Klin, A., Jones, W., Schultz, R., Volkmar, F., & Cohen, D. (2002). Visual fixation patterns during viewing of naturalistic social situations as predictors of social competence in individuals with autism. Archives of General Psychiatry, 59, 809–815. Locke, J., Shih, W., Kretzmann, M., & Kasari, C. (2016). Examining playground engagement between elementary school children with and without autism spectrum disorder. Autism, 20(6), 653–662. https://doi.org/10.1177/1362361315599468 Lord, C., & Magill-Evans, J. (1995). Peer interactions of autistic children and adolescents. Development and Psychopathology, 7(4), 611–626. Macintosh, K., & Dissanayake, C. (2006). A comparative study of the spontaneous social interactions of children with high-functioning autism and children with Asperger’s disorder. Autism, 10, 199–220. Mundy, P. (2018). A review of joint attention and social-cognitive brain systems in typical development and autism spectrum disorder. European Journal of Neuroscience, 47, 497–514. https://doi.org/10.1111/ejn.13720 Murdock, L. C., & Hobbs, J. Q. (2011). Picture me playing: Increasing pretend play dialogue of children with ASD. Journal of Autism and Developmental Disorders, 41(7), 870–878. Nah, Y., & Poon, K. (2011). The perception of social situations by children with autism spectrum disorders. Autism, 15, 185–203. Odom, S., & Peterson, C. (1990). Eco behavioral analysis of early education/specialized classroom settings and peer social interaction. Education and Treatment of Children, 13, 316–331. Paul, R., Orlovski, S. M., Marcinko, H. C., & Volkmar, F. (2009). Conversational behaviors in youth with high-functioning ASD and asperger syndrome. Journal of Autism and Developmental Disorders, 39, 115–125. Reszka, S. R., Odom, S. L., & Hume, K. A. (2012). Ecological features of preschools and the social engagement of children with autism. Journal of Early Intervention, 34, 40–56. https:// doi.org/10.1177/1053815112452596 Rice, C. E., Adamson, L. B., Winner, E., & McGee, G. G. (2016). A cross-sectional study of shared attention by children with autism and typically developing children in an inclusive preschool setting. Topics in Language Disorders, 36(3), 245–265. https://doi.org/10.1097/ TLD.0000000000000099 Rotheram-Fuller, E., Kasari, C., Chamberlain, B., & Locke, J. (2010). Social involvement of children with autism spectrum disorders in elementary school classrooms. Journal of Child Psychology and Psychiatry, 51, 1227–1234.

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Rubin, E., & Lennon, L. (2004). Challenges in social communication in asperger syndrome and high-functioning autism. Topics in Language Disorders, 24, 271–285. Schuler, A. L., & Wolfberg, P. J. (2000). Promoting peer socialization and play: The art of scaffolding. In B. Prizant, & A. Wetherby (Eds.), Language issues in autism and pervasive developmental disorder: A transactional developmental perspective (pp. 225–227). Baltimore, MD: Paul H. Brookes. Sigman, M., & Ruskin, E. (1999). Continuity and change in the social competence of children with autism, Down syndrome, and developmental delays. Monographs of the Society for Research in Child Development, 64(1), 1–114. Sontag, J. C. (1997). Contextual factors influencing the sociability of preschool children with disabilities in integrated and segregated classrooms. Exceptional Children, 63, 389–404. Stefanatos, G., & Baron, I. S. (2011). The ontogenesis of language impairment in autism: A neuropsychological perspective. Neuropsychology Review, 21, 252–270. Tomasello, M. (2000). Do young children have adult syntactic competence? Cognition, 74(3), 209–253. Wolfberg, P. J. (1999). Play and Imagination in Children with Autism. New York: Teachers college Press, Columbia University. Wolfberg, P. (2016). Integrated play groups model: Supporting children with autism in essential play experiences with typical peers. In L. A. Reddy, T. M. Files-Hall, & C. E. Schaefer (Eds.), Empirically based play interventions for children (pp. 223–240). Washington D.C: American Psychological Association.

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Research on Interventions Promoting Social Interaction, Play, and Conversation in Preschoolers with ASD

What Can We Learn from Prior Peer Interventions? As elaborated in the first chapter of this book, young children experience important social learning processes by means of their early peer interactions, play activities, and conversations—which contribute not only to their immediate interpersonal functioning and relationships but also to their well-being and later development. Yet, as seen in the second chapter, young children with ASD are at high risk for more delayed, infrequent, and unsatisfying experiences with their peers. This disparity calls urgently for well-targeted and evidence-based peer interventions in the major domains of social functioning shown to be crucial building blocks of social learning. However, surprisingly, an examination of recent review studies on early interventions that have been conducted for children with ASD at ages 6 and below yields a rather low number of research studies focusing explicitly on peer-to-peer interventions to facilitate child-child interactions, social forms of play, and social talk. Indeed, the vast majority of early interventions has focused on children’s exchanges with a parent or other adult (e.g., French & Kennedy, 2018; Green & Shruti, 2018; Sandbank et al., 2020; Tachibana et al., 2018). Reichow and Volkmar (2010) found that only 14% of social skills interventions during preschool involved peers as delivery agents. Likewise, in reviewing 14 articles that examined peer-mediated interventions’ efficacy in ASD, Watkins et al. (2015) found that only 3 articles (21%) referred to preschoolers ages 4–5 years. Thus, adult–child engagement has been of greater interest to researchers than naturalistic child-child engagement in past attempts to empirically investigate early interventions for populations with ASD. It should be noted, as was discussed along Chap. 2, that peer relations pose a much more complex social challenge for children with ASD than do adult–child interactions. Adults, as social experts, can more easily scaffold the interaction and the social setting for the child with ASD compared to peers of the same age or developmental level (e.g., APA, 2013; Bauminger-Zviely, 2013; Clifford et al., 2010; Germani et al., 2017; Locke et al., 2016). © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 N. Bauminger-Zviely et al., Preschool Peer Social Intervention in Autism Spectrum Disorder, Social Interaction in Learning and Development, https://doi.org/10.1007/978-3-030-79080-6_3

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Despite the limited scope of prior peer-to-peer interventions during preschool, it is important to consider the available research evidence as a backdrop for our PPSI holistic intervention that is delineated in the upcoming section of this book. Here, next, the available previous intervention studies are reviewed, separately presenting existing research on the three building blocks of peer engagement, although keeping in mind that peer interaction, play, and conversation are interconnected components within a holistic model of peer relations.

Research on “Social Interaction” Interventions in Preschoolers with ASD Social interaction is a vital constituent in children’s development. To recall, for the purpose of this book, peer social “interaction” refers to children’s reciprocal process of effectively initiating and responding to peers’ social stimuli in diverse social settings and situations (Shores, 1987), which incorporates verbal and nonverbal socio-communicative behaviors. Social interventions for children with ASD have been shown to be effective when they target the main peer-interactive behaviors that have been identified as challenging for these children, such as skills for initiating and responding to interactions, maintaining and developing interactions, enacting prosocial behaviors like offering help, resolving conflicts, and so forth (Rao et al., 2008). However, most peer interaction-focused interventions to date have focused on school ages (e.g., Bauminger, 2002, 2007a, b; Gates et al., 2017; Kaat & Lecavalier, 2014; Rao et al., 2008; Wolstencroft et al., 2018; Wong et al., 2015) rather than on preschool ages. These peer interventions for school-aged children (6– 15 years) with ASD who had average cognitive functioning levels (termed “high-functioning ASD”) targeted social competencies including social knowledge, social communication, social cognition, and emotion recognition, overall, children showed nice improvement that differed somehow by reporters (e.g., Gates et al., 2017; Hughes et al., 2013; Kaat & Lecavalier, 2014; McMahon et al., 2013). A wide variety of techniques were found to be beneficial to some degree in prior interventions aiming to facilitate peer engagement for children with ASD. These have included modeling, prompting behaviors, reinforcements, role play, rehearsals, didactic learning, direct instruction, teaching social rules, problem solving, and perspective-taking techniques (e.g., Camargo et al., 2016; Gates et al., 2017; McMahon et al., 2013; Radley et al., 2020; Wolstencroft et al., 2018). Furthermore, a broad range of strategies have been implemented in prior intervention studies, which have utilized both adults and children as change agents and have involved different configurations of children. Adult involvement could entail direct instruction by an adult (e.g., Camargo et al., 2016; Landa et al., 2011) or parent mediation during intervention (e.g., Laugeson et al., 2012; Vernon et al., 2012). Children could participate in peer-dyadic intervention (Stanton-Chapman & Snell, 2011) or in social skill groups of 3 or more children, which could be either homogeneous,

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comprising only children with ASD (e.g., Freitag et al., 2016; Leaf et al., 2017; Radley et al., 2014; Waugh & Peskin, 2015; Won et al., 2018), or could be mixed groups of children with ASD and children with typical development. Of prominent focus, peer-mediated interventions have been conducted where typically developing children learn how to increase peer interactions with children with ASD (e.g., Barber et al., 2016; Katz & Girolammetto, 2015; Zagona & Mastergeorge, 2018). In such peer-mediated interventions, the typically developing children were trained to mediate the behaviors needed for successful interactions, mostly skills for modeling, prompting, and reinforcing of the targeted behaviors in their peers with ASD. The targeted skills were often initiating and, in turn, responding to the social partner, continuation of the interaction, or joint activity (Banda et al., 2010; Chang & Locke, 2016; Gunning et al., 2019; Watkins et al., 2015). Overall, peer-mediated interventions and social skills group interventions have shown high social validity (Disalvo & Oswald, 2002). Conditions that were helpful at obtaining positive results in prior intervention research were: inclusion of typical children in the program, intervening in the natural school setting, parental involvement, and involvement of the target child’s other social agents such as teachers and peers (Rao et al., 2008). Thus, an ecological orientation is important to take the child’s natural environment into consideration—referring both to the social and physical environment. Inasmuch as social challenges continue throughout the lives of individuals with ASD and social practicing has been shown to hold potential for improving social functioning, interaction-focused intervention programs are needed at an early age (Hansen et al., 2014; Kasari et al., 2014; Moody & Laugeson, 2020). Despite its importance, peer-intervention studies for preschool-age children with ASD have been very limited to date. For example, although peer mediation was found to be an effective strategy for promoting social skills in the natural environment for preschoolers as well as for older children, several reviews have pointed to the limited number of peer-mediation studies on young children. In Radley et al.’s (2020) review of 201 studies on social skills teaching for children with ASD, spanning a large age range (3–17 years), only 28 studies (14%) used peer-mediated intervention as the main strategy, and the average age of the children was 10.6 years. Also, in Zagona and Mastergeorge’s (2018) review of 17 studies on peer-mediated intervention (age range: 3–14), only 3 studies (17.6%) targeted children under 5 years of age. Among their findings related to young children, the children were found to advance in their social communication skills (mainly initiations and responses) in their inclusive preschool and could also generalize the learned skills to interactions on the playground. Duration of peer interaction also increased. Similar results were obtained in another study of peer-mediated intervention for three preschool children (ages 4–5), who all increased their responses and initiations in the short term, maintained those skills four weeks later, and generalized their gains to an untrained peer (Katz & Girolametto, 2015).

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Indeed, additional research indicates that incorporating typically developing peers into the intervention programs of preschool children seems to contribute to the training’s effectiveness in increasing peer interaction, and to the generalization of the learned interactive behaviors into the preschool environment. For example, Gunning et al.’s (2019) review of 31 peer-mediated intervention studies on preschoolers in inclusive settings (N = 85; ages 2:9–5:11 years) supported the use of peer-mediated intervention to promote the social skills of young children with ASD. In these intervention studies, the most common target skills were social communication and play that focused on reciprocal interaction, initiation, and response. Most of the reviewed studies (23/31 = 72%) reported positive outcomes, and the rest reported mixed outcomes (Gunning et al., 2019). Thus, it seems clear that successful peer interactions can benefit from the training of typically developing peers to create opportunities for children with ASD to interact socially and to practice the skills that they learn in different activities and settings. The typical peer constitutes a sort of anchor or “transitional person” who may play a key role in social interaction interventions (e.g., Gunning et al., 2019; Hughes et al., 2013; Zagona & Mastergeorge, 2018). Interventions to increase peer interaction for preschool children have also involved adult mediation, mostly in combination with peer mediation. Research has shown that children with ASD can also benefit from interactions with typical peers, if those interactions are mediated for them by an adult. A combination of adult mediation on the one hand and peer involvement and preparation on the other has been recommended to optimize the interactions of children with ASD and their peers (e.g., Chang & Locke, 2016; Hansen et al., 2014). The integration of both typical peers and adult mediation together has been found to contribute to the targeted children’s acquisition of social interaction skills (e.g., initiations toward peers, responses, engagement, peer imitation, and even play- and conversationrelated skills as detailed below) and also to the generalization of these skills in other environments such as different settings (classroom, playground) and different activities (e.g., Gunning et al., 2019; Hu et al., 2018; Hughes et al., 2013). For example, in one intervention study, visual aids (“keys”) were provided to children with ASD, to encourage their social initiations toward children with typical development, but the involvement of the preschoolers with ASD remained low despite the opportunities given. However, an adult’s mediation and assistance greatly improved children's responsiveness to the visual aids (Nelson et al., 2007). In another study that encompassed all three building blocks of social engagement (Barber et al., 2016), three typically developing kindergartners (ages 3–5) were trained to stay with a friend, to play with a friend, and to talk to a friend and later were paired with three children with ASD (ages 3–4) for a dyadic play session twice a week for 20 min for 6–8 weeks. Results showed that all children showed improvement in their responses, and more reciprocation and initiation was also noted. However, the gains were not maintained two months after completion of the intervention (Barber et al., 2016).

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Some research has also supported the effectiveness of direct teaching procedures within social interaction interventions. Kroeger et al. (2007) compared two intervention groups of children with ASD ages 4–6 years. One group, the direct teaching group, used video modeling to teach specific skills like social initiation, turn taking, seeking partners, and more. The second group was a free playgroup without mediation. After 5 weeks of intervention, the prevalence of prosocial behavior increased in both groups, but only the direct teaching group showed an improvement in children’s acquisition of social skills, such as initiating social interactions, responding to others’ initiations, and maintaining interactions (Kroeger et al., 2007). Although the body of research on social skills intervention has grown, the effectiveness of most of these programs has yet to be determined. We can see large heterogeneity in research methodologies as well as in intervention contents, techniques, and strategies. Results have shown good improvement when children’s numbers of initiations and responses were measured, but researchers did not always evaluate the quality of those interactive behaviors (e.g., Hansen et al., 2014; Reichow et al., 2012). Some prior research studies have demonstrated limitations, including various methodological problems such as small sample size; lack of a control group for empirical comparison; and inadequate description and characterization of participants in terms of age, sex, cognitive level, and ASD severity. Targeted skills, settings, and intervention durations also differed between studies, making it difficult to compare outcomes. Furthermore, few studies have published a systematic evidence-based intervention protocol. Also, the research literature’s references to peer interaction in inclusive settings, and to the generalization of skills to other persons and settings, were seldom noted (e.g., Bottema-Beutel et al., 2018; Gates et al., 2017; Hu et al., 2018; Kaat & Lecavalier, 2014; Moody & Laugeson, 2020; Pallathra et al., 2019; Watkins et al., 2015; Zagona & Mastergeorge, 2018). As delineated in Chap. 5, our proposed PPSI protocol that is directed toward preschoolers’ first building block—peer social interaction—gleans its components from the prior evidence reviewed here. Among the heterogeneity of previously utilized techniques and strategies, some were shown to be effective and have been incorporated into our curriculum, such as the combination of peer and adult mediation, the use of direct teaching procedures combined with unstructured interactive opportunities, as well as the inclusion of different types of visual aids. The PPSI social interaction protocol integrates these evidence-based strategies and techniques to foster the skills that prior research identified as vital in order for children with ASD to effectively begin, sustain, and expand social interactions with peers, with an emphasis on sharing, prosocial action, and conflict resolution. Importantly, as pinpointed by prior research evidence, our PPSI peer interaction intervention is applied in the child’s natural ecological setting, the preschool, with the child’s natural change agents by combining direct learning and social group child-to-child practice sessions with an adult mediator.

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Research on “Social Play and Social Pretend Play” Interventions in Preschoolers with ASD As described in the previous chapters, another crucial constituent in children’s development is their social play, but young children with ASD face challenges in this domain. Based on several review studies, some more recent than others, we can see that summarizing the research examining interventions aiming to facilitate play skills and peer engagement among young children with ASD may be challenging because such studies have been varied in their empirical methodologies and in the investigated interventions’ characteristics. In a review from 2010, many of the reviewed studies (89%) only included a small number of participants, which can limit generalizability, and the samples were diverse in terms of children’s cognitive ability (e.g., 26% of studies included children with ASD who were cognitively able, with an IQ > 75) (Reichow & Volkmar, 2010). Very few of the reviewed interventions (6%) were executed in a group play context. Crucially, considering the importance of peer-to-peer social engagement, only 14% of the reviewed interventions used peers as intervention agents, while the remainder used parents, professional therapists, and educators as mediators (Reichow & Volkmar, 2010). In more than 50% of the reviewed studies, the interventions’ duration was only 15 min on average, and lasted less than 12 weeks (Reichow & Volkmar, 2010). In a more recent review (Kent et al., 2020) that focused specifically on play behavior in children between the ages of 2 and 12 years, a similar picture emerged, where only 19 studies out of 470 (4%) used randomized control methods and only 58% of them (11 studies) included our population of interest—young participants at preschool ages (2–5 years). Kent et al. (2020) also underlined the fact that the reviewed studies included variables such as solitary play, social-communication skills like joint attention, language, and general social competence but did not always include specific social play skills as their outcome. Furthermore, play was defined and conceptualized in different ways by the various studies, resulting in a large variety of strategies and goals for teaching play skills. This heterogeneity in study goals, strategies, and outcomes impedes efforts to draw reliable conclusions about these interventions’ efficacy for enhancing the target children’s play skills. Keeping this in mind, we next provide a short review of the basic models that have been used in the literature to facilitate play behaviors in children with ASD. Interventions that have focused on the facilitation of play in young children with ASD can be broadly subdivided into two main types: structured/direct and unstructured/indirect. Structured play intervention models usually entail direct didactic teaching of play skills, mostly in a dyadic setting with a peer or an adult. Unstructured play intervention models are usually oriented toward facilitating social play skills through experiential free-play group situations that stimulate peer play. Interventions that espouse more structured didactic learning procedures often focus on improving play skills with objects such as functional operation of toys and symbolic play (e.g., Akers et al., 2016; Kasari et al., 2006; Stahmer et al., 2003).

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The intervention agent in such structured formats is most likely an adult, who scaffolds the play situation to the child by providing play ideas and scripts and by demonstrating and modeling the course of the play. Children’s imitation of the adult’s play is the most common learning strategy in such dyadic models. For example, in reciprocal imitation training, the child learns to play through reciprocal imitation of play activities between the child and a therapist. Through such training, children were found to learn to imitate symbolic play acts and were also able to generalize the learned play acts to some extent to a novel environment, new objects, and various therapists (e.g., Stahmer et al., 2003). Children can also watch and imitate play acts that are presented in video modeling, either theirs or others’ (e.g., Barnett, 2018; Duenas et al., 2019; Hine & Wolery, 2006). However, those play acts—learned mostly with adults—were not sufficiently tested in peer play situations. A fairly frequently used structured procedure for direct teaching of play skills to young children with ASD is the Joint Attention, Symbolic Play, Engagement and Regulation intervention model—the JASPER (e.g., Chang et al., 2016; Shire et al., 2018). In the JASPER intervention, the child learns social communication and symbolic play in the natural educational setting or in a clinic, through an adult’s mediation. Findings from research examining JASPER have indicated good improvement in children’s joint attention and symbolic play (as well as social initiations and social engagement); however, the explicit skills for social play and social pretend play with peers have not usually been taught or investigated by research. Other structured learning procedures have been implemented into naturalistic environments (preschool, home) to teach pivotal play skills, mainly in term of playing with objects (e.g., Barnett, 2018; Ganz & Flores, 2008; Godin et al., 2019; Koegel et al., 1999; Neff et al., 2017; Oppenheim-Leaf et al., 2012; Pierce & Schreibman, 1997). In these studies, the emphasis was on pre-tutoring of typically developing peers or siblings regarding how to play and support object and symbolic play in the target children with ASD (Neff et al., 2017; Oppenheim-Leaf et al., 2012) or on utilizing typically developing peers as role models to enhance the play behaviors of preschoolers with ASD (e.g., Ganz & Flores, 2008). Other interventions used scripts (play dialogue or play narratives) and direct play instruction and guidance to help the child with ASD to increase play behaviors during play groups (e.g., Murdock & Hobbs, 2011) or during structured outdoor activity (e.g., Morrier & Ziegler, 2018). Pivotal response training is another technique to teach pivotal play skills and symbolic acts while using structured learning procedures. In this technique, incidental learning occurs through manipulation of the child’s natural social environment to ameliorate play behaviors, such as showing play skills with various objects while using different environments such as moving from one therapy room to another (e.g., Godin et al., 2019; Ingersoll & Schreibman, 2006; Vilson et al., 2017). Godin et al. (2019) highlighted the importance of using the naturalistic play environment as an important context in which to teach play skills and also to obtain generalization of those skills.

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However, those programs that used structured learning in various forms have mostly focused on teaching object play rather than social play with peers. Moreover, they mainly teach specific play skills through imitation of functional operation or symbolic use of objects, as well as through the mediation of an adult who scaffolds the activities for the child. Such interventions were not found to lead to children’s development of communication through sharing meaning with peers or to the development of play with peers in the role of social collaborators. This may be attributed to such interventions’ heavy dependence on adults’ mediation and modeling. Strauss et al. (2014) underscored the advantages of using peers over adults as intervention agents leading to the development of complex play skills in children with ASD. The second intervention type that is described in the literature for the learning of social play with peers—what we termed above unstructured or indirect—focuses on “learning through experience” procedures that occur through participation in mixed play groups of typically developing children with children with ASD. In such groups, the typical peers act as role models for adaptive social play behavior, and the targeted play skills are acquired through repeated naturalist group play activities, which may or may not undergo some modifications by an adult (e.g., Gadaire et al., 2018; MacDonald et al., 2009; Murdock & Hobbs, 2011). A well-known model following this procedure is Pamela Wolfberg’s “integrated play group” (Wolfberg, 2016), which focuses on teaching play skills within the child’s naturalistic play settings that are organized by an adult to enable free-play experiences of children with ASD together with their typical age-mates. Play is acquired in small mixed groups, including novices (children with ASD) and experts (children with typical development), which meet on a regular basis to play together under the guidance of an adult. Research on the integrated play group procedure showed improvements in children’s play behaviors with their peers such as increases in the quantity and quality of the child’s social play and social pretend play, such as more complex forms of coordinated and symbolic play, as well as reductions in stereotypical and solitary play (Wolfberg, 2016). Parents and teachers also reported that participants in an integrated play group were able to generalize their learned play behaviors outside of the play group. However, the reported efficacy of this play group model was usually based on a small number of participants who were age 5 years and up, without a control group and without following up on longitudinal effects. In general, despite the methodological limitations of some play intervention studies (such as a small sample size, lack of a control group, and lack of randomization) and the fact that fewer studies focused on improving social play skills with peers compared to research examining object play or child–adult engagement, we can still carefully draw several conclusions (Kent et al., 2020). First, it appears that play intervention within the context of mixed groups, where peers with typical development can serve as role models and can elicit adaptive play behaviors, is an effective setting conducive to the development of peer play capabilities in children with ASD (Wolfberg, 2016). Second, the combination of didactic learning procedures with naturalistic free-play experiences seems to work effectively to improve

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children’s play capabilities (e.g., Kasari et al., 2012). Indeed, research demonstrated that the integration of both intervention models (structured and experiential) together resulted in better progress in play skill acquisition compared to interventions that adopted only one model (Godin et al., 2019; Kroeger et al., 2007). Moreover, the combination of multiple techniques–such as peer mediation, together with modeling of spontaneous social play situations, along with didactic teaching of social play and social pretend play through adult mediation and instruction—can lead to better improvement in play skills compared to the utilization of only a single strategy (e.g., Jordan, 2003; Kent et al., 2020). Third, the group context can provide children with play experiences that resemble those occurring naturally outside of the group, thereby improving the likelihood that children will be able to generalize what they learned in the group and apply it in additional preschool and home environments. In the peer play curriculum of the PPSI protocol that is delineated in Chap. 6, we follow these recommendations based on the reviewed research evidence. Our proposed PPSI protocol that is directed toward preschoolers’ second building block —peer social play and social pretend play—uses the small play group as a context for children to experience and practice the play skills that they acquire through adult-led structured learning.

Research on “Social Conversation” Interventions in Preschoolers with ASD As described in the previous chapters, typically developing preschoolers can show fairly complex social conversation skills; however, young children with ASD reveal atypical development in this domain, especially with regard to pragmatic language skills. Research has investigated various intervention programs that aimed to enhance conversational skills in children with ASD. Such interventions have documented attempts to promote conversational skills in ASD using a wide variety of techniques. For example, in “video modeling,” children watch a short video presenting a conversation between partners and are asked to participate in a conversation with an adult on the same topic (e.g., Charlop & Milstein, 1989). In “script fading” procedures, children receive written or audiotaped utterances, and then appropriate participation in each phase of the conversation is modeled for them, focusing on question-asking and initiations during conversation (Charlop-Christy & Kelso, 2003; Sarokoff et al., 2001). In “self-monitoring” techniques, children are taught how to use a reflective checklist referring to specific behaviors that occur during conversations, such as question-asking, adding information to the conversation topic, and appropriate responses during conversation (e.g., Koegel et al., 2014; Krasno et al., 2011). Behavioral techniques for conversational skill training may include structured practice sessions that entail providing a model, stimulating, fading the stimulus, and providing feedback and reinforcement (e.g., Conallen & Reed, 2016, 2017). Most interventions to date have relied

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mainly on behavioral therapeutic approaches and have concentrated on various dysfunctional aspects that characterize the peer conversations of individuals with ASD. For example, this type of method may focus on usage of personal expressions as a reply in conversation (Conallen & Reed, 2016, 2017), asking questions (Krasno et al., 2011; Palmen et al., 2008), or conversational skills such as aiming to gain listeners’ attention by calling their name before talking, elaborating on conversation by adding new information about the topic, or performing conversational repairs by repeating or changing unintelligible expressions (Müller et al., 2016). Most intervention studies targeting social conversation to date have some methodological limitations that do not permit wide generalizability—such as a small number of participants (up to six in each intervention program or single-case studies) or else the lack of a control group for empirical comparison (e.g., Brodhead et al., 2019; Brown et al., 2008; Chin & Bernard-Opitz, 2000; Müller et al., 2016). Furthermore, most available interventions targeting social conversational skills were conducted for older children at school ages and during adolescence (e.g., Bambara et al., 2018; Brodhead et al., 2019; Krasno et al., 2011; Müller et al., 2016; Palmen et al., 2008; Scattone, 2008) rather than for preschools. Moreover, the social context of these conversational interventions was mainly individual training with an adult (Brodhead et al., 2019; Conallen & Reed, 2016, 2017; Koegel et al., 2014; Krasno et al., 2011), rather than peer-to-peer contexts. In these prior interventions, children practiced various conversational skills with an experienced adult conversational partner—a teacher, parent, or experimenter—who could support any difficulties that might arise while talking with the child, unlike age-matched peers. A few previous intervention studies utilized a group context for applying different conversational features, such as learning to use appropriate remarks in conversation, to ask questions, or to establish reciprocity during conversations— although the participating children with ASD were of school age rather than preschool age. For example, Krantz and McClannaham (1993) trained four children with ASD (ages 9–12 years) by using written scripts of conversation initiations during participation in social activities with peers (outdoor recess games and indoor art activities). At the end of the intervention, all four participants had increased their number of talking initiations toward peers, and when followed up two months later, three of the participants were continuing to initiate conversations with peers at about the same increased level. Also, after training, all four participants demonstrated better ability to use unscripted verbal utterances, which three of them maintained at follow-up. In other research, Müller et al. (2016) conducted a pilot study that promoted social conversation skills in a group context for four children with ASD (ages 7:5–9:11 years) who were cognitively able (IQ > 75). After training, all four participants increased their peer-directed talk, asking questions while introducing new topics and/or extending the existing topics of conversation. Documented preschool-age interventions with peers are scarce for improving conversational skills. Peer-mediated interventions, where typically developing children act as mediators for preschoolers with ASD, often involve a combined set of conversation and interaction goals (see Gunning et al., 2019 for systematic review) such as skills for commenting while interacting with peers, asking and

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sharing toys and objects, and prearranging shared play (Kamps et al., 2015). For example, Kalyva and Avramides (2005) showed that three preschoolers with ASD who participated in a peer-mediated intervention decreased their inappropriate conversational-initiations and responses more than two other preschoolers who did not participate. Katz and Girolammetto (2015) also showed that their three preschoolers with ASD improved in their responsiveness toward peers during a conversation after attending peer-mediated intervention for 12 sessions of 20 min each, and they even were able to improve their conversational skills like initiations and responsiveness toward other peer partners who had not participated in the intervention. Lastly, Kamps et al.’s (2015) study of 95 preschoolers with ASD assigned 56 of the children to peer-mediated intervention sessions, 3 times a week for 6 months, while the other 39 children continued adult-mediated treatment as usual. Their results after the intervention indicated that the peer-mediated group significantly surpassed the adult-mediated group on various general communication and conversational skills toward their peers. In summary, most of the documented interventions promoting social conversation skills for children with ASD have revealed a positive improvement in competencies such as active participation in social conversation, asking more relevant questions, increasing communication initiations and responsiveness, and obtaining a partner’s attention. Furthermore, the involvement of peers was found to render a positive effect on the participation of children with ASD in a variety of peer exchanges including peer talk. Nevertheless, it should be noted that most of the available interventions to date have investigated a small number of participants, have carried out conversational training practices via an adult trainer rather than peers, and have mainly included school-age children. Preschoolers’ conversationfocused interventions are relatively rare. In our proposed PPSI intervention protocol that is directed toward preschoolers’ third building block—social communication and conversation between peers— which we delineate in Chap. 7, we aim to close these gaps in the literature. Based on the existing research evidence, our PPSI social conversation curriculum focuses on combining learning and practice of conversational skills with the help of both an adult “expert” and of peer age-mates as role models and mediators.

Conclusions Overall, our systematic review of available research that has attempted to evaluate the effectiveness of prior interventions identified some very important components that should be incorporated into the design of any holistic treatment targeting the three building blocks underlying children’s peer relations in preschoolers with ASD. For example, an advantage was noted for peer mediation versus adult mediation (Strauss et al., 2014), suggesting that the integration of typically developing peers into social intervention programs seems important when the goal is to promote interpersonal skills in the preschool years. Despite the limited scope

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of prior peer interventions during preschool, the studies that did implement such peer-engagement procedures revealed positive results such as increases in play complexity, play, conversation and interaction adequacy, and even generalization to situations with unfamiliar peers (e.g., Watkins et al., 2019). However, as seen, the scientific literature to date has mostly investigated training programs that attempted to promote the interaction, play, and conversation skills of older school-age children or adolescents with ASD, rather than preschoolers. Furthermore, some studies were methodologically limited by their small sample sizes, the absence of randomization and control groups, and/or the lack of simultaneous separate delivery of interventions in all three key domains within a comprehensive holistic model (e.g., Kent et al., 2020; Luckett et al., 2007; Müller et al., 2016; Reichow & Volkmar, 2010; Rogers, 2000). In all, the currently available body of research suggests that the ASD field could benefit substantially from more evidence-based manualized peer interventions in naturalistic settings—targeting spontaneous peer interaction, social play and social pretend play, and social conversation—to contribute to improvements in these preschoolers’ quality of life by mitigating social-communicative symptoms associated with their disorder. As seen in the next section of this book, our evidence-based PPSI protocol (Bauminger-Zviely et al., 2020) offers such a comprehensive and integrative model that strives to adopt recommendations from past studies in the field. As detailed next, the PPSI intervention espouses a holistic perspective of social relations, using an ecological and developmental protocol that is based on peer-to-peer exchanges in small groups, with the mediation of an adult, which integrates both learning and practicing of the targeted social interaction, play, and conversation components. In order to understand the unique contribution of the PPSI in increasing comprehensive peer engagement, the next section will first present this innovative holistic intervention program’s concepts, principles, and techniques before presenting the full, detailed contents of the PPSI protocol for preschoolers’ social interaction, play, and conversation.

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Radley, K. C., O’Handley, R. D., Ness, E. J., Ford, W. B., Battaglia, A. A., McHugh, M. B., & McLemore, C. E. (2014). Promoting social skill use and generalization in children with autism spectrum disorder. Research in Autism Spectrum Disorders, 8, 669–680. https://doi.org/10. 1016/j.rasd.2014.03.012 Rao, P. A., Beidel, D. C., & Murray, M. J. (2008). Social skills interventions for children with asperger’s syndrome or high-functioning autism: A review and recommendations. Journal of Autism and Developmental Disorders, 38, 353–361. Reichow, B., Steiner, A. M., & Volkmar, F. (2012). Social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD). Campbell Systematic Reviews, 8, 1–76. https://doi.org/ 10.4073/csr.2012.16 Reichow, B., & Volkmar, F. R. (2010). Social skills interventions for individuals with autism: Evaluation for evidence-based practices within a best evidence synthesis framework. Journal of Autism and Developmental Disorders, 40(2), 149–166. Rogers, S. J. (2000). Interventions that facilitate socialization in children with autism. Journal of Autism and Developmental Disorders, 30, 399–409. https://doi.org/10.1023/A:1005543321840 Sandbank, M., Bottema-Beutel, K., Crowley, S., Cassidy, M., Dunham, K., Feldman, J. I., Crank, J., Albarran, S. A., Raj, S., Mahbub, P., & Woynaroski, T. G. (2020). Project AIM: Autism intervention meta-analysis for studies of young children. Psychological Bulletin, 146(1), 1–29. Sarokoff, R., Taylor, B. A., & Poulson, C. L. (2001). Teaching children with Autism to engage in conversational exchanges: Script fading with embedded textual stimuli. Journal of Applied Behavior Analysis, 34, 81–84. Scattone, D. (2008). Enhancing the conversation skills of a boy with asperger’s disorder through social stories and video modeling. Journal of Autism Developmental Disorders, 38(2), 395– 400. Shire, S. Y., Shih, W., Chang, Y. C., & Kasari, C. (2018). Short play and communication evaluation: Teachers’ assessment of core social communication and play skills with young children with autism. Autism, 22(3), 299–310. Shores, R. E. (1987). Overview of research on social interaction: A historical and personal perspective. Behavioral Disorders, 12(4), 233–241. https://doi.org/10.1177/019874298701 200408 Stahmer, A. C., Ingersoll, B., & Carter, C. (2003). Behavioral approaches to promoting play. Autism International Journal of Research and Practice, 7, 401–413. Stanton-Chapman, T. L., & Snell, M. E. (2011). Promoting turn-taking skills in preschool children with disabilities: The effects of a peer-based social communication intervention. Early Childhood Research Quarterly, 26(3), 303–319. https://doi.org/10.1016/j.ecresq.2010.11.002 Strauss, K., Esposito, M., Polidon, G., Giovanni, V., & Fava, L. (2014). Facilitating play, peer engagement and social functioning in a peer group of young autistic children: Comparing highly structured and more flexible behavioral approaches. Research in Autism Spectrum Disorders, 8(4), 413–423. Tachibana, Y., Miyazaki, C., Mikami, M., Ota, E., Mori, R., Hwang, Y., Terasaka, A., Kobayashi, E., & Kamio. (2018). Meta-analyses of individual versus group interventions for pre-school children with autism spectrum disorder (ASD). PLoS ONE, 13(5), e0196272. https://doi.org/ 10.1371/journal.pone.0196272 Vernon, T. W., Koegel, R. L., Dauterman, H., & Stolen, K. (2012). An early social engagement intervention for young children with autism and their parents. Journal of Autism and Developmental Disorders, 42, 2702–2717. https://doi.org/10.1007/s10803-012-1535-7 Vilson, E. R., Wine, B., & Fitterer, K. (2017). An Investigation of the MATRIX training approach to teach social play skills. Behavioral Interventions, 32, 278–284. Watkins, L., O’Reilly, M., Kuhn, M., Gevarter, C., Lancioni, G. E., Sigafoos, J., & Lang, R. (2015). A review of peer-mediated social interaction interventions for students with autism in inclusive settings. Journal of Autism and Developmental Disorders, 45, 1070–1083. https:// doi.org/10.1007/s10803-014-2264-x

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Watkins, L., O’Reilly, M., Kuhn, M., & Ledbetter- Cho, K. (2019). An interest-based intervention package to increase peer social interaction in young children with autism spectrum disorder. Journal of Applied Behavior Analysis, 52, 132–149. https://doi.org/10.1002//jaba.514 Waugh, C., & Peskin, J. (2015). Improving the social skills of children with HFASD: An intervention study. Journal of Autism and Developmental Disorders, 45, 2961–2980. https:// doi.org/10.1007/s10803-015-2459-9 Wolfberg, P. J. (2016). Integrated play groups model: Supporting children with autism in essential play experiences with typical peers. In L. A. Reddy, T. M., Files-Hall & C. E. Schaefer (Eds.), Empirically-based play intervention for children (2nd ed, pp. 223–240). American Psychological Association. Wolstencroft, J., Robinson, L., Srinivasan, R., Kerry, E., Mandy, W., & Skuse, D. (2018). A systematic review of group social skills interventions, and meta-analysis of outcomes, for children with high functioning ASD. Journal of Autism and Developmental Disorders, 48, 2293–2307. https://doi.org/10.1007/s10803-018-3485-1 Won, R., Chan, S., Nga, C., Leung, W., Ching, D., Ng, Y., Sania, S., & Yau, W. (2018). Validating a culturally-sensitive social competence training programme for adolescents with ASD in a Chinese context: An initial investigation. Journal of Autism and Developmental Disorders, 48, 450–460. https://doi.org/10.1007/s10803-017-3335-6 Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., Brock, M. E., Plavnick, J. B., Fleury, V. P., & Schultz, T. R. (2015). Evidence-Based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45, 1951–1966. https://doi.org/10.1007/s10803-0142351-z Zagona, A. L., & Mastergeorge, A. M. (2018). An empirical review of peer-mediated interventions: Implications for young children with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 33(3), 131–141.

Part II

Principles, Techniques, and Contents of the PPSI Protocol: Interaction, Play, and Conversation Interventions

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Conceptual Basis, Principles, and Rationales for the PPSI

The Conceptual Basis Underlying the PPSI The current chapter provides readers with the conceptual background that can serve as a context for understanding the rationales and evidence-based approaches underlying implementation of the PPSI intervention for preschoolers with ASD. By preschool, in this book, we are referring to educational settings for the 3- to 6-year age range, which may include pre-K and kindergarten classes. Before detailing the full PPSI protocol in Chaps. 5, 6 and 7—for the enhancement of interaction, play, and conversation—this chapter next delineates the PPSI’s conceptual basis, main principles, and rationales. As elaborated below, the PPSI is a psychoeducational ecological intervention program upholding a holistic perception of social functioning among preschoolers with ASD. The PPSI is holistic in that it systematically encompasses the three main building blocks of adaptive peer relations for children of young ages—namely, peer interaction, social play and social pretend play, and social conversation or peer talk. The PPSI is psychoeducational in that it dynamically incorporates young children’s developmental features and the unique learning profiles of preschoolers with ASD; it also utilizes principles and methods adapted from cognitive-behavioral therapy (CBT), integrating cognitive social-learning strategies together with experiential behavioral strategies. The PPSI is ecological in that it is implemented in young children’s real-time natural settings together with their actual targeted social partners—their preschool peers—while involving their own teachers/therapists and peers as mediators, models, and change agents. Specifically, several important principles, techniques, and rationales driving the PPSI intervention approach merit some discussion before embarking on examination of the full protocol. The next sections expand on the PPSI intervention’s: (a) ecological naturalistic setting, (b) CBT-based psychoeducational model, (c) developmentally appropriate activities, (d) two-stage integrative structure including

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 N. Bauminger-Zviely et al., Preschool Peer Social Intervention in Autism Spectrum Disorder, Social Interaction in Learning and Development, https://doi.org/10.1007/978-3-030-79080-6_4

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skill acquisition/learning and skill practice/experiencing, (e) emphasis on peer-peer modeling, (f) adult mediation, (g) mobilization of the visual strengths of children with ASD, and (h) holistic model comprising three content areas conducive to intervention personalization.

Ecological Naturalistic Setting The PPSI curricular program is implemented in an ecological treatment setting (e.g., Bronfenbrenner, 1992). Namely, the PPSI takes place within the child’s natural educational environment—the preschool, is provided by the child’s teacher, and includes active participation of the child’s age-mates. Rogers and Vismara (2014) suggested that interventions carried out within the natural educational setting not only increase the connections between the intervention activities and the child's natural needs but also enhance the intervention’s social validity and the feasibility of generalization. The positive and important contribution of staff members who are familiar to the child, in the role of intervention mediators, has been highlighted in various studies for school-age children with ASD (e.g., Mason et al., 2014) and for preschoolers with ASD (e.g., Barber et al., 2016).

CBT-Based Psychoeducational Model The PPSI espouses a psychoeducational orientation based on the cognitive-behavior therapy (CBT) approach, although the young age and cognitive profile of our targeted intervention participants necessitates some adaptations from the full CBT model. The interplay between how children think, feel, and behave is the main conceptual supposition of CBT, in which social learning and cognitive processes are conceived as the mediators between social events and the child’s enacted behavioral or emotional responses (Hart & Morgan, 1993). Cognitive and behavioral techniques are integrated throughout the CBT treatment to achieve specific targeted changes in children’s thoughts, feelings, and behaviors (Scarpa & Lorenzi, 2013). Through CBT activities, children receive opportunities to learn constructive strategies for improving social cognition and social competence. Thus, under the umbrella of CBT, children are perceived as active “cognitive constructors” of their social world who can actively work to change their misperceptions or distorted understanding of social stimuli as well to build new and more adaptive social schema (Dobson & Dobson, 2009). Overall, CBT-based treatment strives to change the child’s maladaptive cognitive processes, construct new cognitive knowledge and emotional understanding of relevant social situations, and practice adaptive social behaviors within the child's natural social environment (Bauminger-Zviely, 2013).

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Due to the young age of the PPSI participants—children in preschool—a full CBT treatment model could not be performed. However, the PPSI utilized age-appropriate cognitive techniques like problem solving and concept clarification for the learning of social constructs, combined with behavioral techniques like role-play for practicing peer engagement behavior within the peer group (Dobson & Dobson, 2009). CBT adaptations were also required to account for the unique learning profile of young children with ASD such as specific atypicalities in pragmatic and social conversation as well as their concrete logic and rigid thinking profile, alongside relatively more advanced visual reasoning abilities. Thus, the PPSI curriculum adopted recommended CBT reworkings such as constructing a learning process based on demonstrations and visual imagery while placing less emphasis on conversation throughout the learning process (Attwood & Scarpa, 2013). Correspondingly, executive function challenges in areas such as cognitive flexibility during problem solving or set shifting may contribute to a lack of generalization from the learned context to the child’s social environment, thus leading to the CBT-based activities’ delivery within the PPSI program’s ecological treatment setting.

Developmentally Appropriate Contents and Activities The PPSI program includes interaction, play, and conversational contents, activities, and materials that interest and promote typically developing preschoolers of the same chronological age as our targeted intervention participants with ASD. Thus, the PPSI systematically entails common preschool activities like arts and crafts, snack time, breaks, and outdoor play. In addition, developmentally appropriate everyday toys, games, and materials are utilized naturally throughout the PPSI protocol, such as building sets and blocks, construction toys, dolls, board games, animals, pretend play sets, and so on. These ordinary activities and materials were selected to make repetitive age-appropriate practice available in the children's daily routines and to maintain the young children’s interest. Developmentally, the PPSI protocol includes age-appropriate curricula for play, interaction, and conversation skills while accounting for age in the targeted 3- to 6-year-olds and for their individual differences in social-communication abilities (Krasny et al., 2003). Generally, each of the three curricula upholds a developmental orientation, whereby the preschoolers gradually, step-by-step, build up their social engagement capabilities. This gradual progression begins with the more basic, simple social capabilities that require less integration and coordination with peers and then slowly moves toward the more complex, advanced capabilities that demand greater reciprocity. Contents, tasks, activities, and games may initially present a broad concept (e.g., “What is cooperation?”) and then proceed to offer numerous variants for fine-grain learning and practice of that general concept while increasing the complexity of social engagement.

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This developmental progression is clearest for the PPSI play curriculum (see Chap. 6), which directly follows Howes’s (1980; Howes et al., 1992) model that outlined the expected ages for young children’s development of social and social pretend play skills, as described in Chap. 1. Similarly, the PPSI social interaction curriculum (see Chap. 5) moves from the general concept of preschoolers’ joint activity—learning to collaborate and coordinate social actions with peers—to the learning and practice of its fine-grain age-appropriate components such as sharing objects, ideas, and feelings; prosocial skills like providing help, comforting, and encouraging; and using conflict resolution skills (Krasny et al., 2003; Rao et al., 2008). Likewise, the PPSI social conversation curriculum (see Chap. 7) begins by clarifying basic concepts such as “What is a social conversation?” and gradually promotes learning and practice of that general concept’s underlying components such as the fine-grain skills for initiation, maintenance, and ending of various age-appropriate types of conversation like activity-oriented, interpersonal, or argumentative talk (Blum-Kulka et al., 2004). Overall, the PPSI protocol thus accounts for developmental needs and interests, enabling each young child to build up capabilities gradually through familiar and enjoyable activities. Through everyday tasks and materials, the preschoolers can gradually move from more basic, less complex social behaviors to those that are more challenging in terms of their needed level of co-regulation and coordination with peers.

Two-Stage Integrative Structure: Skill Acquisition via Adult Mediation (Conceptual Learning Stage) and Skill Practice with Peers (Experiencing and Performing Stage) The challenges inherent to spontaneous learning of peer engagement skills in young children with ASD are twofold, encompassing on the one hand children’s conceptual understanding of the building blocks of peer engagement (interaction, play, and conversation) and on the other hand children’s actual performance of these social behaviors appropriately in everyday encounters with peers. Therefore, the PPSI intervention protocol is designed to foster the interplay between the child’s learning and the child’s experiencing of the targeted social functioning domains. During each week of the intervention, the first session—the “learning” or “skill acquisition” stage—provides structured learning of social concepts and skills for the child with ASD, delivered in the context of a dyadic child–adult session mediated by the PPSI facilitator (e.g., the child’s educator or therapist). The second and third sessions of that week—the “experiencing” or “skill practice” or “performance” stage—provide the child with ASD with practical hands-on live experiences in trying out and applying the newly learned skills within a consistent, familiar, small group of peers. All in all, these three weekly sessions that incorporate

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learning/acquisition and experiencing/practice create an intervention process of sufficient intensity to achieve the desired dual outcomes of both understanding as well as demonstrating social engagement behaviors (e.g., Boyd et al., 2008).

Skill Acquisition (Learning) Stage In the first of the three weekly PPSI sessions in the preschool, the adult PPSI facilitator meets alone with the child with ASD to explore the manual’s targeted social construct for that week. Acting as a mediator for the conceptual material, the adult facilitator helps expand the child’s social understanding and social cognition by exposing the child to social concepts (e.g., what is play, what is a friend, what are conversation rules, what is compromise, what are the topics for peer talk, and so on), social norms (e.g., how we take turns, how we listen to a friend), social importance (why it is important to listen to a friend, why it is important to compromise with a friend). To expand the child’s social understanding, the main mediation tools are CBT-based cognitive strategies that were found to be effective in promoting social competence. Such techniques include cognitive reconstruction and concept clarification, namely, helping to ameliorate the child’s atypical conceptualizations of the social world and build social-emotional knowledge through explaining, clarifying, and teaching of social constructs and norms (e.g., Attwood, 2004). Another example of an important skill acquisition technique is problem-solving activity; for example, the adult mediator may suggest a social schema to help the child perceive and learn about various social situations, and then the child is asked to define the problem/social task, explore solutions, consider consequences, organize a plan, and act, while evaluating how it went (e.g., Barnes et al., 2018; Bauminger-Zviely, 2013). In preparation for the peer practice of learned skills, the adult mediator also helps the child to concretely train in applying the acquired construct under conditions resembling the natural environment but while still in the safety of the supported adult-mediated dyadic session. This preparation is promoted through several CBT-based behavioral techniques such as modeling (demonstration of the particular behavior); role-playing by the facilitator and child (including doll or puppet play) that offers opportunities to train in the concrete or symbolic social concepts, rules, norms, or actions; and behavioral rehearsal of the learned skills (Bauminger-Zviely, 2013; McCoy et al., 2016).

Skill Practice (Experiencing and Performing) Stage In the small peer-group activities twice a week, the child with ASD can experience and practice the actual social interaction, play, and conversation skills attained in that week’s learning-acquisition stage. Children’s participation in this small-group experience offers opportunities to practice newly learned skills in a relatively naturalistic semi-structured social environment that may promote spontaneous

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exchanges with other children. Scheduled small-group activity was found to increase social engagement for children with ASD more than individual child-therapist sessions alone (Gadaire et al., 2018). Moreover, the small size of the group is important: Preschoolers with ASD were shown to engage in more social initiations (verbal or gestural behaviors) and more social interactions with peers while participating in a small-group setting (2–4 children) compared to large-group arrangements (Boyd et al., 2008; Reszka et al., 2012). Through participation and shared actions with typically developing children in the PPSI semi-structured small-group activities, children with ASD can experience collaborative acts, conversations, and play exchanges. The PPSI peer-group participation stage aims to stimulate and strengthen the degree of overt social engagement that children with ASD experience with their typically developing peers, in a setting as close as possible to natural social environments that they may encounter in everyday life. Thus, each week’s target behavior is practiced via semi-structured activities performed in this small peer group, such as playing indoors with toys, a joint crafts activity, or maintaining a conversation while eating snacks. The typically developing peers in the group are not given specific instructions other than being asked to cooperate and participate in the sets of activities organized by the PPSI facilitator, according to the given protocol’s various social goals (i.e., to interact, play, or converse), with a focus on promoting a fun and enjoyable group atmosphere.

Emphasis on Peer-Peer Modeling The PPSI program is uniquely situated to create ample opportunities for social engagement and thereby enhance the social functioning of young children with ASD because of its primary reliance on typically developing age-matched peers as change agents. Learning how to engage with peers is best learned while actually engaging with them. Children with ASD who acquire social skills in adult–child social situations do not spontaneously transfer those learned skills to their social situations with peers. Indeed, interventions incorporating peers were found to increase the social participation of children with ASD (DiSalvo & Oswald, 2002; Wolstencroft et al., 2018). Moreover, studies showed that placement in inclusive classrooms promotes the social initiative skills and the overall generalization of social skills in children with ASD because peers with typical development exhibit modeling of appropriate social behavior (e.g., Rotheram-Fuller et al., 2010). It seems that, for young children with ASD, peer-to-peer engagement is a “different language” of social behavior compared to the “language” of child–adult engagement, where the adult can more easily scaffold the situation for the child. Repeated, semi-structured exposure to typically developing peers as social partners offers crucial role-modeling of dynamic, adaptive overt social engagement behaviors, which helps the child with ASD to contextualize, clarify, and rehearse the novel

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behavioral “language” enabling adequate functioning with peers during diverse social experiences and situations. As mentioned, the PPSI’s unique implementation procedure includes two peer-to-peer experiential group sessions per week for practicing that week’s learned social construct. Several features of these peer groups are important to note. First, in line with evidence indicating the benefit of small group size over large groups (Boyd et al., 2008; Reszka et al., 2012) each of the PPSI small groups contains three to four children. Second, each of these small peer groups is “mixed”—consisting of one or two children with ASD as well as two peers with typical development who can help to model the week’s targeted behavior and offer opportunities for practicing it in a naturalistic group setting. It is important to note that the PPSI experiencing and performing stage can also be practiced within non-mixed groups of ASD participants, when mixed groups are not possible (see expansion in Chap. 9 about the PPSI’s implementation). Third, the same peer collaborators consistently participate in all group practice sessions across the PPSI intervention period, in line with former studies in the field showing that children with ASD demonstrate better social functioning with familiar than unfamiliar peers (Bauminger-Zviely, 2013). Familiarity enables the development of rapport during group work and thus may lead to better treatment results.

Adult Mediation The mediation of children’s skill acquisition and practice by adults, in combination with peer involvement, has been found effective in a variety of intervention studies targeting children with ASD—demonstrating an important role in promoting social skills (Bellini et al., 2014), play skills (Rogers & Vismara, 2008), and conversational skills (Dotson et al., 2010; Müller et al., 2016; Palmen et al., 2008). In the case of the PPSI intervention, the trained PPSI facilitator who leads the manualized protocol can be an on-site preschool therapist, the child’s preschool educator, or other trained professional. The adult facilitator’s vital role in the PPSI intervention encompasses not only direct mediation during the learning/acquisition phase but also scaffolding of the small group’s social activities during the experiencing/practice phase. Thus, in the one-on-one session taking place between the adult and the child with ASD, the facilitator helps the child develop and expand understanding of social cognition. Then, within the two small-group sessions each week, the adult facilitator monitors the peer group’s activities. Both in the dyadic child-facilitator session and in the two peer-group sessions, the PPSI facilitator can provide feedback and reinforce appropriate responses as needed, to help children stay focused on the targeted behaviors while encouraging children’s enjoyment.

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Mobilization of the Visual Strengths of Children with ASD to Support Social Learning Children with ASD have been characterized in the literature as “visual learners”— meaning that the integration of visual aids into their social learning processes corresponds well with these children’s relatively strong visual processing capabilities (Quill, 1997; Rutherford et al., 2020). Moreover, visual aids to support and concretize verbal material is one of the most common psychosocial intervention techniques recommended for persons with ASD across the lifespan (Denne et al., 2018; Krasny et al., 2003; Rutherford et al., 2020; SIGN, 2016). By using visually based instruction aids—visual and/or audiovisual stimuli like illustrations, photos, and video clips—abstract social concepts may become more concrete and tangible, thereby promoting the child’s social understanding processes (e.g., Krasny et al., 2003). For example, drawings and photos may be used to demonstrate, clarify, and define social concepts and processes like turn-taking, facial expressions, and body language. Such visual tools are even more important in young children such as preschoolers, for whom written words are not yet tangible. Visual support has been also found to reduce anxiety throughout the learning process and help the child become more attenuated to various stimuli (Rutherford et al., 2020). Indeed, various visual supports and visual aids have been developed to promote the communication, play, language, and social skills of children with ASD (e.g., Ganz & Flores, 2008; Nelson et al., 2007; Waugh & Peskin, 2015). In the PPSI intervention program, we use diverse visual stimuli extensively. Our visual tools include drawings and photos, various cards, video clips, and more. For example, to concretize the abstract concept of role reversal in coordinated play, two adjacent photos may be used, each depicting the same pair of children playing run-and-chase but with a different child as the chaser. Navigation cards are implemented using colorful graphic-visual symbols to guide and prompt the child to make a decision or to offer clues or reminders of target behavior, such as the steps needed to initiate a peer interaction or the symbols that prompt the choosing!planning!acting steps comprising joint activity. Illustrated definition cards help children concretize and internalize social concepts such as what is a friend. The PPSI visual tools also include a range of flash cards, storytelling pictures, short video-clips, and role-playing puppets (see Appendix for a full list of the PPSI visual aids). To be noted, beyond utilizing visual supports to help promote social learning processes by illustrating the targeted social concepts, behaviors, and skills, the PPSI intervention also employs illustrated activity schedules to help children orient toward and organize their sessions.

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Holistic Model Configured as Three Content Areas to Foster Professional Expertise, Skill Assessment, and Intervention Personalization Bearing in mind that peer social interaction, play, and conversation are all vital and interconnected components for adaptive peer relations among preschoolers with ASD, our comprehensive holistic PPSI model explicitly incorporates all three of these content areas. The world of social engagement with young peers is a diverse and complex one, especially for children with ASD. Thus, it is important to emphasize that the holistic PPSI intervention’s structure deliberately separates these interrelated building blocks of peer engagement into three distinct, detailed curricula within the PPSI protocol. Underlying this separate configuration are three major rationales: (a) to help focus and organize professionals’ specialized knowledge and growing expertise in each of the three interrelated content areas, thereby honing practitioners’ specialized intervention efforts; (b) to facilitate systematic assessment of children’s skills sets in the three content areas and to evaluate each separate curriculum’s relative effectiveness and reciprocal influences; and (c) to promote personalization and tailoring of the intervention to individual children’s needs. Overall, by concentrating on only one building block at a time—interaction, play, or conversation—we were better able to create a focused, systematic, in-depth, progressively developmental model for the enhancement of each key domain that makes up the necessary interplay for promoting peer relations. Let us briefly elaborate on our rationales for separating the three content areas and configuring the PPSI intervention accordingly into three distinct curricula. First, structuring the holistic PPSI intervention in the form of these three separate content areas helps furnish PPSI facilitators with a clearer and more detailed conceptual and practical work-model for each key social relations domain, thereby fostering the facilitators’ deeper expertise in each of the three building blocks. This three-part configuration aimed to better enable facilitators to recognize and distinguish the three different interrelated skill sets that together afford peer engagement and thus to utilize them more congnizantly in their intervention efforts. This more specialized awareness expertise in each of the three content areas involved in the development of peer engagement were expected to foster facilitators’ greater professionalism in delivering a holistic peer-to-peer training program. Second, the three-part structure for intervention can permit the execution of more systematic, focused research and assessment. On the one hand, as described in detail in Chap. 9, the PPSI facilitators can utilize the separate interaction, play, and conversation building blocks to systematically assess each individual child’s relevant skill sets (e.g., see practical guidelines for each building block in Tables 9.1– 9.4). On the other hand, rigorous empirical investigation can be applied to examine the unique contribution of each of the three PPSI curricula, as reported in detail in Chap. 8. Namely, beyond examining each separate curriculum’s effectiveness for directly promoting these young children’s peer relations, we were able to examine whether participation in intervention targeting only one of the content domains

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might have desirable indirect spillover effects on the other two domains, as discussed thoroughly in Chap. 8. In other words, we scrutinized the effectiveness of training in each separate domain as well as children’s ability to generalize from training in one social domain to another untrained domain (e.g., to determine if acquisition and practice of trained peer play skills might lead to improvements in untrained peer conversation skills). Overall, each of the three PPSI curricula showed the best improvement rates in its trained content domain, as expected. However, we also found interesting generalizations from one content area to another, as elaborated in Chap. 8. These domains’ separation within the PPSI protocol can enable future researchers and intervention facilitators to continue conducting empirical examination of the effectiveness of training in each building block for their target children with ASD. Third, the holistic PPSI model’s separation into three distinct, comprehensive, specialized curricula can permit PPSI facilitators to tailor the intervention to the specific needs of individual preschoolers with ASD in their particular learning environments. This potential flexibility is crucial in the case of young children with ASD because of the broad heterogeneity in their social functioning profile. The extensive depth and specialization characterizing each of the three separate curricula making up the PPSI protocol permit facilitators to design an individualized, personally tailored intervention for each child, either sequentially or simultaneously, to fit each child’s own peer engagement needs. Decisions about which of the three curricula to deliver most urgently, or which aspects of the protocol could be integrated together, can be made in collaboration with each child’s therapeutic team, preschool staff, and parents. Thus, based on growing holistic expertise in all three key domains for effective peer engagement, the PPSI facilitator can generate treatment priorities, foci, and sequencing for each child. For example, intervention may begin with the play curriculum if social play is identified as the most challenging domain in a specific preschooler’s repertoire. Alternatively, a child’s evaluation may lead the facilitator to combine domains, for instance to emphasize the child’s quality of peer talk (conversation) and prosocial capabilities (interaction) when working on play skills. In Chap. 9, we expand on the complementarity of the three curricula and working methods to assist in the customization of PPSI implementation for individual children (e.g., see practical guidelines for each building block in Tables 9.5–9.8).

Conclusions This chapter focused on providing readers with the conceptual framework and methodological reasoning for the PPSI’s design and objectives. Major underlying principles and important techniques were delineated to help orient readers to the contents and structure of the upcoming full intervention protocol to be presented next. Helpful additional practical guidelines for the full implementation of the PPSI

Conclusions

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will be elaborated in Chap. 9. We next present the full PPSI protocol comprising the three separate curricula representing the three building blocks of young children’s peer engagement: peer social interaction in Chap. 5, social play and social pretend play in Chap. 6, and social conversation in Chap. 7.

References Attwood, T. (2004). Cognitive behaviour therapy for children and adults with Asperger’s syndrome. Behaviour Change, 21, 147–161. Attwood, T., & Scarpa, A. (2013). Modification of cognitive-behavioral therapy for children and adolescents with high functioning autism and their communication difficulties. In A. Scarpa, S. Williams-White, & T. Attwood (Eds.), CBT for children and adolescents with high-functioning autism. Guilford Press. Barnes, T. N., Wang, F., & O’Brien, K. M. (2018). A meta-analytic review of social problem-solving interventions in preschool settings. Infant and Child Development, 57, 1–22. Bellini, S., Gardner, L., & Markoff, K. (2014). Social skill interventions. In F. R. Volkmar, S. J. Rogers, R. Paul, & K. A. Pelphrey (Eds.), Handbook of autism and pervasive developmental disorders (pp. 887–906). Wiley. Barber, A. B., Saffo, R. W., Gilpin, A. T., Craft, L. D., & Goldstein, H. (2016). Peers as clinicians: Examining the impact of Stay Play Talk on social communication in young preschoolers with autism. Journal of Communication Disorders, 59, 1–15. Bauminger-Zviely, N. (2013). Social and academic abilities in children with high-functioning autism spectrum disorders. Guilford Press. Blum-Kulka, S., Huch-Taglicht, D., & Avni, H. (2004). The social and discursive spectrum of peer talk. Discourse Studies, 6, 307–329. Boyd, B. A., Conroy M. A., Asmus, J. M., McKenney, E. L. W., & Mancil, G. R. (2008). Descriptive analysis of classroom setting events on the social behaviors of children with autism spectrum disorder. Education and Training in Developmental Disabilities, 43, 186–197. Bronfenbrenner, U. (1992). Ecological systems theory. In R. Vasta (Ed.), Annals of child development. Six theories of child development: Revised formulations and current issues (pp.178–249). Jessica Kingsley. Denne, L. D., Hastings, R. P., & Hughes, C. J. (2018). Common approaches to intervention for the support and education of children with autism in the UK: An internet-based parent survey. International Journal of Developmental Disabilities, 64, 105–111. DiSalvo, C. A., & Oswald, D. P. (2002). Peer-mediated interventions to increase the social interaction of children with autism: Consideration of peer expectancies. Focus on Autism and Other Developmental Disorders, 17, 198–207. Dobson, D., & Dobson, K. (2009). Evidence-based practice of cognitive behavioral therapy. Guilford Press. Dotson, W. H., Leaf, J. B., Sheldon, J. B., & Sherman, J. A. (2010). Group teaching of conversational skills to adolescents on the autism spectrum. Research in Autism Spectrum Disorders, 4, 199–209. Gadaire, D. M., Bartell, J. K., & Villacorta, J. (2018). Evaluating group activity schedules to promote social play in children with autism. Learning and Motivations, 64, 18–26. Ganz, J. B., & Flores, M. M. (2008). Effects of the use of visual strategies in play groups for children with autism spectrum disorders and their peers. Journal of Autism and Developmental Disorders, 38, 926–940. Hart, K. J., & Morgan, J. R. (1993). Cognitive behavioral therapy with children: Historical context and current status. In A. J. Finch, W. M. Nelson, & E. S. Ott (Eds.), Cognitive behavior procedures with children and adolescents: A practical guide (pp. 1–24). Allyn Bacon.

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Howes, C. (1980). Peer Play Scale as an index of complexity of peer interaction. Developmental Psychology, 16, 371–372. https://doi.org/10.1037/0012-1649.16.4.371 Howes, C., Unger, O. A., & Matheson, C. C. (1992). The collaborative construction of pretend: Social pretend play functions. State University of New York Press. Krasny, L., Williams, B. J., Provencal, S., & Ozonoff, S. (2003). Social skills interventions for autism spectrum: Essential ingredients and a model curriculum. Child and Adolescent Psychiatric Clinics, 12, 107–122. Mason, R., Kamps, D., Turcotte, A., Cox, S., Feldmiller, S., & Miller, T. (2014). Peer mediation to increase communication and interaction at recess for students with autism spectrum disorder. Research in Autism Spectrum Disorders, 8, 334–344. McCoy, A., Holloway, J., Healy, O., Rispoli, M., & Neely, L. (2016). A systematic review and evaluation of video modeling, role-play and computer-based instruction as social skills interventions for children and adolescents with high-functioning autism. Review Journal of Autism and Developmental Disorders, 3, 48–67. Müller, E., Cannon, L. R., Kornblum, C., Clark, J., & Powers, M. (2016). Description and preliminary evaluation of a curriculum for teaching conversational skills to children with high functioning autism and other social cognition challenges. Language, Speech, and Hearing Services in Schools, 47, 191–208. Nelson, C., Mcdonnell, A. P., Johnston, S. S., Crompton, A., & Nelson, A. R. (2007). Keys to play: A strategy to increase the social interactions of young children with autism and their typically developing peers. Education and Training in Developmental Disabilities, 42, 165–181. Palmen, A., Didden, R., & Arts, M. (2008). Improving question asking in high-functioning adolescents with autism spectrum disorders: Effectiveness of small-group training. Autism, 12, 83–98. Quill, K. A. (1997). Instructional considerations for young children with autism: The rationale for visually cued instruction. Journal of Autism and Developmental Disorders, 27, 697–714. Rao, P. A., Beidel, D. C., & Murray, M. J. (2008). Social skills interventions for children with asperger’s syndrome or high-functioning autism: A review and recommendations. Journal of Autism and Developmental Disorders, 38, 353–361. https://doi.org/10.1007/s10803-007-0402-4 Reszka, S. R., Odom, S. L., & Hume, K. A. (2012). Ecological features of preschools and the social engagement of children with autism. Journal of Early Intervention, 34, 40–56. https:// doi.org/10.1177/1053815112452596 Rogers, S. J., & Vismara, L. A. (2008). Evidence-based comprehensive treatments for early autism. Journal of Clinical Child and Adolescent Psychology, 37(1), 8–38. Rogers, S. J., & Vismara, L. A. (2014). Interventions for infants and toddlers at risk for autism spectrum disorder. In F. R. Volkmar, S. J. Rogers, R. Paul, & K. A. Pelphrey (Eds.), Handbook of autism and pervasive developmental disorders (4th ed., pp. 739–756). Wiley. Rotheram-Fuller, E., Kasari, C., Chamberlain, B., & Locke, J. (2010). Social involvement of children with autism spectrum disorders in elementary school classrooms. Journal of Child Psychology and Psychiatry, 51, 1227–1234. Rutherford, M., Baxter, J., Grayson, Z., Johnston, L., & O’Hare, A. (2020). Visual supports at home and in the community for individuals with autism spectrum disorders: A scoping review. Autism, 24, 447–469. Scottish Intercollegiate Guidelines Network-SIGN. (2016). Assessment, diagnosis and interventions for autism spectrum disorders (SIGN 145). Author. Scarpa, A., & Lorenzi, J. (2013). Cognitive-behavioral therapy with children and adolescents: History and principles. In A. Scarpa, S. Williams White, & T. Attwood (Eds.), CBT for children and adolescents with high-functioning autism spectrum disorders (pp. 3–26). Guilford Press.

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Waugh, C., & Peskin, J. (2015). Improving the social skills of children with HFASD: An intervention study. Journal of Autism and Developmental Disorders, 45, 2961–2980. Wolstencroft, J., Robinson, L., Srinivasan, R., Kerry, E., Mandy, W., & Skuse, D. (2018). A systematic review of group social skills interventions, and meta-analysis of outcomes, for children with high-functioning ASD. Journal of Autism and Developmental Disorders, 48, 2293–2307.

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The PPSI Peer Social Interaction Protocol

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 N. Bauminger-Zviely et al., Preschool Peer Social Intervention in Autism Spectrum Disorder, Social Interaction in Learning and Development, https://doi.org/10.1007/978-3-030-79080-6_5

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The “Social Interaction” protocol was developed through Dr. Dganit Eytan’s doctoral dissertation under the supervision of Prof. Nirit Bauminger-Zviely.

Introduction to the “Social Interaction” Curriculum As seen in the upcoming outline, the PPSI “social interaction” protocol entails 13 overall themes. The details for each theme are presented below, including the goals, contents, and techniques both for the learning/acquisition stage (delivered by the adult PPSI facilitator) and for the experiencing/practice stage (delivered in the small peer group under the facilitator’s supervision). The link to the supported visual aids for this curriculum can be found in the Appendix.

Outline for “Social Interaction” Protocol. (THEME) Lesson nos.

Lesson topic

Detailed acquisition/practice goals and contents

(1) 1–3

Joint Activity/Cooperating

(2) 4–6

Initiating a Social Activity

(3) 7–9

Joining a Social Activity

(4) 10–12

Sharing Objects

(5) 13–15

Sharing Ideas

(6) 16–18

Pro-Social Skills: Giving in and Compromising

1. Definition and concept clarification 2. Concept illustration 3. Practicing activities 1. Definition and concept clarification 2. Steps of initiating social activity 3. Concept illustration 4. Practicing activities 1. Definition and concept clarification 2. Steps of joining social activity 3. Concept illustration 4. Practicing activities 5. Mid-summary activity 1. Definition and concept clarification 2. Concept illustration 3. Practicing activities 1. Sharing ideas, feelings, experiences, thoughts etc. 2. Definition and concept clarification 3. Concept illustration 4. Practicing activities 1. Definition and concept clarification 2. Concept illustration 3. Practicing activities (continued)

Outline for “Social Interaction” Protocol.

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(continued) (THEME) Lesson nos.

Lesson topic

Detailed acquisition/practice goals and contents

(7) 19–21

Pro-social Skills: Helping

(8) 22–24

Pro-social Skills: Encouragement and Support

(9) 25–27

Pro-Social Skills: Comfort/Console/Sympathize Consolation and Sympathy

(10) 28–30

Conflict Resolution: Quarrels/Arguments

(11) 31–33

Conflict Resolution: Bullying

(12) 34–36

Forgiving

(13) 37–39

Summary Activity

1. 2. 3. 4. 1. 2. 3. 1. 2. 3. 4. 1. 2. 3. 1. 2. 3. 1. 2. 3. 1. 2.

Giving help and asking for help Definition and concept clarification Concept illustration. Practicing activities Definition and concept clarification Concept illustration Practicing activities Definition and concept clarification Concept illustration Practicing activities Mid-summary activity Definition and concept clarification Concept illustration Practicing activities Definition and concept clarification Concept illustration Practicing activities Definition and concept clarification Concept illustration Practicing activities Review of the concepts learned Summary activities

Full “Social Interaction” Intervention Protocol

NOTE: THROUGHOUT THIS PROGRAM, THE USE OF THE MALE/ FEMALE GENDER IS FOR CONVENIENCE ONLY AND MAY REFER TO EITHER.

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Theme 1. Joint Activity/Cooperating Lesson 1. Skill acquisition/learning stage (Adult mediation setting) 1. Introducing and presenting the topic: a. Presentation with dolls: – Danny, Ben and Tom are standing together and thinking what they want to play: Danny: “Maybe we will play catch?” Tom suggests: “Maybe we will play hide-and-seek?” Ben suggests: “Let’s play ball.” They talk and decide to play catch. Tom says he wants to catch first. The children play the game and have a lot of fun. b. Show the child a picture of two children trying to lift a heavy box to move to another place in the preschool. Ask the child: “What can they do?” (Ask for help, plan how they will help each other, etc.) 2. Review the example from the introduction. Let’s remind ourselves: What did the children choose? (To play catch.) What did they plan? (Who catches.) What did they do? (Played and enjoyed together.) 3. Definition

JOINT ACTIVITY: WHEN CHILDREN DO SOMETHING TOGETHER. IN A JOINT ACTIVITY, THEY CHOOSE, PLAN AND WORK TOGETHER. (SHOW FLASHCARDS FOR “CHOOSE,” “PLAN” AND “ACT.”)

4. Why is it important to cooperate? Presentation with dolls: One doll asks, and the others answer and turn to the child (ren) for more ideas. Write down what the children say so they can be reminded later. • • • •

When we work together, we enjoy more. When we work together, we can play games we can’t play by ourselves. When we work together, we can complete tasks more quickly and efficiently. What else? (Ask the children to offer more ideas.)

5. Show the child(ren) some pictures of activities that can be done together: Playing with a ball, board games, building with Lego, building a car track, etc.

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a. Remind them the steps using flashcards: choosing, planning, acting/ executing. b. The child chooses and plays with the therapist. 6. Weekly assignment for the preschool: Prepare with the children a list of activities that they want to do with a friend(s) and cannot do alone. During the week, choose an activity from the list, plan and execute. Lesson 2. Joint activity—Skill practice/experiencing stage (Small peer group setting) 1. Introductory activity: The children pass a ball of yarn from one to the other. For the first round, everyone says their name so they can get to know each other. In the second round, everyone says the name of the friend to whom he is passing the ball. In the third round, everyone says what his favorite game is. In the fourth round, everyone says what he likes to eat. After several rounds a “knot” has been produced and now the children plan together how to untie it. 2. Review the definition JOINT ACTIVITY: WHEN CHILDREN DO SOMETHING TOGETHER. IN A JOINT ACTIVITY, THEY CHOOSE, PLAN AND WORK TOGETHER. (SHOW FLASHCARDS FOR “CHOOSE,” “PLAN” AND “ACT.”)

3. Illustrative activities: a. Prepare a “bank” of common activities that are fun to do together: The children offer ideas of their own. More ideas: tag, hide-and-seek, group ball games, board games, making chocolate balls, preparing a fruit salad, etc. b. The children choose one activity from their “bank” of activities—choose, plan and act (show the flashcards). 4. Summary: In the circle, everyone says hello to another child and adds a detail that they remember from the introductory activity for example: “Hello to Danny who likes to eat pizza” or: “Hello to Ben who loves to play soccer.” 5. Remind the preschool teacher of the weekly activity for the preschool: Prepare with the children a list of activities that they want to do with a friend(s) and cannot do alone. During the week, choose an activity from the list, plan and execute.

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Lesson 3. Joint activity—Skill practice/experiencing stage—continued (Small group setting) 1. Introductory activity. Prepare a box containing many pieces of games, crayons, craft materials, and other items that need to be sorted into baskets and returned to the storage area in the preschool. (Help the children divide up the jobs and plan how to do this efficiently.) 2. Present the idea bank from the previous session (the play ideas offered by the children presented as pictures or symbols or by a representative object). The children choose activities and games together. 3. Why is it important to cooperate? Presentation with dolls: One doll asks and the others answer and turns to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • • • •

When we work together, we enjoy more. When we work together we can play games we can’t play by ourselves. When we work together we can complete tasks more quickly and efficiently. What else? Ask the children to offer more ideas.

4. Review the definition

JOINT ACTIVITY: WHEN CHILDREN DO SOMETHING TOGETHER. IN A JOINT ACTIVITY, THEY CHOOSE, PLAN AND WORK TOGETHER. (SHOW FLASHCARDS FOR “CHOOSE,” “PLAN” AND “ACT.”)

5. Illustrative activity. Building a model from blocks. The children must choose what to build: a zoo, playground, shopping center, or preschool with blocks and other relevant toys (dolls, animals, etc.). The children choose what to build, plan, and build (Show flashcards). 6. Summary. Each child says what they enjoyed most about the activities of the week and what they enjoyed the least. Remind children of the definition of a joint activity and again mention everything they said about “Why is it important…?” and the activity bank. 7. Remind the preschool teacher of the weekly activity for the preschool: Prepare with the children a list of activities that they want to do with a friend(s) and cannot do alone. During the week, choose an activity from the list, plan and execute.

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Theme 2. Initiating a Social Activity Lesson 4. Skill acquisition/learning stage (Adult mediation setting) 1. Review of previous session: Show a video/verbally remind the child about one of the group activities with reference to concepts of joint activity (choosing, planning, executing). Ask the child to remember what he/she enjoyed the most and emphasize the pleasure of doing things together. 2. Introducing and presenting the topic: a. Story with dolls: A child chooses a box game from the shelf and looks around for a friend. He goes to one of the children and asks him: “Do you want to play with me?” The other child (doll) tells him “yes” and they go together to sit at a table and play. b. Flashcards: A child looks around and goes over to a friend and asks him, “Do you want to play together”? The friend asks “Yes, but what?” Together they choose a game and play. 3. Definition WHEN I WANT TO PLAY WITH OTHER FRIENDS, I HAVE TO APPROACH THEM AND INVITE THEM TO PLAY WITH ME.

4. Why is it important to initiate a joint activity? Presentation with dolls: One doll asks and the others answer and turns to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • There are games that you can’t play alone so you have to invite a friend. • If I don’t ask a friend to play with me, he won’t know I want to play with him. • Playing with a friend is fun. • If I invite a friend to play with me, next time he will invite me. • Encourage children to offer more ideas. 5. Steps in initiating interaction (show them the board with the steps): a. Choose an activity. b. Choose a friend I want to play with. c. Check that it is convenient for him, make sure he is not busy with any other activity.

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d. e. f. g.

The PPSI Peer Social Interaction Protocol

Go up to him and make eye contact with him. Invite him to play. Play together. When you’re done playing, put the game away and say goodbye to each other.

6. Illustrative activity: Presentation with hand puppets or dolls. (The therapist tells the whole story first and then gives one doll to the child and together they act out the sequence described.) a. Defining the goal: “I want to play a game of snakes and ladders with a friend.” b. I can go up to Danny and ask him, “Do you want to play with me?” or I can ask Danny, “Do you feel like playing together?” or I can ask him, “Do you like this game? Do you want to play together? “or I can ask out loud, “Who wants to play with me?” c. If Danny agrees to play with me, then we will have fun together. Maybe Danny wants to choose a different game. Maybe he doesn’t feel like playing this game at the moment and then I will need to find another friend or I might agree to play the game he wants to play. 7. Preparation for the next session: Let the child choose an activity to open the next joint session with friends. 8. Weekly assignment for the preschool: Prepare with the child a list of activities he/she would like to do with a friend(s). During the week, help the child initiate approaching their friend and suggest at least one activity from the list. Lesson 5. Initiating a social activity—Skill practice/experiencing stage (Small group setting) 1. Introductory activity: When the children arrive, help the child initiate the activity chosen during the previous (acquisition) session and invite friends to play together. 2. Illustrative activities: a. Ask one of the children in the group what he/she wants to play: offer two options where you can’t play alone. For example, catching a ball, ping-pong, other catch games, board games, etc. The child chooses and now has to invite a friend to play together. b. Each child gets pictures with ideas for activities with friends. They have to pick and invite children to play with.

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3. What to do when you want to play with a friend? Ask the children to list the steps (remind them if needed) described in the acquisition lesson (show the board with the steps). a. Choose an activity. b. Choose a friend I want to play with. c. Check that it is convenient for him, make sure he is not busy with any other activity. d. Go up to him and make eye contact with him. e. Invite him to play. f. Play together. g. When you’re done playing, put the game away and say goodbye to each other. 4. Review the definition

WHEN I WANT TO PLAY WITH OTHER FRIENDS, I HAVE TO APPROACH THEM AND INVITE THEM TO PLAY WITH ME.

5. Summary activity: Roleplaying (videotape the interaction (if possible), or document it in writing). a. Assign the roles: i. A child to initiate the game. ii. A child who is busy doing something else. iii. A child who suggests playing with something else. b. Let the children act out their roles. c. Put the games away and say goodbye. 6. Remind the preschool teacher of the weekly activity for the preschool: Prepare with the child a list of activities he/she would like to do with a friend(s). During the week, help the child initiate approaching their friend and suggest at least one activity from the list. Lesson 6. Initiating a social activity—Skill practice/experiencing stage— continued (Small group setting) 1. Review of previous session: Show the children the video/verbally remind them of the previous activity, and ask them to relate to each of the roles. How did the child initiate? How did he approach the child who was busy? How did he feel when someone suggested something else?

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2. Idea bank: Plan in advance with one of the children that he/she will initiate an activity from the idea bank they prepared during the second session. He/she must initiate and invite some friends. 3. Why is it important to initiate a joint activity? Presentation with dolls: One doll asks and the others answer and turns to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • There are games that you can’t play alone so you must invite a friend? • If I don’t ask a friend to play with me, he won’t know I want to play with him. • Playing with a friend is fun. • If I invite a friend to play with me, next time he will invite me. • Encourage children to offer more ideas. 4. Review the definition WHEN I WANT TO PLAY WITH OTHER FRIENDS, I HAVE TO APPROACH THEM AND INVITE THEM TO PLAY WITH ME.

5. Summary activity: The child chooses one of the activities from the activity bank and invites other friends to play with him. Naturally, the members join or offer another idea to play together. At the end of the game, tidy up and say goodbye. 6. Remind the preschool teacher of the weekly activity for the preschool: Prepare with the child a list of activities he/she would like to do with a friend(s). During the week, help the child initiate approaching their friend and suggest at least one activity from the list. Theme 3. Joining a Social Activity Lesson 7. Skill acquisition/learning stage (Adult mediation setting) Introducing and presenting the topic: a. Sequence of images (Flashcards): Children playing tag in the playground and a child stands by and watches them. What does he ask them? “Can I play too?”, “What do they say to him?”, “Yes, you are it.” b. Sequence of images (Flashcards): (1) A child sees a group of children playing tag in the playground. (2) The child starts running after them. (3) The children stop and look at him and tell him something (“You can’t play,” or “We’re in the middle. Wait for the next round.”) c. Story with dolls: A child sees children playing in the family corner. He approaches them and asks: “May I join? I want to be the big brother.” The

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children tell him that Danny is already the big brother but he can be the little brother. The child agrees and joins. d. Story with dolls: A child comes over to children playing in the family corner and asks them if he can join. The children tell him they’re already in the middle of the game and he can’t. He stands at the side and watches them. e. Discuss the examples with the child: What did we see? How did the child feel in each of the examples? What else could he have done? What is the difference between Examples a and b and examples c and d? f. During the discussion, point out to the Flashcard of the components of the joint activity: choosing, planning and execution. 1. Definition

WHEN I SEE CHILDREN PLAYING AND ENJOYING A GAME THAT I ALSO LIKE, I CAN APPROACH THEM AND ASK IF I CAN JOIN THEIR GAME.

2. Steps in joining the interaction (show the step board /poster): a. b. c. d. e. f. g. h.

Look around and see what other children are playing. Choose what I want to play with friends who are already playing. Go up to them and make eye contact with them. Wait for the proper time. Ask if I can play with them. Ask a specific child in the group. Play together. When you’re done playing, tidy up the game and say goodbye.

3. Why is it important to join the activity? Presentation with dolls: One doll asks and the others answer and turns to the child(ren) for more ideas. Write down what the children say so they can be reminded later: • There are games that are fun to play together and sometimes children are already playing them. • If I do not ask, I will not be able to take part. • I have to pay attention to know when it is a good time to ask. • It is a good idea to ask a specific child because then I am more likely to receive a response. Calling the child by name is even better. • If I don’t ask to join, maybe the other children won’t know I want to play with them and won’t invite me to join. • Encourage children to offer more ideas.

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4. The therapist starts playing a game that the child loves very much. If necessary, give him a hint that he should ask to join. 5. Weekly assignment for the preschool: Guide the teacher to help the child join a group game whenever there is an opportunity. Praise him for it and inform the group therapist of these experiences. Lesson 8. Joining a social activity—Skill practice/experiencing stage (Small group setting) 1. Illustrative activities: role-playing games a. The child and the therapist start playing a game that needs more than two participants before the rest of the children arrive. When they come in they will ask to join (they can be coached in advance to do so). b. In the group: In turn, one child goes out and the other children start playing a game that requires more than two children. The child comes back and must ask to join the game. c. In the group: Another child goes out. Before she returns, the therapist guides the other children to refuse when the child asks to join (you can tell him: “But we have already started, so wait for the next round”). d. In the group: A third child deliberately waits until the game is almost finished and then when he returns he has to wait for the game to finish. e. Have a brief discussion of the various examples. 2. Review the definition

WHEN I SEE CHILDREN PLAYING AND ENJOYING A GAME THAT I ALSO LIKE I CAN APPROACH THEM AND ASK THEM TO JOIN THEIR GAME.

2. Why is it important to join the activity? Presentation with dolls: One doll asks and the others answer and turns to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • There are games that are fun to play together and sometimes children are already playing them. • If I do not ask, I will not be able to take part. • I have to pay attention to know when it is a good time to ask. • It is a good idea to ask a specific child because then I am more likely to receive a response. Calling the child by name is even better.

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• If I don’t ask to join, maybe the other children won’t know I wanted to play with them and won’t invite me to join. • Encourage children to offer more ideas. 3. Illustrative Activity. Roleplaying games (Use flashcards): a. Defining the goal: “I want to play with friends, and they are already playing other games.” b. The children are playing in the family corner. Each has his or her own role. Give the child a role to ask one of the children to join. (Help with words: “May I also play?”, “May I join?”, “Is there room for me too?”) c. Instruct one of the children to say that he does not know and that he should ask another child. d. The child should ask another child if he can join. e. Stop and ask: What can happen now? (1) They will agree that I can join in and we will have fun together. (2) They will say that they are finishing up soon and that I have to wait. (3) They will say that they are already in the middle and it is impossible. I will have to look for something or someone else to play with. 4. Remind the preschool teacher of the weekly activity for the preschool: Guide the teacher to help the child join a group game whenever there is an opportunity and praise him for it and inform the group therapist of these experiences. Lesson 9. Joining a social activity + Intermediate summary (Collaboration, Initiation and Joining a Joint Activity)—Skill practice/ experiencing stage—continued (Small group setting) 1. Review of the previous session. The role-playing game: Review the steps in initiating an interaction, addressing the various possibilities of initiation and the reactions of the interaction partners. Problem solving: What can be done in case of refusal? What can be done if it is no longer convenient to join? Etc. 2. Bring all the products from the last sessions and review them: • “Why is it important?” Bring everything the children said that you wrote down and remind them. • Pictures of shared activities. • A list of activities that the children suggested that they like to do together. • Sequence of images (Flashcards). • Definitions.

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3. Bowling: Give the children the bag/box with the game. They must arrange the pins, decide on the order, and play. (Emphasize the benefit and the fun of doing a joint activity). 4. Each child chooses one activity from the list (accompanied by pictures): • What to play: Each child makes a suggestion and then the children have to choose. • Plan what to play now and what to play later. What needs to be organized before each game or activity? • Play/work together according to the choices made. (If possible, photograph the interaction; if not, document it in writing.) • Tidy up the game. 5. Review the definitions of joint activity, initiative and joining. 6. Look at the pictures together/read out the documentation of the interaction while reinforcing the relevant behaviors. 7. Remind the preschool teacher of the weekly activity for the preschool: Guide the teacher to help the child join a group game whenever there is an opportunity, then praise him for it and inform the group therapist of these experiences. Theme 4. Sharing Objects Lesson 10. Skill acquisition/learning stage (Adult mediation setting) 1. Introducing and presenting the topic: a. Sequence of images: (1) A child holds a box of animals; (2) He gives each child a few animals; (3) They sit and play together. b. The therapist gives the child a large box of colored clay. After about a minute she asks if she may join. The child gives her some clay and they play together. c. Talk about joining and sharing using the different examples. 2. Definition WHEN WE PLAY TOGETHER WE COOPERATE WITH EACH OTHER.

SHARE

OBJECTS

AND

3. Why is it important to share with friends? Presentation with dolls: One doll asks and the others answer and turns to the child(ren) for more ideas. Write down what the children say so they can be reminded later.

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• When we share, we think about our friends as well. • When we share, we help a friend, and when the friend shares with us, he helps us. • When we share, each one gives a part and helps everyone. Like the puzzle we put together. • If I share something that is mine with other children, next time they will share with me too. • I want to play with a friend(s). • Sometimes it’s hard for me to give up something I love, if I share it with a friend, then I will have less. • It is worth sharing even if I have less, because then I will have friends. • If I don’t share with friends, then maybe I won’t have anyone to play with. • If I share with friends, next time they will share with me. • Encourage the child to suggest his own ideas. 4. Sorting Pictures (Flashcards): The child indicates whether there is sharing or not and what is being shared a. A child offers a bag of snacks to children sitting together in a class. b. A child sits on the grass eating a bag of chips next to other children who are playing ball. c. A child hands out crayons to children sitting in front of blank sheets of paper. d. A child is sitting with a big box of Lego and another child is sitting next to him watching. e. A child is handing out balloons to a group of children. f. A child is holding a bunch of balloons at a birthday party. After the child has sorted the pictures into the two groups, discuss the examples and emphasize what sharing is. 5. Concluding Activity: The therapist gives the child a bag of snacks or a page with stickers and sends him to share it with the children in the preschool. 6. Weekly assignment for the preschool: Create as many situations as possible in which the child hands out things to the other children in the preschool (crayons, work craft materials, musical instruments during circle time, toys in the playground and the like). Encourage and reinforce him for it.

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Lesson 11. Sharing objects—Skill practice/experiencing stage (Small group setting) 1. Introductory activity: When the children arrive, the child hands them a snack or candy from a bag. 2. Illustrative activities: • Game: Dominoes for younger children or quartets (“Go Fish”) for older children: One child gives each player 4 dominos or 4 cards according to the game they are playing. • Game: A child gives balloons to all the friends and they play catch. You can also stretch a string between two chairs and play volleyball with the balloons. • Game: The child brings a box of a large floor puzzle and gives each child a number of pieces. Together they put the puzzle together. 3. Roleplaying: Give one of the children a box with many pretty stickers. The children ask the child to give them stickers. The child holding the box keeps all the stickers and doesn’t want to share (“I got it first,” “it’s mine”). Questions: What can you do? Why should he share the stickers? What would I do instead? 4. Why is it important to share with friends? Presentation with dolls: One doll asks and the others answer and turn to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • When we share we think about our friends as well. • When we share we help a friend and when the friend shares with us he helps us. • When we share each one gives a part and helps everyone like the puzzle we put together. • If I share something that is mine with other children, next time they will share with me too. • I want to play with a friend(s). • Sometimes it’s hard for me to give up something I love, if I share it with a friend then I will have less. • It is worth sharing even if I have less, because then I will have friends. • If I don’t share with friends then maybe I won’t have anyone to play with. • If I share with friends, next time they will share with me. • Encourage the child to suggest his own ideas.

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5. Review the definition WHEN WE PLAY TOGETHER WE COOPERATE WITH EACH OTHER.

SHARE

OBJECTS

AND

6. Remind the preschool teacher of the weekly activity for the preschool: Create as many situations as possible in which the child distributes things to the other children in the preschool (crayons, craft materials, musical instruments, toys in the playground etc.). Encourage and reinforce him for it. 7. Ask each child to bring a game or something else from home to share with friends. Lesson 12. Sharing objects—Skill practice/experiencing stage—continued (Small group setting) 1. Watch together the video from the previous session/verbal description of activity: Emphasize the benefits of sharing. Repeat the concepts from previous sessions (joint activity, initiating and joining). 2. Illustrative activity: Ask who brought something from home to share with the group. (It is important to send a reminder home a day before the session so the children will bring something with them). The children, in turn, show what they brought and share with their friends. (Pre-arrange games, crafts materials, refreshments, etc. to give children who didn’t bring anything so that they can participate). 3. Roleplaying: Each child gets a “secret” package from the therapist. Each child has something else: floor puzzle, bowling game, crayons and stickers, assembly game, etc. The therapist tells one child to share with friends and another child not to share with friends. The other friends should ask the child to share with them. 4. Summary Review: Why is it important to share with friends? Presentation with dolls: One doll asks and the others answer and turns to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • When we share, we think about our friends as well. • When we share, we help a friend and when the friend shares with us, he helps us. • When we share, each one gives a part and helps everyone like the puzzle we put together. • If I share something that is mine with other children, next time they will share with me too. • I want to play with a friend(s).

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• Sometimes it’s hard for me to give up something I love; if I share it with a friend, then I will have less. • It is worth sharing even if I have less, because then I will have friends. • If I don’t share with friends then maybe I won’t have anyone to play with. • If I share with friends, next time they will share with me. • Encourage the child to suggest his own ideas. 5. Review the definition WHEN WE PLAY TOGETHER COOPERATE WITH EACH OTHER.

WE

SHARE

OBJECTS

AND

6. Remind the preschool teacher of the weekly activity for the preschool: Create as many situations as possible in which the child distributes things to the other children in the preschool (crayons, craft materials, musical instruments, toys in the playground etc.). Encourage and reinforce him for it. Theme 5. Sharing Ideas Lesson 13. Skill acquisition/learning stage (Adult mediation setting) 1. Introducing and presenting the topic: a. Ask the child to share experiences about what he did this weekend. Add to the conversation how he felt, who he was with, what he was thinking, and so on (use icons or pictures to remind what to talk about: What did we do, with whom, how did we feel, and so on). b. The therapist tells the child about an experience she had this weekend (points to the icons for reference). c. The therapist and the child pass a ball back and forth and each in turn says something he likes to do before passing the ball back. d. Pass the ball back and forth and offer ideas for a game to play later. 2. Definition

WE CAN SHARE OUR IDEAS WITH OUR FRIENDS AND TELL THEM ABOUT EXPERIENCES WE HAD AND HOW WE FEEL.

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3. Why is it important to share ideas? Presentation with dolls: One doll asks and the others answer and turn to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • If we are doing something together with friends, and we have a good idea, our friends will be glad to hear it. • If I share my ideas with my friends, they will share theirs with me too. • Hearing ideas from other children can help me learn something new. • When everyone offers an idea, we have more choices to choose from. • If I tell a friend how I feel, he can help me or rejoice with me. • Encourage the child to offer ideas of his own. • Emphasize to the child that the very activity we are doing now is an activity where ideas are being shared. 4. Sorting Pictures (Flashcards): The child indicates where there is sharing and where not: i. Children sitting on a bench. ii. The same picture but with another child sitting at the side looking at them. Ask if they are sharing with him? Is he sharing with them how he feels? iii. Two friends are whispering to each other and smiling. iv. Children are sitting on a sofa and everyone is busy with something else. v. Children are happy together playing on the slide. 5. Illustrative activity: Play together using one of the ideas that came up in the first activity (remind them that because we shared ideas, we now know what the other want to play). 6. Weekly assignment for the preschool: The preschool teacher asks each child to bring photos from a family trip or family event during the week and hang them on a board. During the week, ask the children to tell about their experiences in the pictures. Lesson 14. Sharing ideas—Skill practice/experiencing stage (Small group setting) 1. Illustrative activities: a. In the group: Use flashcards to create a spinner and cards that symbolize “What,” “with whom,” “where,” “when,” etc. The spinner will display pictures of activities, food, TV, etc. Help the children tell each other what they

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like, what they don’t like, what they enjoy, who they like to spend time with, and so on. b. Pass a ball or a balloon back and forth and each time another child suggests what they will say. For example: Pass the ball and say names of favorite/disliked foods, names of favorite games, favorite activities, etc. c. Emotion cards: happy, sad, angry—In turn, every child picks up a card and shares with his friends when he was happy, sad, or angry—depending on the emotion card he has in hand. 2. Review the definition WE CAN SHARE OUR IDEAS WITH OUR FRIENDS AND TELL THEM ABOUT EXPERIENCES WE HAD AND HOW WE FEEL.

3. Remind the preschool teacher of the weekly activity for the preschool: The preschool teacher asks each child to bring photos during the week of a family trip and hangs them on a board. During the week, ask several children to tell about the experiences in the pictures. Lesson 15. Sharing ideas—Skill (Small group setting)

practice/experiencing stage—continued

1. A reminder and verbal repetition of the activities from the previous session: What we shared (ideas, feelings, experiences, etc.). 2. Why is it important to share ideas? Presentation with dolls: One doll asks and the others answer and turns to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • If we are doing something together with friends, and we have a good idea, friends will be glad to hear it. • If I share my ideas with my friends, they will share theirs with me too. • Hearing ideas from other children can help me learn something new. • When everyone offers an idea we have more choices to choose from. • If I tell a friend how I feel, he can help me or rejoice with me. • Encourage children to offer their own ideas. • Emphasize to the child that the activity we are doing now is an activity in which ideas are shared.

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3. Review the definition WE CAN SHARE OUR IDEAS WITH OUR FRIENDS AND TELL THEM ABOUT EXPERIENCES WE HAD AND HOW WE FEEL.

4. Illustrative activity: a. Bring a box containing different objects. Each child picks an object and imagines what it might be. The object passes from child to child in turn and each offers a different idea, for example: A hoop that is the wheel of a car or a handbag, etc. b. Bring large sponge blocks and build two towers: • Each child tells what activity he enjoys most in the group and places a cube on one tower. • Each child tells what activity he least enjoys in the group and places a cube on the other tower. Note: The children will need to build the tower so that it is stable. During the activity, emphasize the elements of joint activity, helping, sharing, consideration, etc. 5. Summary activity: The therapist brings various creative materials and the children offer ideas what can be created from them. Then choose one idea, plan and create (again mentioning the elements of the joint activity and concepts learned in the previous sessions). 6. Remind the preschool teacher of the weekly activity for the preschool: The preschool teacher asks each child to bring photos during the week of a family trip and hangs them a board. During the week, ask several children to tell about the experiences in the pictures. Theme 6. Pro-social Skills: Giving in and Compromising Lesson 16. Skill acquisition/learning stage (Adult mediation setting) 1. Review of previous session: Show the child the video / narrative of the summary activity and refer to all the components: Joint activity, initiative, joining, sharing resources and sharing ideas. Ask if he did what he wanted, or what he chose? Did he have to give up something he wanted? Did anyone else have to give up something they wanted? Was there a compromise (there were several ideas to create and only one idea selected).

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2. Presentation of the topic: • Sequence of images (Flashcards): (1) Two children are quarreling over bicycles, each pulling the bicycle in their direction. The preschool teacher comes and asks “What happened?” (2) One child decides to give in and the other suggests that they play in turns: “First me and then you.” • Sequence of images (Flashcards): (1) The preschool teacher offers a group of children a choice between two board games. All the children point to one except one child, who points to the other box. (2) The children start playing and are happy. The child stands aside with a sad look. (3) The child joins the game with the other children and is now happy. • Talk to the child about the two examples: Why give in? When should you compromise? 3. Definition

“GIVING IN” MEANS GIVING SOMETHING I WANT VERY MUCH TO ANOTHER CHILD WHO WANTS IT TOO. COMPROMISE MEANS THAT I GIVE IN A LITTLE AND THE OTHER FRIEND GIVES IN A LITTLE TOO.

4. Why is it important to give in and compromise? Presentation with dolls: One doll asks and the others answer and turn to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • When we give in/compromise, we help our friends. • When we compromise, we quarrel less. • If you want to play with friends, then sometimes you have to give in. • When you compromise, then everyone gives up a little and at the end everyone is satisfied. • When we compromise, we also learn to enjoy things we didn’t know before. • If I give in, then next time someone else will give in and so I will have friends. • If I do not compromise, then I will be left alone. • Encourage the child to suggest his own ideas.

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5. Illustrative activity: The therapist presents two activities to the child one of which she knows is a favorite. She asks what he wants to play? Then she says she wants to do second activity. She asks him to start playing the activity of her choice. If the child gives in, she, of course, praises him; if not, she tries to convince him: “Please, I really want to play with X now. We will play your game later.” If he doesn’t want to, she can model and say, “Okay, this time I will give in and next time you will give in.” Play together with both games. 6. Weekly assignment for the preschool: Offer the children two activities, one of which the preschool teacher knows the child prefers. Help the children make a joint decision and encourage the child to give in to a friend. Point out that sometimes it is difficult to give in, but in return you make your friend happy and next time he will make you happy. General note to the preschool teacher: During the week, praise any behavior of giving in and compromising in the preschool in general. Lesson 17. Giving in and compromising—Skill practice/experiencing stage (Small group setting) 1. Illustrative activities: a. In the group: The therapist lets children choose just one game from a selection of games and play with it. They have to discuss and decide what to play. Emphasize choice, planning and execution, and the components of joint activity. If they do not reach an agreement, the preschool teacher will call a vote and the majority rules. b. In the group: Let the children choose from a number of attractive activities (add pictures to illustrate) and tell them that they need to talk together and choose only one activity that all or most of them agree on. (Sample activities: making chocolate balls, making chocolate drink, playing ball in the playground, playing water games in the playground, etc). c. Talk about how we chose, who gave in, how we compromised. Emphasize the enjoyment of the joint activity even at the cost of giving in. 2. Sequence of images (Flashcards): a. Four children go to the swings and there are only three swings: what can be done? b. A child eats ice cream and a sad friend next to him points to the ice cream. The child gives him the ice cream and the friend is happy.

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3. Why is it important to give in and compromise? Presentation with dolls: One doll asks and the others answer and turn to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • • • • • • • •

When we give in/compromise, we help our friends. When we compromise, then we quarrel less. If you want to play with friends, then sometimes you have to give in. When you compromise, then everyone gives up a little and at the end everyone is satisfied. When we compromise, we also learn to enjoy things we didn’t know before. If I give in, then next time someone else gives in and so I will have friends. If I do not compromise then I will be left alone. Encourage children to suggest their own ideas.

4. Review the definition “GIVING IN” MEANS GIVING SOMETHING I WANT VERY MUCH TO ANOTHER CHILD WHO WANTS IT TOO. COMPROMISE MEANS THAT I GIVE IN A LITTLE AND THE OTHER FRIEND GIVES IN A LITTLE TOO.

5. Remind the preschool teacher of the weekly activity for the preschool: Offer the children two activities, one of which the preschool teacher knows the child prefers. Help the children make a joint decision and encourage the child to give in to a friend. Point out that sometimes it is difficult to give in, but in return you make your friend happy and next time he will make you happy. General note to the preschool teacher: During the week, praise any behavior of giving in and compromising the preschool in general. Lesson 18. Giving in and compromising—Skill practice/experiencing stage— continued (Small group setting) 1. Illustrative activity: Roleplaying with dolls: Distribute dolls and give roles to the children. The therapist defines the purpose and the problems and turns to one of the children: “What would you do?” a. Defining the goal: “I want to play with a friend(s) but there are not enough game boards for everyone.” b. The friends play a game I like less but I want to play with them.

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2. Definition of problem: a. I want to play with a friend(s) but there is not enough for everyone. b. I want to play, but they chose a game I like less 3. Possible solutions to A: It is important to let the children first offer solutions by themselves and then the preschool teacher can join in with her doll and offer solutions that have not yet been offered. i. I can suggest that we take turns to play, and each time one child gives in and sits at the side. ii. I can wait for them to finish playing and then invite other friends to play with me. iii. I can ask one friend to switch with me. 4. Possible solutions to B: i. I can give in and play the game everyone has chosen ii. I can later suggest we all play the game I like. iii. I can look for other friends who would like to play the game I like with me. 5. Watch the video/verbal description of the activity from the previous session. Discussion of the components of the joint activity: Choice, planning and execution; did we share things? ideas? Who gave up? Why is it important? 6. Review the definition

“GIVING IN” MEANS GIVING SOMETHING I WANT VERY MUCH TO ANOTHER CHILD WHO WANTS IT TOO. COMPROMISE MEANS THAT I GIVE IN A LITTLE AND THE OTHER FRIEND GIVES IN A LITTLE TOO.

7. Summary activity: Pass a ball around and every child says what activity he wants to do again. The therapist notes them on a page and at the end of the round the children have to choose only one activity. They have to convince their friends to choose their activity, compromise (“I’ll give in now and you’ll give in next time so we have fun together”), or give in. 7. Remind the preschool teacher of the weekly activity for the preschool: Offer the children two activities, one which the preschool teacher knows the child prefers. Help the children make a joint decision and encourage the child to give

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in to a friend. Point out that sometimes it is difficult to give in, but in return you make your friend happy and next time he will make you happy. General note to the preschool teacher: During the week, praise any behavior of giving in and compromising in the preschool in general. Theme 7. Pro-social skills: Helping Lesson 19. Skill acquisition/learning stage (Adult mediation setting) 1. Introducing and presenting the topic: Sequence of images (Flashcards) a. A child stumbles in the yard. Another child comes up to him and reaches out to him. (Ask the children what the child who fell might say. What does the child who comes to him say?) b. A child sits with puzzle pieces scattered on the carpet and looks at the picture with a look that says he does not know what to do. Another child sits down next to him. (Ask what each child says). c. A child digs a hole in the sandbox, and a friend brings a bigger shovel and helps him dig. d. A child falls off the bike and tries to lift it up, and a friend comes and helps him. 2. Definition WHEN WE DO THINGS TOGETHER, SOMETIMES SOMETHING WILL BE DIFFICULT FOR ONE PERSON AND THEY WILL NEED HELP. YOU CAN OFFER HELP TO A FRIEND AND YOU CAN ALSO ASK FOR HELP FROM A FRIEND.

3. Why is it important to help? Presentation with dolls: One doll asks and the others answer and turn to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • Sometimes there are things that are difficult to do alone and then you can ask for help from a friend. • When it is difficult for a friend to do something, he will be happy if we offer to help and then it will be easier for them. • Sometimes someone can’t do something alone and then I can help them. • Encourage the child to suggest his own ideas.

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4. Illustrative activity: a. The therapist gives the child a tightly closed box (in a way that it will be difficult for the child to open alone) that contains parts of a game he wants to play. Ask him to open it and set up the game. Hint to the child to ask for help. Play a game and then ask the child to help put all the pieces away. b. The preschool teacher asks the child to bring something that is on a high shelf. Hint to the child to ask for help. c. The therapist takes out a lot of boxes that she can’t hold by herself and calls for the child to come and help her. 5. Weekly assignment for the preschool: Create many opportunities during the week where you can ask the child to help (e.g., setting the table, tidying up the classroom, bringing different things, etc.). Give the child different chores and remind him that he can also ask for help. Generally in the preschool: During the week, praise children who help their friends in the preschool and encourage them to ask for help from friends. Lesson 20. Helping—Skill practice/experiencing stage (Small group setting) 1. Illustrative activity: d. Bring a box of pegs or beads to the children and “accidentally” drop it so everything scatters. Ask them to help collect the pieces. a. Send a child to bring something from the supply cupboard that you have previously hidden, and hint to the child to ask his friends to help him when he cannot find it. b. Ask one of the children to arrange a motoric track in the space/playground (a beam, stairs, barrel, etc.), and hint to the other children to offer to help. c. The therapist comes and asks the child to come out and collect all the toys from the sandbox. The other children offer to help. 2. Group discussion: d. Ask the children when they asked for help. Ask them to remember when it happened that they needed help and asked a friend. e. Ask the children when they offered help to a friend. 3. Why is it important to help? Presentation with dolls: One doll asks and the others answer and turn to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • Sometimes there are things that are difficult to do alone and then you can ask for help from a friend.

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• When it is difficult for a friend to do something, he will be happy if we offer to help and then it will be easier for him. • Sometimes someone can’t do something alone and then I can help him. • Encourage children to suggest their own ideas. 4. Review the definition WHEN WE DO THINGS TOGETHER, SOMETIMES SOMETHING WILL BE DIFFICULT FOR ONE PERSON AND THEY WILL NEED HELP. YOU CAN OFFER HELP TO A FRIEND AND YOU CAN ALSO ASK FOR HELP FROM A FRIEND.

5. Illustrative activity: Give the children the job to hang paintings on the board in the preschool at the top of the board. The children need to work collaboratively and help one another. Highlight the components of the joint activity: Planning and execution. Emphasize the importance of providing help to succeed in the task. Emphasize that sometimes it is difficult to do things alone and by working together everyone helps each other and enjoys the work more. 6. Remind the preschool teacher of the weekly activity for the preschool: Create many opportunities during the week where you can ask the child for help (e.g., setting the table, tidying up the classroom, bringing different things, etc.). Give the child different chores and remind him that he can also ask for help. Generally in the preschool: during the week, praise children who help their friends in the preschool and encourage them to ask for help from friends. Lesson 21. Helping—Skill practice/experiencing stage—continued (Small group setting) 1. Introduction: Watch the video/verbal description of the activity from the previous session. Focus on asking for help and offering help. Emphasize the components of joint activity and other concepts learned in the previous sessions to the extent relevant. Ask the children how they felt when they asked for help? How did they feel when they offered help? Give more examples of help from preschool life (ask in advance for examples from the teacher). 2. Illustrative activity: Divide into pairs. One of each pair covers his eyes with a scarf or handkerchief. Scatter obstacles (upside down chairs and other items) in the room. The partner that can see leads the blindfolded partner to the other side of the room without encountering obstacles. Then switch roles.

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a. Conduct a discussion: How did I feel as the friend helping out? How did I feel as the friend receiving help? We all sometimes help and we all sometimes need help, etc. 3. Illustrative activity: a. Let the child move a heavy crate with sandbox toys in the yard. Hint to another child to approach him and ask him if he needs help. The two children lift the crate and carry it together to the sandbox. b. The therapist asks one of the children to tidy up the room and quickly put everything away. The child goes to a friend and asks him for help. The children quickly tidy up the whole room. 4. Review the definition WHEN WE DO THINGS TOGETHER, SOMETIMES SOMETHING WILL BE DIFFICULT FOR ONE PERSON AND THEY WILL NEED HELP. YOU CAN OFFER HELP TO A FRIEND AND YOU CAN ALSO ASK FOR HELP FROM A FRIEND.

5. Summary: In a circle, roll a ball and every child says what they need help with in the preschool/home, how they help in the preschool/home. (Commend them for sharing stories and ideas with each other.) 6. Remind the preschool teacher of the weekly activity for the preschool: Create many opportunities during the week where you can ask the child to help (e.g., setting a table, tidying up the preschool, bringing different things, etc.). Give the child different chores and remind him that he can also ask for help. Generally in the preschool: During the week, praise children who help their friends in the preschool and encourage them to ask for help from friends. Theme 8. Encouragement and support Lesson 22. Skill acquisition/learning stage (Adult mediation setting) 1. Introducing and presenting the topic: a. Sequence of images (Flashcards): A child sinks a basketball into the basket, children stand around and clap. Help the children express themselves: “Well done,” “You did it!” and so on. b. Sequence of images (Flashcards): In a session, a child stands by the preschool teacher and shows everyone the painting he made: All the children compliment him and tell him “good show” and “very nice” (help the children suggest what they say).

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2. Definition WHEN WE DO THINGS TOGETHER, IT’S NICE TO HEAR WORDS OF ENCOURAGEMENT. IT GIVES EVERYONE A GOOD FEELING, AND HELPS US CONTINUE WITH THE TASK EVEN IF IT IS A LITTLE DIFFICULT. WHEN SOMEONE SAYS SOMETHING GOOD ABOUT SOMEONE ELSE AND EMPHASIZES THE GOOD THINGS, IT’S CALLED ENCOURAGEMENT.

3. Why is it important to encourage and support others? Presentation with dolls: One doll asks and the others answer and turn to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • Sometimes we are trying to succeed in something. When someone is giving us encouragement from the side, it helps us keep going. • When friends encourage me and say good things about me, it makes me feel good. • Words of encouragement and kind words make my friends happy. • Write a list of words that are appropriate for encouragement and support: “Well done!”, “You’re the best!”, “Excellent!”, “You did it!”, “Good job!”, “You’re one in a million!”, etc. • Encourage the child to suggest his own ideas. 4. Playing with Dolls: (possible scripts): a. Race (cheering and encouraging) b. Basketball game (cheering and encouraging) c. Dressing a doll nicely to make it beautiful (giving compliments). 5. Illustrative activity: a. Make a painting or other creative piece together and go to show the preschool teacher who will complement the work a lot. b. The therapist prepares a work of art and shows it to the child (hinting to him, if necessary, that he needs to compliment her). 6. Weekly assignment for the preschool: Write a story together with the child about an instance when we encouraged someone in preschool. Bring it to the next group session.

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Lesson 23. Encouragement and support—Skill practice/experiencing stage (Small group setting) 1. Introduction: a. Split into two small groups (two pairs) and play “puff football” (blowing a ping pong ball from both sides of the table). Each member of the pair encourages his or her partner. (If there is an odd number, two children play each time and the third cheers them on. In this case, you can repeat such concepts as giving in and compromising.) b. Preparing a motoric track in the playground: Walking on a balance beam, jumping on a small trampoline, crawling through a tunnel, shooting a basket, etc. The children, in turn, begin the route and the friend who is waiting for his turn in the meantime encourages his friend. As each child completes the route, they return to the starting point and give a “high five” to the next in queue. 2. Why is it important to encourage and support others? Presentation with dolls: One doll asks and the others answer and turn to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • Sometimes we are trying to succeed in something. When someone is giving us encouragement from the side, it helps us keep going. • When friends encourage me and say good things about me, it makes me feel good. • Words of encouragement and kind words make my friends happy. • “Well done!”, “You’re the best!”, “Excellent!”, “You did it!”, “Good job!”, “You’re one in a million!”, etc. • Encourage children to suggest their own ideas. 3. Review the definition WHEN WE DO THINGS TOGETHER, IT’S NICE TO HEAR WORDS OF ENCOURAGEMENT. IT GIVES EVERYONE A GOOD FEELING, AND HELPS US CONTINUE WITH THE TASK EVEN IF IT IS A LITTLE DIFFICULT. WHEN SOMEONE SAYS SOMETHING GOOD ABOUT SOMEONE ELSE AND EMPHASIZES THE GOOD THINGS, IT’S CALLED ENCOURAGEMENT.

4. Flashcards: a. Children play soccer and a child scores a goal. What do his friends tell him? (Ask the children what they might say).

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b. A child builds a complex model out of blocks/puzzle and is almost finished. A friend sitting nearby cheers him on (ask the children what he might say). c. A child shows a drawing to a friend (ask the children what they might say). 5. At the end of the session, each child gives a compliment (says a good word) to a friend. 6. Remind the preschool teacher of the weekly activity for the preschool: Write a story about an instance where we encouraged someone in the preschool. Bring it to the next group session. Lesson 24. Encouragement and support—Skill practice/experiencing stage— continued (Small group setting) 1. Introductory activity: Pass a ball from one to the other and while passing it, shout out a word of encouragement or compliment the child to which it is being passed. 2. Verbal repetition of the previous session: Refer to the words of encouragement given. How did it make your friends feel? Did it make them want to be more successful? 3. Read the story from the weekly activity in the preschool: Let each child tell his or her story and suggest to the other children to applaud him at the end of the story. 4. Review the definition

WHEN WE DO THINGS TOGETHER, IT’S NICE TO HEAR WORDS OF ENCOURAGEMENT. IT GIVES EVERYONE A GOOD FEELING, AND HELPS US CONTINUE WITH THE TASK EVEN IF IT IS A LITTLE DIFFICULT. WHEN SOMEONE SAYS SOMETHING GOOD ABOUT SOMEONE ELSE AND EMPHASIZES THE GOOD THINGS, IT’S CALLED ENCOURAGEMENT.

5. Summary activity: Divide into two teams (two pairs) for a bowling/basketball/ soccer game. Each time, one of the team plays against one from the other team while his partner shouts encouragement from the side. At the end of the game, congratulate the winning team. (If there is an odd number, everyone plays and everyone encourages the friend who plays).

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Theme 9. Consolation and Sympathy Lesson 25. Skill acquisition/learning stage (Adult mediation setting) 1. Introducing and presenting the topic: a. Story with dolls: (1) Children are playing tag together in the playground; (2) a child who has fallen holds his knee and is crying; (3) Another child comes up to him and says something to him. Encourage the child to say what might be said: “Are you okay?”, “It’s all right,” “It will pass soon,” “Do you need help?”) b. Story with dolls: (1) A child spills some water in the workshop and wets the paintings of the other children; (2) everyone is angry with him; (3) He goes away sad. Encourage the child to say what could have been said: “It’s okay,” “It’s not that bad,” “ You didn’t do it on purpose,” “ It could happen to anyone.” 2. Definition WHEN A FRIEND IS SAD I CAN CHEER HIM UP IF I ASK HIM WHY HE IS SAD, OFFER HIM HELP, OR SAY SOMETHING NICE. NICE WORDS ARE WORDS THAT ARE PLEASANT TO HEAR AND GIVE A GOOD FEELING. FOR EXAMPLE: “IT WILL BE OKAY,” “IT’S NOT SO TERRIBLE,” “IT COULD HAPPEN TO ANYONE.”

3. Why is it important to comfort a friend? Presentation with dolls: One doll asks and the others answer and turns to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • Sometimes when we are sad, it makes us feel better when someone comes and comforts us. • When I comfort a friend, he realizes that I care about him and that he is important to me. • Write a list of words and record the child saying words that are appropriate for comforting friends: “It’s not that bad,” “ It could happen to anyone,” “It will be okay,” “Don’t be sad,” “I’ll help you,” etc. • Draw different pictures and icons such as the “like” icon, “√,” smiley ☺, OK, etc., next to some of the words. • Encourage the child to suggest his own ideas. 4. Flashcards: a. A child falls off his bike and hurts his hand; a friend reaches out to him (help the child express what the friend could say).

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b. The preschool teacher scolds a child and the child is sad. A friend comes over and comforts him (help the child express what the friend could say). 5. Weekly assignment for the preschool: Write a story with the child about an instance when we comforted someone in preschool. Bring it to the next group session. Lesson 26. Consolation and sympathy—Skill practice/experiencing stage (Small group setting) 1. Roleplaying: (You can use puppets that show the scenario to help children play the role.) a. One child builds a tower and another child knocks it down. The first child is sad and starts to cry and his other friends comfort him (you can play the recordings with the words of comfort and show the symbols from the previous session). b. A child can’t put together a puzzle and gets frustrated. The other friends comfort him. c. A child is sad because his mother went away. The other children comfort him. 2. Why is it important to comfort a friend? Presentation with dolls: One doll asks and the others answer and turn to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • Sometimes when we are sad, it makes us feel better when someone comes and comforts us. • When I comfort a friend, he realizes that I care about him and that he is important to me. • Write a list of words and record the children saying words appropriate for comforting their friends: “It’s not that bad,” “It could happen to anyone,” “It will be okay,” “ Don’t be sad,” “I’ll help you,” etc. • Draw different pictures and icons such as the “like” icon, “√,” smiley ☺, OK, etc. next to some of the words. • Encourage children to suggest their own ideas. 3. Review the definition WHEN A FRIEND IS SAD I CAN CHEER HIM UP IF I ASK HIM WHY HE IS SAD, OFFER HIM HELP, OR SAY SOMETHING NICE. NICE WORDS ARE WORDS THAT ARE PLEASANT TO HEAR AND GIVE A GOOD FEELING. FOR EXAMPLE: “IT WILL BE OKAY,” “IT’S NOT SO TERRIBLE,” “IT COULD HAPPEN TO ANYONE.”

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4. Playing with Dolls (Possible scripts)—Use recordings, pictures, and icons to help children express comfort. a. b. c. d.

A doll makes chocolate milk for a friend and it spills. A puppet races another but falls in the middle. A puppet has a stomach ache and doesn’t feel good. The puppet’s dog is lost and she cries.

5. Read the stories from the weekly assignment to preschool—each child tells his or her story. Lesson 27. Interim Summary (Sharing, Giving in and Compromising, Helping, Encouragement, Support and Consolation)—Skill practice/experiencing stage—continued (Small group setting) 1. In a small group, ask the children to split into pairs. (If there is an odd number of children, emphasize the concept of giving in and compromising: One child must wait at the side. If he is not pleased, he can be comforted). Children are instructed to stand side by side and tie together the inside legs of each pair with a scarf (helping: Asking and providing). The pairs race from one side of the playground to the other. The children waiting at the side encourage the pairs. They cheer for the winning pair and comfort the losing pair. Each member of the pair supports his partner. 2. At the end of the activity, let one of the children pass a bowl of snacks/candy between everyone. 3. Sitting in a circle for discussion: Show all the “Why is it important…?” pictures and repeat the rules and definitions of the skills learned. 4. Emphasize the “cost” of giving in and compromising versus staying alone or not playing. 5. The children share their thoughts and feelings as a result of the various activities. Each child receives a card with the beginning of a sentence to complete (the therapist reads to him what is written and writes down what he says): • • • •

When When When When

we encouraged our friends we felt…. I was encouraged I felt… I finished last I felt…. I finished first I felt….

6. Read the stories they brought from the preschool. 7. Remind the children of the different activities that they experienced together or show short videos of the different activities, emphasizing the elements of joint activity, helping, encouragement and support, comforting, etc. 8. Pass a ball around and in every round say something else:

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1. Each child calls out something encouraging or says something nice to a friend. 2. Each child says something to comfort the child who handed the ball to him. 3. The children tell (sharing) which activity they liked best. 9. Of the activities mentioned, the children choose one that they would like to do again (the majority decides). Emphasize the concept of choosing, compromising and giving in (compromising), planning and execution, supporting/encouraging a child who gives up, and comforting if someone is sad. Theme 10. Conflict resolution: Quarrels/arguments Lesson 28. Skill acquisition/learning stage (Adult mediation setting) Introductory activity: Mention some of the skills already learned such as giving in, compromising, sharing. 1. Introducing and presenting the topic: a. Story with dolls: A child is playing with a ride-on toy in the playground and another child tries to grab it from him. They start quarreling and shouting. (Encourage the child to tell what they might be saying to each other, adding symbols of how they feel). b. Story with dolls: Children are standing in line during a preschool sport activity. One child pushes the child in front of him and takes his place in line. Encourage the child to say what they might say: “I was here first,” “Why are you pushing?”, “I was in front of you,” etc. 2. Definition

WHEN WE DISAGREE ON SOMETHING WE MAY FIGHT OR ARGUE AND THEN WE GET ANGRY. ARGUING MEANS THAT WE DISAGREE AND WE TRY TO CONVINCE OUR FRIEND TO AGREE WITH WHAT WE ARE SAYING. WHEN WE FIGHT, PEOPLE SOMETIMES YELL AND HIT EACH OTHER. WHEN WE FIGHT, SOMEONE CAN GET HURT AND OFFENDED. INSTEAD OF FIGHTING, WE CAN GIVE IN OR SHARE WITH THE FRIEND AND THEN IT WILL BE NICER FOR EVERYONE.

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3. Why is it problematic? Presentation with dolls: One doll asks and the others answer and turn to the child (ren) for more ideas. Write down what the children say so they can be reminded later. • • • • •

When we fight and argue it hurts our friends. When we fight, everyone loses. When we fight, it is not pleasant for us. When we argue, sometimes we don’t listen to what our friend is telling us. When we fight, we are sometimes very angry and then we may be in trouble because the preschool teacher or parents will be angry with us. • Encourage the child to suggest his own ideas. 4. What would you do if…? Using flashcards, show conflict situations and help the child offer solutions: a. A child grabs a toy that I am holding. b. A child pushes me in line. c. A child plays on the computer for a long time and doesn’t stop even when I ask. d. A child is swinging on a swing for a long time and doesn’t give me a chance even when I ask him to. e. A child deliberately knocks over a building I built with blocks. f. I see a child holding a toy that I like and I take it by force. g. I want to be first in line and so I pushed. h. I am playing on the computer and another child keeps asking me to stop and I’m angry with him. i. A child annoys me so I destroy what he built. 5. Event Reconstruction: Use examples of real events that happened that week (ask the preschool teacher and the parents) and make a flowchart that shows: what happened, how I felt, what I did, what I could have done differently, how I think it would have made me feel, how would it make a friend feel. (Use squares for the behavior, circles for feelings, unbecoming behavior marked in red, proper behavior marked in green). 6. Weekly assignment for the preschool: Give the preschool teacher an outline of the event reconstruction flowchart and explain how to fill it in. Whenever the child is involved in a fight or argument in the preschool, the teacher should fill in the flowchart with the child.

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Lesson 29. Conflict resolution—quarrels/arguments—Skill practice/ experiencing stage (Small group setting) 1. Introduction: Role-playing with dolls a. Two children are fighting over a game and each one pulls it towards her. b. One child is playing on the computer for a long time, a friend comes over and asks her to stop and an argument starts. c. Two children are fighting over a toy and it breaks. They get angry and blame each other. 2. Why is it problematic? Presentation with dolls: One doll asks and the others answer and turn to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • • • • •

When we fight and argue it hurts our friends. When we fight, everyone loses. When we fight, it is not pleasant for us. When we argue, sometimes we don’t listen to what our friend is telling us. When we fight, we are sometimes very angry and then we may be in trouble because the preschool teacher or parents will be angry with us. • Encourage children to suggest their own ideas.

3. Review the definition

WHEN WE DISAGREE ON SOMETHING WE MAY FIGHT OR ARGUE AND THEN WE GET ANGRY. ARGUING MEANS THAT WE DISAGREE AND WE TRY TO CONVINCE OUR FRIEND TO AGREE WITH WHAT WE ARE SAYING. WHEN WE FIGHT, PEOPLE SOMETIMES YELL AND HIT EACH OTHER. WHEN WE FIGHT, SOMEONE CAN GET HURT AND OFFENDED. INSTEAD OF FIGHTING, WE CAN GIVE IN OR SHARE WITH THE FRIEND AND THEN IT WILL BE NICER FOR EVERYONE.

4. Illustrative activity: Get a story started (accompanied with flashcards), (the therapist reads and writes what the children say). The children indicate how they feel, what can be done instead of arguing or quarreling. a. Two children play in the sandbox and one child grabs the other child’s shovel. b. A child swings on a swing for a long time and doesn’t want to get off even when a friend asks him to.

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c. A child pushes a friend in line. d. Two children fight over a doll and each one pulls it to them. e. Two children argue about whose turn it is on the computer. 5. Remind the preschool teacher of the weekly activity for the preschool: Give the preschool teacher an outline of an event reconstruction flowchart and explain how to fill it in. Whenever the child is involved in a fight or argument in the preschool, the teacher should fill in the flowchart with the child. Lesson 30. Conflict resolution—quarrel/argument—Skill practice/experiencing stage—continued (Small group setting) 1. Introductory activity: Story with dolls Two puppets are arguing about a game and start shouting at each other. Problem definition: We disagree. We are quarreling. a. We both want to play and no one is willing to give in. b. We get angry and start shouting. c. Now we are both sad too. Possible solutions: a. b. c. d.

I I I I

can can can can

go to the preschool teacher and ask her for help. suggest to my friend to share the game or take turns to play. give in and go look for another game for me. give in so that the argument doesn’t develop into a big fight.

2. Verbal repetition of the previous session (children’s role-playing games and stories): Emphasize situations of conflict, refer to feelings that arise, point out existing solutions and try to offer additional solutions, help with the event reconstruction flowchart. 3. Storytelling: Guided questions: Tell me about an instance when you were angry. What did you do? How did you calm down? Who did you ask for help? Anything else? (Write down the children’s answers in a notebook). 4. Review the definition WHEN WE DISAGREE ON SOMETHING WE MAY FIGHT OR ARGUE AND THEN WE GET ANGRY. ARGUING MEANS THAT WE DISAGREE AND WE TRY TO CONVINCE OUR FRIEND TO AGREE WITH WHAT WE ARE SAYING. WHEN WE FIGHT, PEOPLE SOMETIMES YELL AND HIT EACH OTHER.

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WHEN WE FIGHT, SOMEONE CAN GET HURT AND OFFENDED. INSTEAD OF FIGHTING, WE CAN GIVE IN OR SHARE WITH THE FRIEND AND THEN IT WILL BE NICER FOR EVERYONE.

5. Remind the preschool teacher of the weekly activity for the preschool: Give the preschool teacher an outline of an event reconstruction flowchart and explain how to fill it in. Whenever the child is involved in a fight or argument in the preschool, the teacher should fill in the flowchart with the child. Theme 11. Conflict Resolution: Bullying Lesson 31. Skill acquisition/learning stage (Adult mediation setting) 1. Introduction and presentation of topic a. Story in pictures (Flashcards): (1) A child knocks down another child and another friend makes fun of him. (2) The child looks at them with a sad face and they laugh and mock him. b. Story with dolls: (1) A child sits in one corner of the preschool and plays. (2) Another child comes over and hits him on the head. (3) The child bends his head down and seems to be in pain. (4) The other child continues to do this over and over. 2. Definition WHEN WE DO OR SAY SOMETHING MEAN TO SOMEONE, IT BOTHERS HIM AND MAKES HIM FEEL BAD.

3. Why is it problematic? Presentation with dolls: One doll asks and the others answer and turn to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • When I make fun of a friend it is insulting and offensive. • If I am mean to other children, they will not want to be my friends. • If I am mean to other children, the preschool teacher will probably be angry with me.

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• If others are bullying me, I should tell them to stop. • If others are bullying me, I can tell the preschool teacher. • Encourage children to suggest their own ideas. 4. Playing with glove puppets/dolls (point out possible solutions): a. Two children are standing in a circle and pointing to another child standing with his head down. (The child should suggest what they are saying to him [insults/ words that are not very nice] and encourage him to offer what the bullied child might say). b. One child tries to climb a ladder and falls. Another child stands beside him and laughs. (What can the child who is being laughed at say)? c. Children are standing in line and one child is constantly pushing the child in front of him. 5. Weekly assignment for preschool: Make a board with two columns: One with happy smilies ☺ and one with sad ones ☹. Every time a child annoys or taunts another, put a sad smiley and every time a child comforts or asks forgiveness from a friend put on a happy smiley. At the end of each day, count together with the children how many smilies there were of each kind and set a better goal number for the next day. On the morning of each day, remind the children of the smiley board. Lesson 32. Conflict resolution: bullying—Skill practice/experiencing stage (Small group setting) 1. Illustrative activity: Story with dolls. Problem definition: One doll mocks and taunts the other doll. Possible solutions: 1. 2. 3. 4.

I I I I

can can can can

say that this is not pleasant for me. ask the other to please stop. ask for help from a friend or from the teacher. ignore it and go play somewhere else.

2. Illustrative activity: a. Presentation with puppets: The children offer ideas for situations of conflict involving bullying and act them out with the puppets. (You can use other puppets or even other animals or characters from the child’s world).

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3. Why is it problematic? Presentation with dolls: One doll asks and the others answer and turns to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • When I make fun of a friend, it is insulting and offensive. • If I am mean to other children, they will not want to be my friends. • If I am mean to other children, the preschool teacher will probably be angry with me. • If others are bullying me, I should tell them to stop. • If others are bullying me, I can tell the preschool teacher. • Encourage children to suggest their own ideas. 4. Review the definition WHEN WE DO OR SAY SOMETHING MEAN TO SOMEONE, IT BOTHERS HIM AND MAKES HIM FEEL BAD.

5. Roleplaying games • A child sits in a circle and the other children walk around him laughing and pointing at him and whispering between them. (What can the child do)? • A child starts talking and after he says a word or two another child bothers him and makes noises. • A child tries to throw a ball into the basket and another child jumps in front of him every time and interrupts him and laughs. • A child draws a painting and another child constantly moves the page and smirks at him. 6. Remind the preschool teacher of the weekly activity for the preschool: Make a board with two columns: one with happy smiles ☺ and with sad ones ☹. Every time a child annoys or taunts another, put on a sad smiley and every time a child comforts or asks forgiveness from a friend put on a happy smiley. At the end of each day, count together with the children how many smiles there were of each kind and set a better goal number for the next day. On the morning of each day, remind the children of the smiley board.

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Lesson 33. Conflict resolution-bullying—Skill practice/experiencing stage— continued (Small group setting) 1. Presentation with dolls: a. A doll plays in the sand and a different doll every time throws leaves at her and makes buzzing sounds near her ear. b. Problem definition: Someone is bothering me and it’s not pleasant to me. c. Possible solutions: • The doll says (what?). • The doll makes the second doll (do what?). • The doll calls the preschool teacher and says (what?). 2. Presentation with dolls: A child playing a loud drum bothers a friend who is trying to learn. Tell a story: What is happening in the picture? Is he considerate? What can be done?—Emphasize the bullying and the consideration 3. Verbal repetition of the roleplaying games from the previous session: Fill in a flowchart to recreate an event for each of the examples. 4. Review the definition:

WHEN WE DO OR SAY SOMETHING MEAN TO SOMEONE, IT BOTHERS HIM AND MAKES HIM FEEL BAD.

5. What can I do when … (The therapist reads and encourages the children to offer solutions and writes them down). a. b. c. d.

Someone Someone Someone Someone

mocks me when I can’t do something ….. intentionally bothers me while I am playing …. laughs at me every time I start talking …. wave games in front of my face ….

6. Remind the preschool teacher of the weekly activity for the preschool: Make a board with two columns: one with happy smiles ☺ and one with sad ones ☹. Every time a child bothers or taunts another, put a sad smiley and every time a child comforts or asks forgiveness from a friend put on a happy smiley. At the end of each day count together with the children how many smiles there were of each kind and set a better goal number for the next day. On the morning of each day, remind the children of the smiley board.

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Theme 12. Forgiving Lesson 34. Skill acquisition/learning stage (Adult mediation setting) 1. Introducing and presenting the topic: a. Story with puppets: (1) Two children build a large tower from blocks and another child is playing next to them with a ball. (2) The ball flies and breaks the tower. (3) The child comes quickly and asks them for forgiveness and says it was not intentional. b. Story with puppets/Sequence of images (Flashcards): (1) A child drinks a glass of water at the crafting table. (2) He places the glass at the end of the table and reaches for the box or colors. (3) His elbow knocks the glass and the water spills onto the table and wets another child’s work. (4) The child who spilled the glass asks for forgiveness. 2. Definition

WHEN WE HURT A FRIEND OR DO SOMETHING UNPLEASANT TO HIM, WE ASK FOR FORGIVENESS AND THEN THE FRIEND IS LESS SAD.

3. Why is it important to ask for forgiveness? Presentation with dolls: One doll asks and the others answer and turn to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • When I ask for forgiveness, my friend realizes that I didn’t mean to do anything wrong to him. • When I ask for forgiveness, my friend will usually feel better afterwards. • If someone unintentionally hurts me and asks me for forgiveness, I should forgive him and it will make me feel better. • Encourage the child to suggest his own ideas. 4. Illustrative activities: a. The therapist and child play together with an assembly game. The therapist gets up from the table for a moment and “accidentally” knocks over what they built and it breaks. The therapist immediately asks for forgiveness and says it was not intentional.

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b. The therapist and the child draw together in watercolor. The therapist moves the glass of water with the paintbrushes to the edge of the table next to the child so he will accidentally knock it. Hint to the child to say sorry, I didn’t mean…, etc. 5. Weekly assignment for preschool: Prepare a jar on a table and a bag of marbles. Whenever one of the children does something that bothers another and asks for forgiveness, place a marble in the jar. When the jar is filled, the children can choose something fun to do together. Lesson 35. Asking Forgiveness—Skill practice/experiencing stage (Small group setting) 1. Illustrative activity: Presentation with dolls. One doll is excited about something that it sees and unintentionally pushes and drops a toy that the other doll is holding in her hand. a. Problem definition: I did something that hurt another but I didn’t mean to do it. Possible solutions: (1) I can ask for forgiveness. (2) I can pick up what has fallen and say that I’m sorry. 2. Illustrative Activity—Roleplaying/Flashcards: a. A child draws a painting and a friend approaches him to see it and without intention, moves his hand and destroys the painting. (What does each child say? How do they feel? Will they feel better after the apology?). b. A child builds a castle in the sand and children that are playing tag accidentally tramples the castle and destroys it. (What does each child say? How do they feel? Will they feel better after the apology?). c. A child prepares a surprise for the preschool teacher and another child tells her what she is preparing. The child is very angry that the surprise has been ruined and yells at or hits the other. (What does each child feel? Who should ask for forgiveness?). 3. Why is it important to ask for forgiveness? Presentation with dolls: One doll asks and the others answer and turns to the child(ren) for more ideas. Write down what the children say so they can be reminded later. • When I ask for forgiveness, then my friend realizes that I didn’t mean to do anything wrong to him. • When I ask for forgiveness, then my friend will usually feel better afterwards.

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• If someone unintentionally hurts me and asks me for forgiveness, I should forgive him and it will make me feel better. • Encourage children to suggest their own ideas. 4. Review the definition WHEN WE HURT A FRIEND OR DO SOMETHING UNPLEASANT TO HIM, WE ASK FOR FORGIVENESS AND THEN THE FRIEND IS LESS SAD.

5. Remind the preschool teacher of the weekly activity for the preschool: Prepare a jar on a table and a bag of marbles. Whenever one of the children does something that bothers another and asks for forgiveness, place one marble in the jar. When the jar is filled, the children can choose something fun to do together. Lesson 36. Asking Forgiveness—Skill practice/experiencing stage—continued (Small group setting) 1. Flashcards: a. A child plays with a ball in the playground and, accidentally, the ball flies into the neighbor’s garden and breaks a flower pot. What does the child say to the neighbor? What does the neighbor say to the child? How does the child feel? b. A child accidentally breaks a friend’s game. c. At lunch, one child’s glass of water spills over the child sitting next to him. 2. Watch the video/verbal description of the of the roleplaying games from the previous session. 3. Game of “Catch the Tails”: Every child who is caught should tell of an instance during the week in which he/she asked for forgiveness. (Get help from the preschool teacher and parents to be able to give hints to the child). 4. Review the definition WHEN WE HURT A FRIEND OR DO SOMETHING UNPLEASANT TO HIM, WE ASK FOR FORGIVENESS AND THEN THE FRIEND IS LESS SAD.

5. Remind the preschool teacher of the weekly activity for the preschool: Prepare a jar on a table and a bag of marbles. Whenever one of the children does something that bothers another and asks for forgiveness, place one marble in the jar. When the jar is filled, all preschoolers will choose something fun to do together.

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Theme 13. Program Summary Lesson 37. Skill acquisition/learning stage (Adult mediation setting) Bring all the materials collected during the activities and go over the “Why is it important…? points of each topic. 1. Allow the child to choose one activity from the selection of activities that were in the program and play with the therapist. The therapist tries to persuade the child to do something else and eventually gives up or reaches a compromise. (Emphasize the different skills). 2. Definition Quiz: The therapist reads a definition of a skill and the children have to tell what skill it is. Also do the reverse: the therapist names a skill and the children have to say the definition. Show symbols and icons that will remind the children of what you are talking about. Lesson 38. Summary Activity—Skill practice/experiencing stage (Small group setting) 1. Bring all the materials collected during the program and prepare an exhibition. 2. On the back of a large floor puzzle, write the words of the interaction skills learned. Let the children assemble the puzzle together (right side up) and point out their collaboration. Then turn the puzzle over and go over the words and definitions. 3. Shoot baskets by lining up in a row and each child in turn tells what he/she enjoyed the most and what he/she enjoyed the least. (Encourage and cheer on anyone who shoots a basket and comforting those who missed.) 4. A child hands out refreshments to his friends. 5. Each child suggests an activity from the selection of activities in the program that he/she enjoyed. Children should choose only one activity. At one point, hint to one of the children to start an argument. The children have to decide whether to give in, vote for a majority decision or any other strategy. 6. Perform the selected activity. Lesson 39. Summary Activity—Skill practice/experiencing stage—continued (Small group setting) 1. Definition quiz: The therapist reads the definition of a skill and the children have to tell which skill it is. Also, do the reverse: the therapist names a skill and the children have to say the definition. Show symbols and icons that will remind the children of what you are talking about.

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2. Game: Pass the parcel: There is a sentence hidden in every layer. Each time, the therapist reads it out and the child must complete it. (Make sure that a new child has a turn each time). Or: Play color tag: Each time someone stops on a particular color, the preschooler will read a sentence and the child completes it. (Make sure that a new child has a turn each time). The sentences a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q. r. s. t.

Playing together with a friend means…. If children are playing something I like, I can…. If I share something with a friend then… If I share my ideas with friends then …. I like to eat…. I don’t like…… When a friend grabs something of mine, I can…. If I give in, then… To argue means that…. Sometimes it’s hard for me to give in but…. When I say nice things, I…. When I want to encourage a friend, I say…. When something’s hard for me, I can…. If I see a friend who can’t do something, I can…. If a friend falls, I can…. When a friend is sad, I …. If a friend fails to do something, I can…. If I don’t succeed, I can…. When I encouraged a friend, I felt …. When I finished first, I felt….

3. Make chocolate balls together. 4. Parting: Award a medal to each child for participation.

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The PPSI Social Play and Social Pretend Play Protocol

The “Social Play and Social Pretend Play” protocol was developed through Dr. Sagit Hoshmand’s doctoral dissertation under the supervision of Prof. Nirit Bauminger-Zviely.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 N. Bauminger-Zviely et al., Preschool Peer Social Intervention in Autism Spectrum Disorder, Social Interaction in Learning and Development, https://doi.org/10.1007/978-3-030-79080-6_6

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Introduction to the “Social Play and Social Pretend Play” Curriculum As seen in the upcoming outline, the PPSI “social play and social pretend play” protocol entails 13 themes. The details for each theme are presented below, including the goals, contents, and techniques both for the learning/acquisition stage (delivered by the adult PPSI facilitator) and for the experiencing/practice stage (delivered in the small peer group under the facilitator’s supervision). The link to the supported visual aids for this curriculum can be found in the Appendix.

Outline for “Social Play and Social Pretend Play” Protocol (THEME) Lesson Nos

Lesson topic—developmental peer play stages

Part I: Introduction (1) Introduction—Concept 1–3 Clarification

Part II: The Stages of Social play (2) Parallel Play and Awareness at 4–6 Close Proximity

(3) 7–11

Simple Social Play

(4) 12–15

Interactive Complementary Play

Detailed acquisition/practice goals and contents

1. Definition and clarification of “play” 2. Distinguishing shared play from solitary (independent) play 3. Group practice: Playing with peers 1. Developing the ability to observe and be aware of peers’ play (the objects they play with and the actions they perform) at close proximity 2. Group practice 1: Developing awareness of other children engaged in similar activities through observation and imitation 3. Group practice 2: Practicing being aware of and attentive to another’s play (coordinated activity) 1. Directing social behaviors toward the interaction partner during play 2. Group practice 1: Exchanging toys, taking turns, coordination, developing a common focus 3. Group practice 2: Coordination, developing a common focus, developing shared enjoyment 4. Group practice 3: Shared enjoyment 5. Group practice 4: Shared enjoyment 1. Acquiring the concepts of reciprocity, cooperation, and role reversal 2. Group practice 1, 2, 3: Social games with rules and shared goals (continued)

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(continued) (THEME) Lesson Nos

Lesson topic—developmental peer play stages

Detailed acquisition/practice goals and contents

(5) 16–18

Reciprocal Social Play

(6) 19

Summary Lesson: Social Play

1. Meta-communication is social games. Games with rules and assigned roles 2. Group practice 1 and 2: Skills’ acquisition in organizing play: assigning roles and constructing social relationships 1. Group practice of the social play skills acquired through peer group semi-constructed interactive play

Part III: Social Pretend Play (7) Solitary Pretend Play and 20–21 Solitary Pretend Play Directed to a Partner (8) 22–23

Coordinated Social Pretend Play

(9) 24–26

Simple Social Pretend Play

(10) 27–30

Associative Social Pretend Play

(11) 31–33

Cooperative Social Pretend Play

(12) 34–36

Complex Social Pretend Play

Part IV: Program Review (13) Summary 37–42

1. Understanding the meaning of the concept: “I perform make-believe acts.” 2. Acquisition at basic and more advanced levels 1. Group practice 1: Creating shared meanings for objects together with peers 2. Group practice 2: Same as 1 with observation and mimicking 1. Pretend play (continued) with a focus on sequences of pretend play actions 2. Enacting everyday life situations in social pretend play 3. Group practice using doll and various scenarios 1. Performing a sequence of pretend acts using substitute objects 2. Group practice 1, 2 and 3 1. Learning rules for cooperative social pretend play using complementary roles 2. Group practice 1 and 2. Expanding the variety of play scenarios by constructing scenarios together with peers to include dramatic activities, complementary roles, and role reversals 1. Meta-communication play processes: Negotiating, assigning roles, playing according to a planned scenario 2. Group practice 1 and 2: Using collaborative planning for specific topics 1. Collaborative play with peers including reciprocal social play skills and complex social pretend play 2. Practicing social play and social pretend play in free play situations according to themes (continued)

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(continued) (THEME) Lesson Nos

Lesson topic—developmental peer play stages

Detailed acquisition/practice goals and contents 3. Group activity with video recording of children playing 4. Free play with minimal mediation

Full “Social Play and Social Pretend Play” Intervention Protocol

NOTE: THROUGHOUT THIS PROGRAM, THE USE OF THE MALE/FEMALE GENDER IS FOR CONVENIENCE ONLY AND MAY REFER TO EITHER. Part I: Introduction Theme 1. Introduction—Concept Clarification Lesson 1. Skill acquisition/learning stage (Adult mediation setting) Topic: Concept clarification of “play” 1. Introduction Show the child different pictures of children playing such as playing in a sandbox; playing on a trampoline; playing with dolls or cars; playing with Lego or with cards (Lotto). Ask the child about each picture: “What are the children doing?”, “How do they feel?” 2. Explain to the child the following definition of “PLAY” Concepts and definitions: PLAY • PLAY IS SOMETHING WE DO TOGETHER WITH A FRIEND, TO ENJOY OURSELVES. • PLAYING WITH ANOTHER CHILD IS FUN.

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• THERE ARE GAMES WITH RULES THAT WE PLAY BY TAKING TURNS LIKE MEMORY GAME, LOTTO, ROPES AND LADDERS. • THERE ARE GAMES WITHOUT RULES WHERE WE CAN PLAY AS WE WISH, LIKE PLAYING WITH CARS OR DOLLS.

3. Activity a. Ask the child: Do you play games? What are your favorite games? b. Play the child’s favorite game with him/her. c. At the end of the game, reflect about the activity with the child: – – – – –

What did we do together? How did you feel? What other games can we play? What are your favorite games at home? In the kindergarten? Who do you like to play with the most?

d. Explain the difference between play and non-play activities. You can sort images of children who are playing (e.g., playing ball) and children who are not playing (e.g., eating ice cream) into two piles. 4. Lesson Summary: Explain to the child about the schedule of your play meetings (“We will meet on days X, Y, and Z”) and the structure (“Sometimes, it will be just the two of us and sometimes we will be joined by other children”). Lesson 2. Skill acquisition/learning stage (Adult mediation setting) Topic: Distinguishing shared play from solitary (independent) play 1. Understanding the concepts “together” and “alone”: Tell a story to the child (accompanied by flashcards): In preschool we play all kinds of games: puzzles, ball, cars, building blocks, tag. There are some games that we play together with other children. There are some games that we can play by ourselves.

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Concepts and definitions: Solitary play (Independent play) and shared play SOLITARY PLAY IS WHEN A CHILD PLAYS ALL BY HIMOR HERSELF WITHOUT INTERACTING WITH PEERS. SHARED PLAY IS WHEN A CHILD PLAYS WITH OTHER CHILDREN.

2. Activity a. Show picture No. 1 (ball games.) Ask: “What are the children in the picture doing? Are they doing it together or alone?” b. Show picture No. 2 (sandbox play). Ask: “What are the children in the picture doing? Who are playing together? Who is playing alone?” c. Show the child pictures of solitary play and of children playing games together. Ask: “Which pictures show children playing together? Which pictures show the child playing alone?” Have the child sort the pictures into “children playing alone” and “children playing together.” d. Review the definitions introduced in Lesson 1 and add the following: Concepts and definitions: Shared play

IF YOU PLAY WITH OTHER CHILDREN, YOU CAN PLAY MANY GAMES THAT YOU CANNOT PLAY ALL BY YOURSELF

e. Show pictures of games that can be played together. Tell the child (while showing the pictures) “There are all kinds of games you can play with other children:” • You can play with objects: ball, skipping rope, Parachute, seesaw, Zoom Ball, cars, dolls. • You can play board games: Lotto, Memory, Ropes and Ladders f. Ask the child to choose a game and play that game together. (Add also one or two of the games that were named as favorite during the previous lesson.) ** NOTE** Make sure there are games available that are suitable for both one or more players (ball, cars, dolls, games like Memory Game), as well as games that must be played with other children (parachute, skipping rope, seesaw, Zoom Ball, etc.). Tell the child that at your next meeting, some friends will join the group to play some games together.

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Lesson 3. Playing with peers—Skill practice/experiencing stage (Small peer group setting) Topic: Getting acquainted with the group’s participants 1. Introductory game: In this lesson, there will be more than one child. Have each child state their name and their favorite game. 2. Activities a. Sitting in a circle, pass around a box of candy to the sound of music. Whenever the music stops, the child holding the box must take out one candy and give it to another child while stating that child’s name. b. Play “Pass the parcel.” Each layer will produce a task that is related to the other children in the group e.g., Pass the package to the child with the shortest hair, to the child named _________, to the child wearing a _____-colored shirt, to the child with _______ eyes, to the child sitting next to you, etc. The final item should be a snack that the target child can share with all the other children. Part II: The Stages of Social Play Theme 2. Parallel Play and Awareness at Close Proximity Description In parallel play, children play next to each other with similar objects. They will observe each other on a basic level and may make eye contact or imitate each other, but without interacting or joining in each other’s play. Characteristics ✓ Each child is aware of the other, the objects being played with, and the acts that are being performed. ✓ The children play in close proximity to each other and perform similar or identical activities (imitating the other). ✓ The basic interaction level includes looking in the partner’s direction, establishing eye contact, observing the other’s activity, imitating it, and coordinating with it. ✓ There is no reciprocal interaction yet and no joining each other’s game. Lesson 4. Skill acquisition/learning stage (Adult mediation setting) Topic: Developing the ability to observe and be aware of peers’ play (the objects they play with and the actions they perform)

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1. Activity a. Show pictures of children playing different games. Ask the child: What are the children playing? What are they doing? b. Show 3 pictures (see below) of groups of children playing with the same items, yet each doing something different. Ask the child: “What are the children playing?” Ask about each child specifically: “What is this child doing?” (Make sure the child can distinguish the specific activity of each child in the picture.) c. Picture 1: Children playing with building blocks: One child is building a tower, one is building a train, and two are building a fence around some toy animals Picture 2: Children playing with a ball: One child is throwing a basketball into a basket, one is kicking a soccer ball to the goal, two are playing catch, and one is dribbling a basketball Picture 3: Children playing in the sandbox: One child is digging a hole, one is filling a bucket with sand using a shovel, one is building a sandcastle, and one is making sand patties d. Say: “Let’s also play at what the children are playing,” and play with similar items in the different ways. Definitions and play rules: Parallel aware play • WHEN WE PLAY NEAR OTHER CHILDREN, WE CAN LOOK AT HOW THEY ARE PLAYING. WHEN WE WATCH WHAT THEY DO, IT CAN GIVE US GOOD IDEAS FOR OUR PLAY. • WHEN WE PLAY NEAR OTHER CHILDREN, THEY MAY ALSO LOOK AT US. THEY LOOK AT HOW WE ARE PLAYING AND WHAT WE ARE DOING BECAUSE IT CAN GIVE THEM GOOD IDEAS FOR THEIR PLAY. ** NOTE **. While playing with the child, prompt him to use goal-oriented interactive behaviors. E.g., say “Look at what XXX is doing. Let’s do the same.” Or “Look at what I am doing. Why don’t you imitate me.” Or “Look! I am doing the same thing you are.”

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Lesson 5. Parallel Aware Play—Skill practice/experiencing stage (Small peer group setting) (1) Topic: Developing awareness of other children engaged in similar activities through observation and imitation Suggested Activities (Play as many of the following as you have time for) Scarves Place a box with colorful scarves in the middle of the room. Invite all the children to take one. a. Each child improvises things to do with a scarf (e.g., compressing the scarf into their palm, spinning it in circles, wearing it on the head, covering body parts with it, etc.). Prompt the children to observe each other and imitate. b. Add music, first slow and then lively music. Encourage the children to match their activity to the music. Prompt the children to observe each other and imitate. c. Music. Give each child a bell, percussion sticks, and a drum. The children take turns with a different instrument each time. Prompt them to observe and imitate each other. d. “Follow the leader.” Appoint one child to be the leader, performing movements and gestures (e.g., hop on one leg, walk fast, stick out tongue, etc.). The others should imitate the “leader.” Let each child take on the role of the leader. Lesson 6. Parallel Aware Play—Skill practice/experiencing stage (Small peer group setting) (2) Topic: Practicing being aware of and attentive to another’s play 1. Suggested Activities (Play as many of the following as you have time for) Follow the leader. Repeat the game introduced in the previous lesson. Playdough. Sit together in a circle. Each child in turn models something and the others make the same shape. Building blocks/magnets. a. b. c.

d.

Put a box full of blocks/magnets in the center of the room. Let the children access and play freely. Prompt the target child to observe the other children, watch how they play, approach them and play next to them with the same items. After some play time, when the children start doing meaningful things with the accessories, prompt the children to look at each other and imitate one another. Use prompts learned in the previous lesson.

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Theme 3. Simple Social Play Description Play that involves only basic interaction with a peer: mainly sharing objects and being responsive towards each other. The children are involved in the same or similar activities. They will direct social behaviors toward the peer: talking and/or vocalizing, offering and/or taking an object or a toy, exchanging toys, smiling, touching, showing objects to the other, and accepting a toy offered to them. Characteristics (as applicable to the preschool child’s developmental stage) ✓ The child is capable of being engaged and involved in fun activities involving one or more peers. The child’s involvement includes: a. Developing a common focus with their interaction partners. b. Communicating with peers during a similar social activity. c. Interacting with peers by reacting to the other, talking, smiling, exchanging things between them, and taking turns to play with objects. ✓ As children develop and mature and become more engaged in the fun activity, in addition to taking turns and exchanging toys, they will gradually start offering help, asking questions, giving instructions, and discussing the game. Lesson 7. Skill acquisition/learning stage (Adult mediation setting) Topic: Directing social behaviors toward the interaction partner during play 1. Introduction: Show the child a video clip of an interaction between two children playing with Lego together. The videotaped interaction should be about 3 minutes long. – A child is building a house from Lego. Another child looks at him, sits next to him and starts building a house too. – Both children look at each other and smile. – Child A: “What are you building?” – Child B: “A house.” – Child B: Offers Child A a window. – Child A (taking the offered object): “Thank you.” – Child B: Asks for red blocks.

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– Child A: Give Child B some blocks. – In the end, they show each other what they built. – Both children want to carry the house they built on a truck. They take turns: Child A goes first and then Child B. After the initial viewing of the video clip, watch it again. For each social behavior that appears, pause, and show the child a relevant flashcard from previous lesson. Use Flashcards as reminders of the rules defined in previous session together with relevant images from the video clip. Definitions and play rules: Social behaviors during play • WHEN WE PLAY WITH CHILDREN, WE LOOK AT THE OTHER CHILD, OBSERVE WHAT THEY ARE PLAYING WITH AND WHAT THEY DO, AND THEN WE DO THE SAME AS THEM. • WHEN PLAYING TOGETHER, YOU CAN SMILE AT A FRIEND AND SAY, “IT’S FUN TO PLAY WITH YOU.” • WHEN PLAYING TOGETHER, SOMETIMES WE LET A FRIEND PLAY WITH SOMETHING THAT IS OURS SO THAT HE CAN ENJOY IT TOO. • WHEN PLAYING TOGETHER WE TAKE TOYS FROM A FRIEND IF THEY OFFER IT TO US. • WHEN PLAYING TOGETHER, WE CAN ASK A FRIEND TO GIVE US SOMETHING THAT WE WANT TO PLAY WITH. • WHEN PLAYING TOGETHER, WE CAN EXCHANGE TOYS. • WHEN PLAYING TOGETHER, WE SOMETIMES TAKE TURNS.

2. Practice During free Lego play with the child, remind the child of the acquired behaviors using flashcards. Additional options: Free play with playdough or building magnets. **NOTE** Lessons 8–11 allow the children to practice different PLAY methods by playing different games together. The aim is to: a. Develop shared enjoyment. b. Encourage common focus on the same activity. c. Engage the target child in activities involving one or more peers. d. Practice skills such as taking turns and sharing, asking for and giving, and exchanging toys.

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Lesson 8. Directing social behaviors—Skill practice/experiencing stage (Small peer group setting) (1) 1. Activities a. Practicing exchanging toys: “Catch the Toy” exchange game. Ask each child to bring their favorite toy in the preschool to the session or have them choose a toy from a basket. – Each child shows the chosen toy to all the friends. – Place all the chosen toys into an opaque bag in the middle of the room. – Everybody runs around the room to the sound of music, and when the music stops, all the children put their hands in the bag and take out one toy. – Now, the children exchange toys (offer, give and ask) toys with each other so that they each end up with their chosen toy. – The game ends when everyone has their original toy. – Game rules: No grabbing. Only asking for a toy and giving a toy are allowed. b. Practicing taking turns: The children take turns on a vestibular plate: One child sits on the plate and the others rotate it. Then another child sits, until everyone has had their turn. Same goes for jumping on a trampoline or crawling through a tunnel. c. Practicing coordination: Two children, working together, must turn a skipping rope together in the same direction, and/or rock/swing a doll on a blanket together, and/or lift up a flat board upon which has a glass of water or a pom-pom ball on it without the water spilling/ball rolling off. d. Practicing developing a common focus: Keeping a balloon in the air: Play catch or pass the balloon from one to another while all the children strive to keep it off the floor. Count how many passes they were able to complete.

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Lesson 9. Directing social behaviors—Skill practice/experiencing stage (Small peer group setting) (2) 1. Practicing coordination and developing a common focus Cooperative activity with a hoop: a. Two children stand facing each other, each holding a hoop on each side. Work on interactive coordination between the children as they move the hoop up/down. b. Two children sit facing each other, each holding the hoop on either side. Rock together back and forth and to the sides, stand up and sit down together while holding the hoop. Pass through a hoop in pairs. c. Place the hoop on the floor, play “Land, Air and Sea” in pairs by holding hands and jumping into and out of the hoop together. d. Arrange all the hoops on the floor in a row, hold hands and walk in a row inside the hoops. e. Connect the hoops into a big circle, hold together and sing together simple well-known nursery rhymes. 2. Practicing coordination, developing a common focus, and developing shared enjoyment: Cooperative activity with a parachute: Hold the parachute together, raise it, lower it, turn it in both directions, take turns entering under it while the rest are lifting it, sit together around the chute and take turns while imitating each other. Lesson 10. Directing social behaviors—Skill practice/experiencing stage (Small peer group setting) (3) 1. Ball Games a. The children sit in a circle and pass a ball from one to another while music is playing. When the music stops, the child who has the ball should throw it to a friend. b. The children take turns shooting a ball into a basket/bucket: Stand in line, the first child shoots the ball and then goes to the end of the line. c. Bowling: Arrange large bowling pins or 1.5-L water bottles (half filled with colored water). All the children stand in a row, each with a ball. At the count of three, they all throw the balls at the pins/bottles to topple them. After that, they take turns and play one by one. d. Play a board game (Lotto/Memory/Domino/Ropes & Ladders) with the children. Encourage taking-turn behaviors such as passing the die /a card, looking at what the partner is doing, etc.

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Lesson 11. Directing social behaviors—Skill practice/experiencing stage (Small peer group setting) (4) a. Put a box in the center of the room with a construction toy, and let the children build freely while prompting to the target child, using flashcards, the rules they previously acquired, including offering and accepting parts, asking for parts. At the end of the activity, every child, in turn, shows the group what they built. b. Play with the children a board game (Lotto/Memory/Domino/Ropes & ladders.) Encourage taking-turn behaviors such as passing on the cube/a card, looking at what the partner is doing, etc. Theme 4. Interactive Complementary Play Description At this stage, another child becomes a social partner who is essential for the play activity. Interactive complementary peer play can involve role reversal, reciprocity, and cooperation. The children act together, look at each other, imitate each other, and take on complementary roles in the game. The play involves common goals and is directed toward a shared collective creation. Children are developing awareness of the existence of social rules. Characteristics ✓ The child plays in cooperation with other children. ✓ The child can play simple games according to rules (board and social games). ✓ The child plays reciprocally with another peer. ✓ The child plays both roles in the social game (e.g., tagger and tagged). Lesson 12: Skill acquisition/learning stage (Adult mediation setting) Topic: Acquiring the concepts of reciprocity, cooperation, and role reversal, while practicing their related skills Remind the child of previously learned social rules: Definitions and play rules • WHEN WE PLAY TOGETHER WITH OTHER CHILDREN, WE OBSERVE THEIR PLAY AND SEE WHAT THEY DO. WHEN WE PLAY WITH OTHER CHILDREN, THEY ALSO LOOK AT US AND OBSERVE WHAT WE PLAY WITH AND WHAT WE DO. • WHEN WE PLAY WITH OTHER CHILDREN, WE GIVE THEM OUR OBJECTS AND THEY GIVE US THEIRS. • WHEN WE PLAY WITH OTHER CHILDREN, WE PLAY BY TURNS.

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1. Definitions and play rules: Reciprocity, cooperation and role reversal in play Add new rules: • WHEN WE PLAY WITH OTHER CHILDREN, WE CAN REVERSE ROLES. • WHEN WE PLAY WITH OTHER CHILDREN, WE TALK TO THEM AND THEY RESPOND. WHEN OTHER CHILDREN TALK TO US, WE RESPOND TO THEM. • WHEN WE PLAY WITH OTHER CHILDREN, WE COOPERATE: ALL THE CHILDREN DO SOMETHING TOGETHER.

2. Activities a. Hiding game. The child hides a tennis ball and the adult must search for it, and then the roles are reversed. b. Tag. The adult counts to 5 and then chases the child. When the adult tags (touches with hand) the child, the roles are reversed. c. Jigsaw puzzle. Assemble a jigsaw puzzle with the child. Divide the pieces between the child and the adult and take turns in placing them to complete the puzzle. Remind the child the new rules. The following three lessons give the children the opportunity to practice the learned concepts of reciprocity, role reversals, peer collaboration, and playing social games with rules through interactive complementary play in a group. Lesson 13. Interactive complementary Play—Skill practice/experiencing stage (Small peer group setting) (1) a. Cooperation-collaboration: Musical Instruments. Each child chooses a musical instrument (drum, bell, recorder, percussion sticks, maracas, triangle, etc.) and everyone plays together to the same rhythm. First, make music together to accompany a familiar song. Then, use the same song and have each child, in turn, play their instrument while the others imitate and play along. b. Role Reversal: The Conductor Game. One child is the conductor of the orchestra (with a cloak, a baton, and a hat). The conductor decides when to play music and when to stop, when to play quickly, slowly, loudly, quietly… and the others collaborate. Children switch roles until everyone has had a turn to conduct the “orchestra.” (The emphasis in this game is not on imitating—as was the case in previous stages—but on role reversals.)

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c. Social play with rules and role reversals: Dragon Tag. Stick a strip of crepe paper in the back of each child’s pants as if it were a tail. The child who is the “catcher” should pull as many “tails” as possible while the others try to escape. The last one to be tagged is the winner and becomes the “catcher” (Attached please find game rules and flashcards.) Lesson 14. Interactive complementary Play—Skill practice/experiencing stage (Small peer group setting) (2) a. Reciprocal play in pairs: Soap bubbles and ball. Start with soap bubbles: one child blows bubbles towards their peer partner, who pops them, and then they reverse roles. Move on to the ball: The children sit facing each other and roll a ball from one to the other, play catch sitting down and then standing up, kick the ball from one to the other. Also, have one child throw a ball into a bucket held by the partner and then switch. b. Cooperation/collaboration: “Pass the Ball.” The children stand in line and pass a ball backwards, above their heads, from the first to the last one at the end of the line without dropping it. The last child in the line, upon receiving the ball, runs with it to the front, and starts passing it backwards all over again. Continue until all the children have been at the front of the line. Then, do the same thing, standing with spread legs and passing the ball on the floor, between the legs. c. Cooperation/collaboration: Building a tower together. Sit in a circle. Every child gets a few building blocks. Each child, in turn, approaches the center and places one block. Together they build a tower until it topples down. Start all over again. Keep count of how many blocks were in each tower and praise the children for the highest tower with the most blocks without falling. (Attached please find game rules and flashcards.) Lesson 15. Interactive complementary Play—Skill practice/experiencing stage (Small peer group setting) (3) a. Role Reversals : Movement King/Queen. One child is king/queen and sits with a crown and performs movements. The others imitate the movements. Then another child is king/queen. (This game also emphasizes role reversals.) b. Reciprocal play. Play ping pong or other racket games. Play catch with a ball. c. Cooperation/collaboration: Building a tree together. Sit with the children around the table. Tell them that today we are going to build a tree together. The tree has parts—a trunk, branches, leaves and fruit. Every child chooses what they want to make. Give out one color playdough per child: brown, green, red, and orange. Each child makes one part, and the children must ask for and give away different colors to each other upon request or suggestion. Finally, work together on combining the tree parts as each child attaches what they have created.

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d. Social play with rules: Tush-tag game. This is just like tag except that the children scoot around on the floor, never lifting their backside off the floor. (Attached please find game rules and flashcards.) Theme 5. Reciprocal Social Play Description Children’s play that involves organizing, planning, and playing complex social interactive games with peers, including games with rules (e.g., hide-and-seek). Or, it may be a collaborative activity with a common plan: the pair’s actions are integrated (e.g. jointly building a block structure). This play includes assigning roles and building social rapport. Characteristics ✓ Meta-communication and pre-planning of the play. Organizing the play in advance is required and includes selecting the game, planning its steps, and assigning roles. ✓ Children take on roles and identities in the game. ✓ Children play complex social games with complex rules. Lesson 16. Skill acquisition/learning stage (Adult mediation setting) Topic: meta-communication in social games 1. Introduction Show a video relating to reciprocal social play (a video of a group of children playing tag.) Show the child the entire video and then watch it again. Stop at each part and show the appropriate definition: The children want to play together: 1. They choose a game (tag) 2. They assign roles in the game (who will be “it”) 3. They play together according to the rules of the game (the child who is “it” chases after all the other children, trying to tag them). 2. Definitions and play rules: Reciprocal social play • WHEN WE PLAY WITH CHILDREN, WE CHOOSE TOGETHER WHICH GAME WE PLAY. • WE ASSIGN ROLES IN THE GAME. • WE PLAY BY THE RULES OF THE GAME. • WE PLAY TOGETHER.

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3. Activity Practice with the child: Prepare 3 flashcards with the rules of the following 3 games: a. Hide and Seek i. Selecting a child who is “it.” The rest of the children hide. ii. The child who is “it” stands with eyes shut, at the wall (basepoint) and counts to 10. iii. The other children find hiding places (e.g., under the table or behind the closet). iv. When “it” is finished counting, he or she begins searching for those hiding. v. Whenever “it” finds a child, he runs to the basepoint and calls out: One, two, three ______ (the name of the child.) vi. The hiders, if not found, can also run to the basepoint, and call out one, two, three ______ (the name of the child who is “it.”) vii. The game ends once all the children are found. The last child to be found, is the winner, and becomes “it” in the next round. b. Tag i. ii. iii. iv.

One child is “it.” “It” counts to 10. “It” starts chasing the other children to “tag” (touch with hand) them. The last child to be caught, is the winner, and becomes “it” in the next round.

c. Musical chairs i. Set up chairs in two rows back to back (one chair less than the number of players). ii. The players walk around the chairs to the sound of music. iii. When the music stops, the children race to sit in an empty chair. iv. The player left standing is taken out of the game and one chair is removed. v. The winner is the last one left. 4. a. b. c.

More practice of the acquired rules Choose a game out of these three games: Tag/hide and seek/musical chairs Assign roles: Who is “It” (seeker/catcher) Play the games with the child. Swap roles each time.

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Lesson 17. Reciprocal Social Play—Skill practice/experiencing stage (Small peer group setting) (1) The goal of the next two lessons is to play different social games in a group. In the first lesson, start with the 3 games that were acquired in the previous lesson: Tag/hide and seek/musical chairs. Before playing each game, go through the following steps with the children, using the flashcards: Definitions and play rules: Play social games

a. b. c. d.

CHOOSE TOGETHER WHAT TO PLAY ASSIGN ROLES RUN THROUGH THE RULES ONCE AGAIN. PLAY

Play each game 2–3 times, emphasizing the role reversals within the game itself. In each lesson, add one more social game from the list below to the available choices and teach its rules. (Note: Advise the child’s teacher of the games so that they can be included in the regular preschool game routine.) Additional games: Choose 4 games from the list below to be taught and played regularly at the beginning and end of each session. Choose games that are appropriate for the ages of the children in the group. Start from simple tag games and gradually move on to games that are more complex in terms of rules and required skills. “Tush-Tag” 1. All the children sit on the floor. 2. Select one child to be “It,” who counts to 5. 3. All the children must move along on their backside only (i.e., scooting around on the floor). 4. No getting up and running is allowed. 5. Anyone who is caught (tagged) becomes “It” and chases the others. Mouse Tag 1. 2. 3. 4. 5.

Select one child to be “It.” “It” counts to 5 The other children run away and “It” tries to “tag” (touch with the hand) them. Whoever is tagged, stands astride. You can save a friend by crawling under them.

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Colors Tag 1. 2. 3. 4. 5.

Select one child to be “It.” “It” announces a color “It” counts to 5 out loud. All the other children run and touch something that is in the announced color. Anyone caught before touching the color becomes “it.”

Dragon Tag 1. 2. 3. 4. 5.

Select one child to be “It.” All the children stick “tails” in the back of their pants. “It” loudly counts to 5 and all the children run off. “It” runs after them and tries to grab their “tails.” The last child with a tail is the winner and becomes “It.”

Volcano Tag (The Floor is Lava) 1. Select one child to be “It.” 2. “It” counts to 5 out loud and all the children escape. 3. They must mount something that is higher than the floor to avoid being caught. For example, they can get on a chair, table, bed, tree, or anything else. 4. Any child who was tagged before making it to a higher place becomes “It.” Red Light/Green Light (Statue Tag) 1. Choose a child to be “It.” He/she will turn their back to the others, facing the wall (basepoint). 2. The other children stand in a straight line on the opposite side of the room. 3. When “It” calls out “Green Light!” the players run/walk in the direction of the basepoint. 4. Then “It” will suddenly turn around and call out “1, 2, 3! Red Light!” All the other must freeze in place. Like statues. 5. The person who is “It” can walk among them and try to make them laugh or move (without touching). 6. Anyone who fails to stop or moves during “Red Light” must return to the starting line. 7. The first player to tag “It” or touch the basepoint without being spotted moving is the winner and becomes “It” for the next round. Land, Sea and Air 1. 2. 3. 4.

Each child stands next to a hoop. Choose one child who is the master and calls out “land,” “sea,” or “air.” When hearing “sea”—the other children jump into the hoop. When hearing “land”—the children jump out of the hoop.

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5. When hearing “air”—children jump as high as they can and land with one foot in the hoop and one foot outside it. 6. Anyone who gets mixed up is out of the game. The winner is the last child left. Polar Bear Tag 1. The children stand in a straight line on one side of the room—they are “fish.” 2. The other side is the “ice cave” where the child who is the “polar bear” stands. The polar bear calls out: “Polar bear is hungry! Who’s afraid?” 3. The fish shout back: “No one.” 4. The bear: “And if the bear comes?” 5. The fish: “Let the bear come.” 6. The bear: “And what if the bear devours?” 7. The fish: “Let the bear devour.” 8. Then, the “fish” must run to the ice cave without being tagged by the bear. 9. Anyone tagged becomes a bear and joins in the hunt. The last fish left is the winner. That person becomes the new bear and the game starts all over again. Drop the Hanky 1. Choose a child to be “It” and give him/her a headscarf. 2. All the other children sit on the floor in a circle with their heads on their knees. 3. The child who is “It” runs around the circle and drops the headscarf behind one of the children. 4. The children must pay attention and check (without looking—only feeling) if the headscarf is behind them. 5. The child behind whom the headscarf was dropped must pick it up and run after “It” trying to tag him/her. 6. “It” tries to complete a full circle, and arrive and sit in the vacant place before the child with the headscarf has a chance to tag them. 7. If “It” is successful, the child with the headscarf now becomes “It.” Lesson 18. Reciprocal Social Play—Skill practice/experiencing stage (Small peer group setting) (2) (See Lesson 17) Theme 6. Summary Lesson: Social Play Lesson 19. Reviewing Social Play—Skill practice/experiencing stage (Small peer group setting)

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Topic: Social Play 1. Activities a. Social games. Let the children choose and play 2 social games from the games they learned and played in previous lessons. b. Free play with magnets. Give the children magnet shapes and observe them during free play. Note if the target child is aware of the other children (observes, imitates, and interacts with them during the activity). c. Imitation. Have each child, in turn, builds something with the magnets. Then, the others should build the same thing. d. Shared sorting activity. Dive each child an assortment of magnet shapes. Place some empty baskets and a pile of face-down flashcards with a square, a circle, a triangle, and a rectangle on the floor. Each child, in turn, turns over one card and all the children place their appropriate-shaped magnets into the basket. To increase motivation and speed, the adult can time them. e. Shared assembly. Each child receives one of the baskets (therefore, has magnets of only one shape). Children are to cooperate in assembling the shapes of a person, a house, and a car. Make sure that aspects of providing help, giving, taking, and exchanging shapes, are manifested in the target child’s activity. f. Build a train from magnets. The children build a long train together by putting together all their magnet pieces. Make sure the activity is done in a cooperative fashion, that is, together (e.g., how many cars will the train have) and assigning roles (e.g., who will build what.) Make sure, during the activity, that the children share parts, help each other, etc. g. End of lesson: the train game. The children line up to form a train, with one child leading as the locomotive. Whenever the music stops, the lead child goes to the back and the next one becomes the locomotive. Part III: Social Pretend Play Theme 7. Solitary Pretend Play and Solitary Pretend Play Directed at a Partner Description Pretend play is characterized by substitution that is the child uses an object to represent another object. “Solitary pretend play directed to a partner” is pretend play where the object of activity is the partner. The children may add other characters to the game (dolls or people). This play stage is mainly object-focused and constitute a crucial basis for the development of imaginative social play.

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Characteristics ✓ The child uses an object as if it were another object. ✓ The child uses items to perform symbolic acts that are aimed at people or dolls. ✓ The child engages others (people or dolls) in the play and assigns them roles (personification). Topic: Understanding the meaning of the concept: “I perform make-believe acts” Lesson 20 may be skipped if the child is mature enough. Lesson 20. Skill acquisition/learning stage (Adult mediation setting) (Basic level) Actually perform several actions and then pretend to perform the same actions while mediating the process to the child. First, do it by yourself and then ask the child to follow along: 1. Eating pudding with a spoon: a. “I am eating pudding.” b. “Now I am pretending to eat pudding.” c. Let the child try it too: “Now let me see you pretend to be eating pudding.” 2. Brushing your hair with a hairbrush. (Go through the same 3 steps. Say: “I am brushing my hair,” etc.) 3. Putting on a hat. (Go through the same 3 steps. Say: “I’m wearing a hat,” etc.) Concepts and definitions: Pretending

MAKING MOVEMENTS, VOICES, AND FACES THAT REPRESENT SOMETHING REAL THAT WE WANT TO DEMONSTRATE EVEN THOUGH THE REAL THING IS NOT PRESENT. WHOEVER SEES US, CAN UNDERSTAND WHAT OUR ACTIONS REPRESENT.

4. Play make-believe games with the child in turns. a. At first the adult pretends, and the child should guess what the adult is doing. For example: “I’m going to bed. Good night.” After demonstrating the action, ask the child: “Am I really sleeping? No! I am pretending to sleep.” b. Ask the child to perform basic pretend acts: Pretend to be going to sleep, act as if eating, as if driving a car, etc.

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d. After each such activity, talk about the child’s pretend activity by name for the purpose of teaching them to communicate meanings. Ask the child: “Are you really sleeping/eating/driving?” “No. You are pretending to sleep/eat/drive.” d. Ask the child: “What other things can we pretend to do?” Play along according to the ideas generated by the child. Tell the child the name of the actions that they are pretending to do. 5. If working with a child with ASD who comprehends the meaning of make-believe, practice more complex acts such as: making a pretend salad together, making sand patties, etc. Lesson 21. Skill acquisition/learning (Advanced level)

stage

(Adult

mediation

setting)

If you did not skip Lesson 20, remind the child of what you did together: that is, pretended to do things that we actually do in real life (such as eating, sleeping, etc.) If you skipped Lesson 20, teach the definition for “make-believe” pretend play: Concepts and definitions: Pretend Play

• WHEN WE PLAY PRETEND WITH THINGS LIKE DOLLS, TOY ANIMALS, AND CARS, WE CAN MAKE BELIEVE THAT THEY ARE DOING THINGS. • WHEN WE PLAY PRETEND, WE CAN USE REAL ITEMS. BUT, USUALLY WE USE TOY ITEMS THAT LOOK REAL BUT ARE SMALLER OR DIFFERENT.

1. Pretend actions using another character and later expanding the variety of “participants.” a. Practice pretend play by imitating acts using various objects such as dolls, toy animals, etc. b. Make believe that the doll/animal is eating, taking a bath, going to bed. In the second stage, add more animal/doll characters who will perform different acts. Add more scenarios, such as going to the playground, celebrating a birthday, etc. 2. Perform with child sequences of pretend acts using real-life items, such as: Baking a cake: Mixing, baking, serving. Bathing a doll: Taking clothes off, bathing, wrapping in a towel, dressing up.

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Making a salad: Dividing the vegetables between the child and the adult, washing, chopping, putting in a bowl, seasoning, mixing, handing out on plates, eating. Theme 8.

Coordinated Social Pretend Play

Description This stage involves symbolic thinking along with social play. This marks the onset of the stage of reciprocity and creating shared meaning with a partner. Both children learn that they can coordinate their play not just by using a real object, but also by coordinating the “make-believe” meaning they attribute to the object. Characteristics ✓ The child communicates or plays with another child in a coordinated manner, based on attributing a common meaning to an object. ✓ The child understands the make-believe acts that the partner does during play, comprehends the symbolic meanings of the other’s actions, and responds accordingly. ✓ The children’s interactions are still object-focused. Lesson 22. Coordinated Social Pretend Play—Skill practice/experiencing stage (Small peer group setting) (1) Objectives 1. To practice the meanings of “make-believe and pretend” that were acquired in the ACQUISITION session, during peer group play. 2. To practice creating shared “make-believe” meanings for objects with other children. 1. Activities: Pantomime games with the children Following are some ideas for pantomime game formats to play with children. Choose what is appropriate based on the age and developmental levels of children in the group: 1. Say a name of an animal and have all the children act as if they were that animal. 2. Have each child pick up a flashcard with pictures of actions and animals and mime the animal or the action. The rest must guess what was on the flashcard. 3. Turn off the lights and announce that all the children are asleep. When you turn on the light, tell them what kind of animal they are, and they must all move around pretending they are that animal.

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4. Repeat the above, except that choose one child to turn on the light and act like an animal. The rest of the children imitate that child. With older children, animals can be replaced by miming an action such as playing a musical instrument or a sports activity. 5. Pantomime game. Place on the floor three stacks of flashcards with themes of animals (red,) activities (green,) and games (blue.) Each child, in turn, rolls a color die (with 2 sides each of blue, red, and green), picks up a card in the color indicted, and then mime whatever is on the card. The others should guess what the card is. Use themes appropriate for the children’s age: only the animal theme for young children; add activities and later games for older children. With even older children, you can exchange the animal theme with the theme of professions (with white cards). Any child who guesses correctly, receives a coin or candy. 6. Pretend musical instruments: Sing the song “If you’re happy and you know it play the ______.” One child will mime playing an instrument of his/her choice and the others must guess which instrument it is and then imitate the pantomime. Continue to give every child a turn. Lesson 23. Coordinated Social Pretend Play—Skill practice/experiencing stage (Small peer group setting) (2) Play any of the games you did not have time to play in the previous lesson, and then revise one of the mime games. After that, play the following: 1. Playing with kitchenware. Give each child a cup, a plate, a knife, a fork, and a spoon. In turn, every child uses them to pretending to do something, and everyone does the same. Ensure that the target child is observing the other children, is doing what they do, and, most importantly, understands the shared meanings in the same way as the other children. 2. Provide additional items (foodstuff, pots, pans, cookware) and tell the children to continue the pretend play. Ensure that the target child continues to observe what the other children are playing and doing, is mimicking their actions, and is communicating the meanings they give to the items in accord. Theme 9. Simple Social Pretend Play Description This type of play is mainly based on the children’s object-focused interactions. The children perform pretend actions together using toy and/or real-life items, and enact everyday scenarios that are related to their personal life situations.

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Characteristics ✓ The child pretend plays with a peer using objects and in parallel roles. ✓ The child pretend plays with a peer enacting scenarios related to their everyday life and world, which include sequences of acts. ✓ The children play together but without yet organizing the game. They will play in mutual, complementary dramatic roles or use a pre-planned script. Lesson 24. Skill acquisition/learning stage (Adult mediation setting) Topic: “pretend play” (continued) with a focus on sequences of pretend play actions 1. Introduction: Tell the child that today we will continue to play pretend. Prepare pictures on flashcards with images of everyday life situations where each situation is described as a sequence: a. A child getting up in the morning: waking up in bed, brushing his/her teeth, going to preschool/kindergarten, playing in the preschool/kindergarten. b. A child preparing food for the family: chopping vegetables for a salad, slicing bread, setting the table, the family sitting and eating. c. A child celebrating their birthday 2. Practice scenarios with the child using the images. a. Show the first image of the child getting up in the morning. Tell the child: “In this picture, the child is waking up in the morning in bed; … is brushing his/her teeth; … is going to preschool/kindergarten; and … playing in the preschool /kindergarten. Show me how you wake up in the morning in make-believe.” Perform the sequence of getting up in the morning with the child: i.e., mime being asleep, waking, brushing teeth, getting dressed, and going to the kindergarten. b. Show the image of preparing food and give the same instructions: “In this picture, the child is preparing food for the family. Here … the child is chopping vegetables for a salad, … slicing bread, … setting the table. Here all the family is sitting down to eat. Show me how you pretend to make dinner for your family.” c. Show the image of celebrating a birthday. Tell the child, “In this picture a birthday is being celebrated. Now, let’s pretend that we are celebrating a birthday.”

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Definitions and play rules: Simple social pretend lay • WHEN WE PLAY WITH ANOTHER CHILD, WE PRETEND TO DO, AND TO EXPERIENCE THINGS THAT WE REALLY DO REGULARLY, AND EXPERIENCE AT HOME WITH MOM AND DAD, AND IN THE PRESCHOOL/KINDERGARTEN WITH FRIENDS. Encourage the child to suggest ideas of their own and practice them together. Lesson 25. Skill acquisition/learning stage (Adult mediation setting) Topic: Enacting everyday life situations in Social Pretend Play Objectives To practice interactive pretend play with peers, including enactments of everyday situations, by performing a sequence of imaginary acts with toy tools and/or real-life accessories. Ensure that the target child continues to observe what the other children are playing and what they do, mimics their actions, interacts with them on a basic level, and gives the items the same meanings that they give to the items. Prompt the target child by using the learned rules/definition and hints during the social game stages (observing what other children do, doing as they do, giving and receiving objects, etc.) Playing with cars Let the children engage in free play with cars and the following items: a road play mat; a car wash facility; a garage; a track; various cars; a bus; a tractor upon which things can be loaded. Ensure that the target child looks at what the other children are doing, plays together with them, and does the same as they do in terms of how the vehicles operate, where they are going, the sounds they make, and so on. Prompt the children to play this “make-believe” game with an emphasize on reciprocity and creating shared meaning e.g., pretending to ride together in a police car that is chasing after thieves, etc. Lesson 26. Simple Social Pretend Play—Skill practice/experiencing stage (Small peer group setting) using various scenarios Show the children a large doll and tell them that this is a new friend joining the group. The children choose a name for the doll. Give the children a box with similar play items, and each time give them a different script for the doll:

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______ is very hungry. We should make breakfast for ______. _________ is very dirty. ______ needs to be washed. ______ is sick and doesn’t feel well. We must take care of ______. Finally: Today is ____’s birthday.

Theme 10. Associative Social Pretend Play Description Children play together according to familiar everyday pretend play scripts. They do not yet take on alternate identities or perform complementary roles. They being to communicate about the play using meta-communication, i.e., talking about the game, scripts, roles, etc., but this is mainly to inform each other on what to do and how to act. Characteristics ✓ The children suggest a basic plan for the game (“What game should we play?”) ✓ The children inform each other of how to play (which acts to perform in the game). ✓ The children use substitute objects in interactive play with a peer partner, utilize symbolic objects that are different from the real items, and share common meanings attributed to the items. Lesson 27. Skill acquisition/learning stage (Adult mediation setting) Topic: Performing a sequence of pretend acts using substitute. objects: Definitions and play rules: Associative social pretend play • WHEN WE PRETEND PLAY, WE CAN ALSO USE OBJECTS THAT ARE ONLY SIMILAR IN THEIR FORM TO THE REAL OBJECTS. • FOR EXAMPLE, WE COULD PRETEND THAT A STICK IS A PRETEND SPOON AND A HOOP IS A PRETEND STEERING WHEEL.

1. Activities Start playing with the child using one of the scripts practiced in previous lessons. Say: “How can we pretend to bake a cake? We don’t have toy kitchen utensils! Let’s see what we have here.” (Look together in a box of basic objects.) Together with the child, find an appropriate substitute for each required accessory or tool, and

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then perform with the child the sequence of pretend acts using the substitute objects. Perform 2–3 sequences: – Cake baking sequence – Dinner preparation sequence – Shower and going to bed sequence. Lesson 28. Associative Social Pretend Play—Skill practice/experiencing stage (Small peer group setting) (1) 1. Sit with the children in a circle. Bring a stick (one of the rhythm sticks.) Pass the stick around the circle and each child should mime what the stick might represent (microphone, guitar, gun, etc.) and the other children should guess. 2. Practice with the children all the scenarios for the new doll once again, but this time with substitute-object items (from the basic props box). Each time. give them a different script for the doll: – – – –

______ is very hungry. We should make breakfast for ______. _________ is very dirty and should be washed. ______ is sick and doesn’t feel well, we must take care of ______. It is ____’s Birthday The children use the items in the basic props box in place of the actual items.

Lesson 29. Associative Social Pretend Play – Skill practice/experiencing stage (Small peer group setting) (2) (Same as Lesson 28) Lesson 30. Associative Social Pretend Play– Skill practice/experiencing stage (Small peer group setting) (3) A bus trip: Tell the children that today we are going to take a pretend bus trip. – Along with the children, arrange some chairs as if they were bus seats. Place a hoop (pretend steering wheel) in front of the driver’s seat. – The children take turns to be the driver (sitting in the front seat with a special hat and holding the “steering wheel”) who says where they are going to. – Everyone else sits in the pretend seats and pretend to buckle up and ride to the specified location. – Upon arrival, they pretend to do 2–3 activities that are related to the place (e.g., if to the beach: swim in water, play ball, etc.). – Children switch roles so that every child get to be the driver.

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Theme 11. Cooperative Social Pretend Play Description At this stage, play starts to involve dramatic activity, which attests to the children having taken on complementary roles as part of the play. These complementary roles are not necessarily expressed or announced in advance, but are understood from the activity. Characteristics ✓ The children take on complementary roles as part of the pretend play. ✓ The roles are apparent through the children’s behavior, even though they are not predefined, do not have names, and are not pre-assigned. ✓ The play scenarios are still related to the children’s everyday familiar world. Lesson 31. Skill acquisition/learning stage (Adult mediation setting) Definitions and play rules: Cooperative social pretend play • WHEN WE PLAY WITH ANOTHER CHILD, EACH ONE OF US CAN TAKE ON A DIFFERENT ROLE IN THE GAME. FOR EXAMPLE, ONE CHILD COOKS AND THE OTHER CHILD EATS. • WE LISTEN TO WHAT FRIENDS SAY WHEN WE PLAY. • WE TALK TO FRIENDS WHEN WE PLAY. • EVERY TIME WE PLAY, WE THINK OF ANOTHER IDEA AND DO NOT DO THE SAME THING REPEATEDLY. The format for playing with the child In both acquisition and practice lessons with peers, a choice of specific play themes will be offered to the children. They will have to choose a different theme every time and play within its framework. Make sure that you do not play the same theme repeatedly, that each theme consists of a variety of ideas, and that you avoid repeating the scenarios. The themes offered are: doctor’s office, shop, family/house, restaurant, police station/fire department a. Spin the “Theme Wheel” (a wheel with a spinner that points to the themes randomly). b. Give the child the appropriate accessories for the chosen theme and start playing together. Note what actions the child is performing and join in, taking on a complementary role. For example, if you play “doctor’s office” and the child takes the doctor’s instruments, take on the role of the patient. If you play “shop” and the child fills a basket with foodstuff, start playing the role of the shopkeeper.

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c. With every scenario, specify to the child, out loud, the role that each is playing, e.g., “you cook, and I will eat; I don’t feel well, and you will take care of me,” and so on. In addition, for each scenario, reverse the roles before moving on to play the next theme. Ensure that the child plays in sync with the complementary role that the adult took on in the game. d. In the next step, the adult is the first to take on the role. Ensure sure that the child takes on a complementary role accordingly. Here, too, accompany each complementary act with a verbal prompt, and make sure the child plays in accordance with the complementary role they took on. Important: At this stage, make sure not to name any of the roles or predefined role assignments; rather allow the complementary roles to be adopted as part of the course of the interactive play. Lesson 32. Cooperative ocial Pretend Play—Skill practice/experiencing stage (Small peer group setting) (1) Play with the children in the peer group according to the themes that were taught in the individual acquisitions session with the target child (doctor’s office, shop, family, house, restaurant, police station/fire department). Use props that are toys or real-life items. Throughout the lesson have the children reverse roles. Remind the target child of the rules and definitions learned till now and make sure the child comprehends the complementary role assignment within the game and plays in accordance with his/her own role, as well as the roles of others. Lesson 33. Cooperative Social Pretend Play—Skill practice/experiencing stage (Small peer group setting) (2) (same as Lesson 32) Theme 12. Complex Social Pretend Play Description At this stage, the child thinks about the game prior to actually playing. This play includes meta-communication such as suggesting play topics; appropriating, assigning, and debating roles; and planning scripts and scenarios for the game. The children take on identities and roles that pertain to interpersonal relationships. Characteristics ✓ Before performing any action, there is collaborative thinking with the other children about the game. ✓ The meta-communication includes discussions and negotiations with the partners, such as offering a scenario (a theme for the game); taking on roles and identities; distinctly naming and assigning roles; selecting props and determining how they will be used; determining rules for the game; negotiating plans and scripts for the game.

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✓ Play takes place according to scenarios that relate to the child’s inner world and will allow him or her to cope with emotional issues. Later, this will occur according to imaginary and abstract scripts. ✓ Play is according to scripts that encompass community and social circles. ✓ The children can play both roles in the game and take on alternating roles. ✓ The children may use substitute objects rather than the real object or real-life toys. Lesson 34. Skill acquisition/learning stage (Adult mediation setting) Topic: Meta-communication play processes: Negotiating, assigning, playing according to a planned scenario Add the following to the rules already taught: Definitions and play rules: Complex social pretend play

BEFORE WE START PLAYING WITH OTHER CHILDREN, WE PLAN THE GAME TOGETHER WITH THEM: • WE COME UP WITH AN IDEA AND CHOOSE WHAT TO PLAY. • WE ASSIGN ROLES—EACH CHILD CHOOSES WHICH ROLE THEY WANT AND DECIDES WHAT THIS ROLE DOES IN THE GAME. • WE CHOOSE WHICH TOYS/PROPS TO PLAY WITH AND DECIDE WHAT THEY WILL REPRESENT. • WE PLAN HOW TO PLAY AND WHAT TO SAY IN THE GAME. WHEN WE WHEN WE PRETEND PLAY, WE CAN ALSO MAKE-BELIEVE THAT WE ARE OTHER PEOPLE, SUCH AS BEING A MAKE-BELIEVE POLICE OFFICER OR DOCTOR.

1. Activity a. Practice with the child the rules and the process of collaborative planning in advance, while including the negotiation component (negotiate with the child which scenario to choose and role assignment and plan the game together.) b. Let the child choose a theme from the options: “We will now play together a pretend game. What do you want to play with?” Present the above-mentioned themes on flashcards. c. Next to the first rule, put an image of the chosen game theme. State to the child that this is what we chose. d. Discuss roles: “What do you want to be? _________. Well, in that case, I would like to be _______.” Point out the act of assigning roles.

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e. Discuss props: Choose together toys/accessories (from three boxes: toy and real-life accessories, basic accessories, and dress-up costumes). Decide what each item is going to represent in the game. f. Plan the actions that will be performed in the game and what we are going to say. g. Start playing, while prompting the relevant rules. h. Reverse roles with the child (e.g., when playing doctor’s office, if the child was the doctor and you were the patient, reverse the roles). Lesson 35. Complex social Pretend Play—Skill practice/experiencing stage (Small peer group setting) (1) Practice interactive play using the same themes as previously played (doctor’s office, shop, family/house, restaurant, police station/fire department) while adding the element of collaborative planning and thinking about the game prior to playing it. At this point, use two boxes for the play: the toy and real-life items box, and the basic items box. Lesson 36. Complex social Pretend Play—Skill practice/experiencing stage (Small peer group setting) (2) (Same as Lesson 35) Part IV: Program Review Theme 13. Summary Lesson 37. Summary—Skill practice/experiencing stage (Small peer group setting) (1) Topic: Collaborative city building Tell the children that in the next two lessons we will build a city together. Plan together what we will have in our city. Bring up the themes played in previous sessions: doctor’s office (hospital), shop (supermarket,) family/house, police station/fire department, restaurant. The steps for this activity are: 1. 2. 3. 4.

Assign the roles—who builds what. Give out Lego or building blocks to the children. Each child builds their individual item. Collaborate to join all the parts to create a city. Continue with the city in the next lesson.

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Lesson 38. Summary—Skill practice/experiencing stage (Small peer group setting) (2) (Same as Lesson 37) 5. Add characters and engage in interactive play using the characters in the city. During both lessons, ensure role reversal take place, e.g., if the target child plays the doctor, after a few minutes initiate a role exchange so that the child becomes the patient and another child gets the role of the doctor. Lesson 39. Summary—Skill practice/experiencing stage (Small peer group setting) (3) Provide the children with costumes and props for all the roles that they practiced during the structured play. The costumes should include medical uniforms, clothes appropriate for mothers and fathers, police, or firefighter’s hats, etc. This is in addition to the real and basic accessory boxes. Practicing pretend play according to the themes: Doctor’s office, shop, family/house, restaurant, police station/fire department The children will be the ones to choose the theme, assign roles, distribute costumes/props, and decide how to play. Have the children exchange roles, at least two or three times, during playtime. Lesson 40. Summary—Skill practice/experiencing stage (Small peer group setting) (4) with video Same as Lesson 39, but make a video recording of a show that the children will prepare and perform about one of the themes. Lesson 41. Summary: Free Play with minimal mediation—Skill practice/experiencing stage (Small peer group setting) (1) Dedicate the last two lessons to free play within the group. Adult mediation should be limited to making sure that the children with ASD are being actively included in the game. Lesson 42. Summary: Free Play—Skill practice/experiencing stage (Small peer group setting) (2)—Same as Lesson 41

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The PPSI Peer Social Conversation Protocol

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 N. Bauminger-Zviely et al., Preschool Peer Social Intervention in Autism Spectrum Disorder, Social Interaction in Learning and Development, https://doi.org/10.1007/978-3-030-79080-6_7

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The “Social Conversation” protocol was developed through Dr. Ofira Rajwan Ben-Shlomo’s doctoral dissertation under the supervision of Prof. Nirit Bauminger-Zviely.

Introduction to the “Social Conversation” Curriculum As seen in the upcoming outline, the PPSI “social conversation” protocol entails 13 overall themes. The details for each theme are presented below, including the goals, contents, and techniques both for the learning/acquisition stage (delivered by the adult PPSI facilitator) and for the experiencing/practice stage (delivered in the small peer group under the facilitator’s supervision). The link to the supported visual aids for this curriculum can be found in the Appendix. Outline for “Social Conversation” Protocol (Theme) Lesson nos.

Lesson topic

Detailed acquisition/practice goals and contents

(1) 1–3

Clarifying the Concept of “Conversation”

(2) 4–6

The Rules of Conversation

(3) 7–9

Types of Conversations

(4) 10–12

An Argumentative Conversation

(5) 13–15

Conversation Topics

(6) 16–18 (7) 19–21

Conversation Topics while Playing Initiating a Conversation

1. Definition and clarification of “conversation” 2. Definition and clarification on how to talk: How to talk 3. Definition and clarification of how to listen: How to listen in conversation 1. Conversation structure explanation: In conversation talk according to taking turns 2. Clarify who the conversation partners are: Who can you talk to? 3. Clarification on where a conversation is being held: Where to talk 1. Explanation of different types of conversations and their purpose: Sharing conversations and activity promotion conversations 2. Clarification: For what and when talking to friends 1. Explain what an argumentative conversation is 2. Clarifying and practicing how to conduct argumentative conversation 1. Explain what is a topic of conversation 2. Explain and practice how to choose a topic for conversation 1. Explain and practice conversation topics while playing 1. Explain how to initiate a conversation 2. Explain and practice sharing an idea or information to start the conversation (continued)

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(continued) (Theme) Lesson nos.

Lesson topic

(8) 22–24

Developing a Conversation: Asking Questions

(9) 25–27

Developing a Conversation: Adding Content

(10) 28–30

Developing a Conversation: Switching Topics Ending a Conversation

(11) 31–33 (12) 34–36

(13) 37—39

Communication Failure in Conversation

Summary of the Conversation Intervention

Detailed acquisition/practice goals and contents

3. Explain and practice asking questions to start a conversation 1. Explain and practice the development of the conversation and its continuity 2. Explain and practice asking questions to develop the conversation 1. Explain and practice adding content to develop the conversation 2. Explain and practice sharing of opinions and emotions to develop the conversation 1. Explain and practice a topic switching for conversation development 1. Explain and practice how to end a conversation 1. Explain and identify communication failure in conversation 2. Practice clarification requests when communicating with a conversation failure 3. Practice communicating communication failure in conversation 1. Summary and review of various content in conversation intervention

Full “Social Conversation” Intervention Protocol NOTE: THROUGHOUT THIS PROGRAM, THE USE OF THE MALE/FEMALE GENDER IS FOR CONVENIENCE ONLY AND MAY REFER TO EITHER.

Theme 1. Clarifying the Concept of Conversation Lesson 1. Skill acquisition/learning stage (Adult mediation setting) Topic: Concept clarification of “conversation”: Definition and functions 1. Introducing topic: Puppet Show: (large glove puppets are recommended) – Hi! I’m Danny … – … and I’m Liam. We’re friends. – Liam, what are you doing?

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– I want to build a train… – Really? I like trains too. I have a train at home. – Once I rode the train all the way to [insert here name of a town in your area]. It’s really far and it was so much fun. – I also rode a train once. My grandfather took me. Yeah, it’s lots of fun. – My grandfather loves trains too and he takes me sometimes. – Yes. My grandpa sometimes takes me too. – Let’s build the longest train, like I once went on with my grandfather… – Okay, but I must go to the bathroom, and then I’ll help you build it… – Okay… Questions • What are the names of the children in the puppet show? (Introduce them to the children again.) • What are the children doing? (Having a conversation) • Who spoke first? (Danny) And what did Liam do? (Listen) (show the puppets) • What did they talk about? 2. Concept and definition: Conversation IN A CONVERSATION, PEOPLE TALK TO EACH OTHER AND LISTEN TO EACH OTHER. A CONVERSATION CAN INCLUDE

2

PEOPLE OR CHILDREN AND MORE.

YOU CAN’T HAVE A CONVERSATION WHEN YOU ARE BY YOURSELF.

3. Activity to practice the concept of CONVERSATION: Use two puppets to present 3 “plays”: “Let’s see some more ways that puppets can act together and decide if they are having a conversation or not.” • Play No. 1: Two children are taking turns building a tower from blocks, but without talking. • Play No. 2: Two children are having a conversation about playing with building blocks, but are not actually playing with them: – I like to build with blocks. – Yes, me too, but sometimes they break up. – Right. I once built a really high tower, but then it fell down.

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– When it falls, I don’t want to build it again. It really upsets me. – I know, but my mom builds the tower for me again… • Play No. 3: Two children are building a tower from building blocks and also talking: – – – – – – –

I can build a rocket. Yeah! I can build a giant rocket! My rocket is going to be really huge. I need all the blocks. But I also need blocks. Don’t take them all! Okay. But look what I’m doing…I’m building wings for my rocket. Maybe I’ll build along with you? Okay. Let’s build one together! ** After each play, ask if the puppets are having a conversation or not.

4. Concepts and definitions: Listening WHEN SOMEONE TALKS TO ME I HAVE TO LISTEN: TO HEAR WHAT HE SAYS TO ME AND TRY TO UNDERSTAND HIM.

HOW DO WE LISTEN?

WITH OUR EARS WITH OUR EYES: WE NEED TO LOOK AT WHO IS TALKING TO US. WITH OUR BODY: OUR BODY NEEDS TO APPEAL TO THOSE WHO SPEAK TO US.

** Present some visual cues together with the definition (eyes, ears, body) Provide more explanations: • When I speak I am happy when people listen to me. My friend will be happy if I pay attention when she speaks. • If I don’t listen, I won’t know what to answer. • When we want to start a conversation, we have to make sure that our friend is paying attention to us. • How do I know our friend is listening to us? He or she will be looking at us, turning to face us, and will answer “what?” when we say their name.

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HOW DO WE GET OUR FRIEND’S ATTENTION? HOW DO WE MAKE SURE HE IS LISTENING TO US? WE CAN:

– CALL HIS NAME AND WAIT FOR HIM TO LOOK OR TURN TO US. – TOUCH HIM ON HIS SHOULDER OR HAND AND WAIT FOR HIM TO LOOK OR TURN TO US.

5. Activity to practice the concept of LISTENING a. Distribute two circles to each child–one red and one green (like traffic lights) and explain that the colors will show us if we can begin a conversation. (Tell them they should hold up green for “go” and red for “no.”) GREEN light. Our friend is looking at us, facing us, and her expression is friendly and shows that she wants to listen. We can start a conversation. RED light. Our friend is not looking at us, her back is toward us, or the expression on her face isn’t very friendly. This is not the time to start a conversation. b. Show the children some flashcards (eight flashcards) with faces and ask them to decide if the child in the picture is ready to talk to them and they can start a conversation of children: (1) looking sideways/in another direction, (2) turning their back, (3) with hands crossed and looking unfriendly, (4) bored, (5) angry, (6), (7), and (8) children with interested expressions. Each time, the children should hold up either the green or red circle depending if it is or isn’t a good time to start a conversation. c. Have the children practice initiating a conversation with a puppet/doll. Each time, have the puppet behaving in a manner that encourages conversation (facing the children) or discourages conversation (with its back to the children, or making scowling sounds). Tell the children should call the puppet by name/touch the puppet, and the puppet may or may not react. Each time, the facilitator should ask if the puppet is paying attention to them and if this is a good time to start speaking. d. Reflective assessment by asking the following questions. Include the flashcards: “Conversation, Paying attention, Taking turns, Eyes, Ear” • Did the puppet listen to us? How do we know it was listening to us? 6. Checking understanding • Through assessment: Are the puppets talking the correct way? a. Use the puppets to present a situation in which 2 children are eating, one calls the other by name, but the other does not turn around and continues eating (“greedily” …).

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b. Use the puppets to present a situation in which some children are sitting around the table, one addresses his friend, and, the friend turns around and responds. • Using questions: When can one start a conversation? How do we know if our friend is listening to us? What we do to make for our friend to listen to us? 7. Review worksheet(s) a. Are the children in the drawing having a conversation? Picture 1: Two children back to back. One is playing with a car and the other is playing with a puzzle. Picture 2: Two children are sitting next to each other on a bench and chatting. b. Which of the children in the picture would like to talk? To whom should he/she turn to start a conversation? There are four pictures of children: 1. Looking sideways 2. Looking straight ahead and smiling. 3. Looking straight ahead with an angry look. 4. Standing with his back in the picture. 8. Guidelines for the educational team Throughout the week, draw the child’s attention to different situations where children are talking in kindergarten, who is talking, when they are talking. Draw the child’s attention to the fact that he should call a child’s name before he starts talking to them and also show him how other children do this (“Look, Sam is touching Ron’s shoulder now because he wants to tell him something.”) Lesson 2. Skill practice/experiencing stage (Small peer group setting) Topic: Practicing conversation while playing with prompts 1. Introduction: Welcome the children, asking general questions: “What did you do today in kindergarten? What did you play?” 2. Activity “Today I brought some blocks. Let’s build a castle together. While we are playing, we can talk. We can talk about what we want to build and we can talk about things we have built before. When we are talking, it is important to speak in turn and listen to our friends.” Play with the blocks and encourage conversation. Encourage descriptions about what the child is doing alongside listening to what the friend is doing. Lesson prompts: + show the flashcards for Conversation, Paying attention. • In a conversation, I listen to my friend. • I am participating in a conversation: Talking and listening too.

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3. Conversation practice during snack time (preferably fruits): Tell the children “bon appetite,” and say: Now we can eat and talk. Anyone who wants to talk should pay attention to see if his friend is listening. (If prompts are needed: I can talk about things I did or saw, or something that happened to me. You can ask you friend a question about what he did …) 4. Lesson summary: What did we play today? Did you like this game? What did we talk about while we were playing? Did we listen to each other? How do you feel when talking to friends? Lesson 3. Skill practice/experiencing stage—continued (Small peer group setting) Topic: Practicing a conversation during a creative activity 1. Introduction Welcome the children and present the activity: “Today we will play with stickers. I brought some animal stickers. Let’s stick the animals onto paper and also stick on some sand for them to stand on it. We can talk while we are working. We can talk about what we are doing. We can talk about what our friends are doing. We can talk about the animals (have we have ever seen or met one?; do we like them or not?). Anyone who wants to talk should pay attention if his friend is listening to him. (Send the children to bring some sand from the yard in cups.) 2. Activity: Crafting + Conversation Lesson prompts: + show the flashcards for Listen, Taking turns, green/red flashcards to show degree of attention to others. • I am participating in the conversation: Talking and listening too. • I need to make sure that my friend is listening to me when I start talking. 3. Lesson summary Today we pasted and painted together. What did we talk about while painting? Did we listen to each other? How did we feel when we talked and our friend paid attention? When we want to talk, we need to make sure that our friend is listening to us. Theme 2. The Rules of Conversation Lesson 4. Skill acquisition/learning stage (Adult mediation setting) Topic: Conversation rules: Taking turns, Who Can We Have a Conversation with, Where Can We Talk

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1. Review of previous lesson (s) 1–3: • What do we do in a conversation? • How do we listen? How do we know when someone is not listening to us? • How do we feel when someone doesn’t listen to us? • How do we feel when we are listened to? 2. Reflection on previous activity: Do remember how we played with our friends and talked to them? Ask the child: • • • •

What did we play with [name of friend/s]? What were you talking about while you were playing? Did they listen to what you said? How did you know they listened? Did you listen to what your friends said? How did they know that you were listening? • How do you feel when you are talking with a friend and also listening to him? 3. Introducing topic: What are the RULES OF CONVERSATION? Puppet Show: – Hello, I’m Danny. Sometimes I talk to my friend Ron. Do you remember that once I had a conversation with him about my blocks? Here’s Ron …Hi, Ron! What are you doing? – I’m going home. – Good. I am going home too. Do you want to come over to my house later? – OK. I’ll bring my Spiderman. – That’s good. I also have a Spiderman. – Here’s my dad…. (The puppets hug, and the puppets get into the car) – Dad, can Ron come over today? – Yes, dear. What will you play with? – He’ll bring his Spiderman – I see. You also have Spiderman, right? – Yes, my Spiderman is the best – Yes, he’s really beautiful. Questions: (If necessary, present each of the 3 puppets to help in answering the questions) • Who appeared in the puppet show? • Who was Danny talking to?

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• Where did they talk? • What did Danny say to Ron? What did Danny want? • What did Ron do? Was Ron listening/paying attention to Danny? What did he answer? • How do you know that Ron was paying attention to Danny? • Who did Danny talk to later? • Where did they talk? • What did Danny say to his dad? • Did his dad pay attention to Danny? How do you know? 4. Concepts and definitions

WHO CAN YOU HAVE A CONVERSATION WITH? YOU CAN TALK TO YOUR DAD/MOM/KINDERGARTEN TEACHER/FRIEND. YOU CAN TALK TO ONE PERSON OR SOME FRIENDS TOGETHER IN THE GROUP.

WHERE DO YOU HAVE A CONVERSATION? PEOPLE CAN HAVE CONVERSATIONS WHEREVER THEY ARE: IN THE KINDERGARTEN, IN THE PLAYGROUND, AT HOME, IN THE CAR DURING A DRIVE.

WHEN TO HAVE A CONVERSATION? ALL THE TIME!! WHEN YOU EAT, WHEN YOU PAINT, WHEN YOU PLAY

…

IN A CONVERSATION WE TAKE TURNS TALKING. ONE TIME I TALK AND MY FRIEND LISTENS TO ME AND THEN WE SWITCH. WHEN MY FRIEND IS TALKING I HAVE TO WAIT MY TURN AND LISTEN. WHEN HE FINISHES I CAN SPEAK AND ANSWER HIM.

Additional explanations: • How do we know it’s our turn to speak? We have to pay attention to when our friend as finished speaking. We look at our friend’s eyes and we can know when he has finished. * Show flashcards: Ear, Listen and Eyes.

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How do we know our friend has finished talking? When he stops talking, when he looks at me, when he finished answering my question. 5. Activity a. Look at the pictures: Who’s talking? Where are they? (Eight pictures of children and/or adults in different combinations, in different places, mainly around the kindergarten). b. Let’s sing a song in turn, each one will sing one line. (Use a toy microphone and sing a song that the children know well or a song appropriate for the subject being taught in the kindergarten.) c. Let’s talk in turn: Let’s talk about things we like to eat. I have a stick here with a card that shows when it is your turn to speak (“Taking turns” flashcard). When a person is holding the stick with the card, it is their turn to speak. d. Let’s talk in turn: Let’s talk about what we like to do in the kindergarten. *Continue with the stick and card to indicate whose turn it is to speak. 6. Checking understanding • Using questions: Who can you talk to? Where can I chat with friends? With the teacher? … With dad and mom? • How do I know when it is my turn to speak? (You have to listen, look at the speaker’s eyes and face.) • Through assessment: Using videos–Two children talking about a birthday cake. a. Taking turns. b. Not taking turns: One child continues to speak without giving his friend the opportunity to answer him. c. Not taking turns: One child constantly interrupts his friend. d. Not taking turns: The two children speak at the same time. 7. Review worksheet(s) Who are the children talking to and where are they? Picture 1: Two children sitting at a table, drawing and talking. Picture 2: Two children sitting at the top of a slide and chatting. 8. Guidelines for the educational team During the week, encourage the children to pay attention to conversations between other children: who is participating in the conversation and who is not (even though they are nearby), whether the children are taking turns (look, Ron and Liam are

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talking … look they are taking turns to speak. First Liam is speaking and now Ron is answering him …). Lesson 5. Skill practice/experiencing stage (Small peer group setting) Topic: Conversation rules: Taking turns, who we can talk with, where we can talk 1. Introduction Welcome the children and ask general questions: “What did you do today in kindergarten? What did you play with?”. Then ask: “Do you remember that the last time we met we played with X and also had conversations? Today we will also play and talk.” 2. Activity a. We will play a game: “Let’s play the tickle game. It is a wordless game. I will call you to come get tickled, but I will not call you out loud. Instead, I will signal to you that it is your turn with my eyes and face. Whoever looks at me will know when it was his turn.” * Play at least 3 rounds for each child participating in the group. b. “Let’s play with the ball. We will take turns to roll the ball between us. Whoever has the ball can talk and tell what he likes to play.” (You can later change the topic, for example, “Now let’s talk about what we like to eat.”) “We play the game by rolling the ball between our legs.” *Use two types of balls. c. Conversation without the ball: “Do you know any more ball games?” Encourage sharing previous experience with ball games, expressing preference for different types of ball games, and taking turns. Lesson prompts: + show the flashcards for “Conversation” “Listen” “Taking turns” • In a conversation we speak in turn. • I am participating in the conversation: Talking and listening too. 3. Lesson summary What did we play today? Did you like this game? What did we talk about while we were playing? We can play and talk at the same time. Did we listen to each other? Did we take turns in our conversation?

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Lesson 6. Skill practice/experiencing stage—continued (Small peer group setting) Topic: Conversation rules: Taking turns, who we can talk with, where we can talk 1. Introduction Welcome the children and ask some general questions: “What did you do today in kindergarten? What did you play with?”. Then ask: “Do you remember that last time when we met we played the tickle game? We also played with a ball and also talked. Today we will play and talk too.” 2. Activity a. Ball or car slide (see picture). Conversation: “How do we play this game? What do we need to do with it?” b. “Let’s make some balls out of clay for rolling in our new game.” Encourage a conversation during the activity. Encourage sharing past experiences that are related (“Do you like to play with clay? What can be made of clay? …”). Encourage active participation in the conversation and taking turns. Lesson prompts: + show the flashcards for “Conversation” “Listen” “Taking turns” • In a conversation we speak in turns. • I am participating in the conversation: Talking and listening too. 3. Lesson summary What did we play today? Did you like this game? What did we talk about while we were playing? Did we listen to each other? How do you feel when talking to your friends? Did we take turns in our conversation? Theme 3. Types of Conversations

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Lesson 7. Skill acquisition/learning stage (Adult mediation setting) Topic: Types of conversations: Conversations for sharing and activities and why do we talk to friends? (Genres) 1. Review of previous lesson: What did we play with (whom)? What did we talk about while we were playing? 2. Introducing topic: There are all kinds of conversations. Use two puppets to demonstrate a conversation. After each demonstration ask the child: • What was the conversation about? • What (for what purpose) were the children talking about? (Prompt using: To tell something to a friend …? To decide how to play? To decide which toys to use and what to do in the game?) (We recommend making a video of the conversation.). Demonstration 1 – – – – – – – – – –

Hi Karen, I want to tell you something funny … What? Yesterday I saw a video on the computer. It was about cats. So what’s funny? The cats were really funny. One cat ran and ran and finally fell into a puddle of water. I died of laughter … Yes, I once saw a cat jumping into a puddle. My friend has a really funny cat. What does it do? He’s always jumping on the piano as if he wants to play. I saw him. I wanted a cat, but my mother won’t let me. I have a cat at home.

Demonstration 2 – – – – – – –

Hi Karen. Let’s play with the Lego … OK. So I will spill everything out onto the floor. No, don’t spill it all out. It makes a mess. Okay. I’ll just take out the big blocks. Then I’ll spill out everything. So get the red blocks out first. They’re the best. So you build with the red ones. I will take out more big ones ….

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3. Concepts and definitions: Introducing topic There are all types of conversations

SOMETIMES WE HAVE A CONVERSATION WHEN WE WANT TO TELL SOMETHING TO A FRIEND AND SHARE WITH HER SOMETHING THAT HAPPENED TO US. IT’S FUN TO TALK AND TELL THINGS. WHEN A FRIEND TELLS US SOMETHING, WE CAN TELL HIM SOMETHING SIMILAR.

* Show flash card: Tell SOMETIMES WE HAVE A CONVERSATION WHEN WE WANT TO DECIDE TOGETHER HOW TO PLAY A GAME OR WHEN YOU WANT TO EXPLAIN TO A FRIEND HOW TO PLAY. SOMETIMES WHEN WE ARE PLAYING TOGETHER, WE WILL TALK ABOUT THINGS RELATED TO THE GAME.

* Show flash card: Talking about playing 4. Activity (accompany the activity with the flashcard corresponding to the type of conversation) a. Practicing sharing information: “I’ll tell you something I want to tell you. Then you will tell me something you want to share, something you want me to know. You can tell about something nice that happened to us, you can tell about something funny or sad. You can use phrases like: ‘I want to tell you something …’ ‘I want to say something to you…’ ‘I want to share with you …” b. Practicing a conversation about an activity: “Let’s play with the dollhouse, but first we must decide how we will play and what we will do.” After the conversation you can point out to the child: “Look. We talked about how we want to play the game.” c. “I will tell you something and then you will tell me something on the same topic or something similar that happened to you.” (Did you tell me something on the same topic?) Practice twice, once giving a model for sharing a pleasant experience and once a model for sharing an unpleasant experience. 5. Checking understanding a. What are the children doing: Sharing with friends/talking about how to do something together? child has to choose the type of conversation from the flashcards. b. Show the child some puppet conversations:

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i. A conversation where a child shares with a friend with what they bought him for his birthday ii. A conversation where two children talk about which game they will play first, and how they will play it (Let’s first play Spiderman,/But how do we play?/You have to put the mask on your face. Look… you do it like this/Spiderman also has a special shirt, and he can climb. Do you want me to climb up to here? …) 6. Assessment Use two puppets: Does Danny answer correctly? What should he say to Ron? – Ron: You know they bought me a new computer? – Danny: Yes? What games do you have? – Ron: My mom got angry that I broke my new game. – Danny: I also broke a game once, but my mother wasn’t angry. – Ron: Let’s put the little pieces together first. – Danny: I love vanilla ice cream. – Ron: You have to open the package here with scissors. – Danny: You can also cut it with a knife. – Ron: I want to sit in front, you sit here. – Danny: I drew a painting in gouache. 7. Review worksheet(s) On the page are 2 different drawings. Ask: “In what picture does the friend tell something to his friend (share) and in what picture are they talking about what needs to be done? Picture 1: Children sit talking, face to face Picture 2: Two children sit with blocks, one pointing to a distant block 8. Guidelines for the educational team Draw the attention of the children to different types of conversations between different people in the kindergarten. Lesson 8. Skill practice/experiencing stage (Small group setting) Topic: Why do we have conversations with friends? (Genres)

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1. Introduction 2. Activity “I have a farm for animals and some animals and I want us to play and set them up together. How do you think we should set up the farm?” Encourage a conversation that starts out about how to manage the game and then model statements relating to farm issues (such as: I once visited a farm). Set up and play with the animals and the farm. Lesson prompts: • In a conversation we talk and discuss how we will play a game. • In a conversation we can talk about things related to the game. 3. Conversation practice during snack time (preferably fruits): Serve them and say: “Now we can eat and we can also talk. Anyone who wants to talk should make sure that his friend is listening. What should we talk about? Everyone will say something he wants to tell a friend.” If the children can initiate a topic on their own, allow them to discuss it. If they have trouble, you can say: “Let’s talk about what we like to do with our parents and family on the weekend.” • Now everyone will tell something funny that happened to him. Lesson prompts: + show the flashcards for Listen, Taking turns, Tell • I am participating in the conversation: Talking and listening too. • In a conversation, I can share a friend of mine and tell him about something that happened to me. 4. Lesson summary Today we played with an animal farm. At first we talked to decide how we would play: Where should we set up the fences, where should we put the animals … Then we also talked about other things that have to do with animals and the farm. Today we also ate together. What did we talk about while we were eating? Everyone got a turn to say something and share with their friends something that happened once. Lesson 9. Skill practice/experiencing stage—continued (Small group setting) Topic: Why we have conversations with friends? (Genres) 1. Introduction: There are all kinds of conversations.

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2. Activity “Today we will also play with the animal farm. But today we will also make animals from clay.” Distribute the clay and some animal cutters. First talk about how the activity works, and then model talking about farm-related issues (e.g., “I once visited a farm”). Arrange and play with the animals and the farm. Encourage collaborative conversation. (Ideas for animals from clay: snake, cat’s head, mouse, etc.). Lesson prompts • In a conversation, we can talk and explain how we want to play a game. • In a conversation you can talk about things related to the game. Lesson prompts: + show the flashcards for Listen, Taking turns, Tell • I am participating in the conversation: Talking and listening too. 3. Lesson summary: Today we played with clay and also had conversations. Everyone told where they met animals and what animals they knew how to make from clay. Theme 4. An Argumentative Conversation Lesson 10. Skill acquisition/learning stage (Adult mediation setting) Topic: Conversation types: Argumentative conversation (continuation of genres) *Explanation: Sometimes everyone has a different opinion. We can try to convince others. 1. Review of previous lesson: What did we play last time with our friends? What did we talk about? What kind of conversation did we have—to share an experience or to decide how to play? 2. Introducing topic: There are many kinds of conversations. Puppet show: – – – – –

You know I’m the best at computer games. So what, I’m the best, too! But I know all the games in the world. Nobody knows all the games in the world. There’s no way. But I do, because my brother taught them to me.

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– My sister also taught me all the games on the computer. She has all the good games. – What does she have? – Everything! Whatever you want. Also mouse games and racing games too. – I am excellent at racing games. – Me too. My sister is better than you at the computer. – Wrong. Do you want me to show you a game I am a champion in? – Yes, I will come to your house. Ask: “What was the conversation about?” 3. Concepts and definitions: There are many kinds of conversations

SOMETIMES IN A CONVERSATION, CHILDREN DISAGREE WITH EACH OTHER. EVERYONE THINKS SOMETHING DIFFERENT; EVERYONE HAS A DIFFERENT OPINION. IN SUCH CONVERSATIONS, CHILDREN SAY DIFFERENT THINGS, SOMETIMES OPPOSITE. EVERYONE SAYS WHAT HE THINKS.

SOMETIMES THE KIDS ARGUE TO GET UPSET OR LAUGH.

SOMETIMES WHEN EVERYONE THINKS SOMETHING DIFFERENT, WE CAN TRY TO CONVINCE OUR FRIEND THAT WE ARE RIGHT. TO CONVINCE: TO EXPLAIN TO A FRIEND THAT I AM RIGHT, AND EXPLAIN WHY OR GIVE IDEAS UNTIL HE AGREES WITH ME. YOU CAN TELL THAT YOUR FRIEND AGREES WITH YOU IF HE WANTS TO DO WHAT YOU SAID, AND IF HE SAYS

“YES”

TO WHAT YOU ASKED FOR.

4. Activity (accompany the activity with the flashcard corresponding to the type of conversation) a. “I will say something, and you will try to convince me that you are right”: • What should I wear to the beach? A coat or a bathing suit? …. But why? • What should I eat now, a vegetable salad or a candy salad? … But why?

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b. “I will tell you something and you have to answer me in the opposite way and argue with me”: • I’m the best at computer games. • I have the biggest toy in the world at home. • My cat is the smartest of all cats.

* Continue the activity, say a sentence and wait for the child’s response and then answer the child in an argumentative manner to continue the “argument” and ask him to respond. c. Show the child 4 pictures and ask him to say what he thinks of each picture and then contradict him and encourage him to continue the conversation. That is: The child starts, the adult answers, the child responds again. If the child does not respond to the adult’s words, you should say to him: “Answer me, what can you tell me when I say: …?” The opening sentences for the four pictures: • I know how to walk on my hands, like this girl …. • Once I ate the biggest ice cream in the world … • Once my ball got stuck on the tree, so I jumped up high and got it down … d. Say some silly statements to the child and ask him to convince us why it is not true and why he is correct. (The child’s explanation does not have to bring scientific support. It should be an explanation appropriate for someone his age) Also, following the child’s explanation, try to “argue” with him a little. The statements: – 2 + 2 = 3 (only if the child really knows a bit of arithmetic …) – Cats can fly. – Mice can hunt and eat cats. e. Persuasion: “Now we will play a game. I brought two games, what would you like to play?” Show the child a domino game and a sliding ball game. After he chooses one of them, you say: “I really want the other game. What should we do? Maybe you can convince me to play the game you want instead…”

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5. Checking understanding

a. Assessment: Using two puppets: “Does Danny answer correctly? What should he say to Ron?” (Let the child hold the “Danny” puppet when he needs to correct what Danny says): – Ron: My computer is the best in the world. – Danny: My computer is the fastest computer in the world. – Ron: You can’t play with blocks because you’re not a girl. Only girls play with blocks. – Danny: You are fat yourself. – Ron: You can’t put together the Lego. – Danny: I can! I’m a Lego champion. – Ron: If you don’t have a birthday then you can’t eat sweets. – Danny: You can also cut with a knife. – Ron: I want to sit at the front. You sit here. – Danny: You don’t decide here. 6. Summary worksheet(s) Show some pictures while you are making statements such as the following and see how the child responds: Picture 1: A child is drawing holding a banana. Statement: “You can draw with a banana.” Picture 2: A boy is walking on his hands. Statement: “I can go for a walk on my hands.” 7. Guidelines for the educational team Create situations where children need to convince others of what they want to achieve or to convince others that they are correct (e.g., following an absurd statement made by an adult). Lesson 11. Skill practice/experiencing stage (Small group setting) Topic: Conversation types: An argumentative conversation

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1. Introduction Welcome the children and present the activity: “Today we are going to make dolls from balloons and sand.” Preparation: Send the children to bring sand in cups. Fill some balloons with the sand (about the size of a tennis ball) and tie the end. When the balloon is full and firm, use markers or stickers to create a face. Glue on scraps of wool on top for hair. 2. Activity: Crafting + conversation During the course of the activity, initiate a conversation such a way as to try to spark an argument. (For example, “My doll is the smartest doll. It knows how to solve problems in arithmetic.” “I once made a doll like this out of clay.”) Lesson prompts: + show the flashcards for Listen, Taking turns, Arguing, Thinking something else. • I’m participating in the conversation: Talking and listening too. • Sometimes in a conversation, everyone thinks something different. • Sometimes you have to convince your friend that you are right or that she will do what you ask. 3. Practicing conversation during snack time (preferably fruits): During snack time, try to stimulate conversation and add argumentative elements (e.g.: “Once I ate 6 bags of chips.” Or, “Once I saw an elephant eating chips.”). 4. Lesson summary Today we made dolls together. What did we talk about during the activity? Sometimes everyone thinks something different and we have different opinions. Sometimes we argue during a conversation. Sometimes we say something opposite to our friend. Sometimes we need to persuade our friend so that he will agree with us. I can explain to him and I can tell him why he should do something. Lesson 12. Skill practice/experiencing stage—continued (Small group setting) Topic: Conversation types: An argumentative conversation 1. Introduction Review the terms Listen, Taking turns, Argue, Thinking something else.

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2. Activity a. “Today I brought puppets that say all kinds of things. The puppet will tell you something and you will have to answer her and convince her that she is wrong.” Puppet’s sentences: – – – – – –

Puppets can eat real food. I’m taller and bigger than you, children. If I want, I can swim in a pool all by myself. I only eat potato chips all day. I never eat anything else. My brother can climb walls. I can drive elephants crazy.

b. “Now I’ll show you a puppet show and then let you participate”: – Danny, you know I have a house full of toys … – I also have more toys even … – Wrong, I have the most in the world… – I also have the most, even more toys – My toys are really new. At this point allow one of the children to take one of the puppets and continue the puppet show in front of the adult. Give each child a little practice in some exchanges. If the theme becomes exhausted, you can tell the children to start a new show: – The most delicious cake ever I ate was made out of wood. – Ugh, there’s no such thing – Yes there is … c. “Now we will play a tickling game with the puppet: The puppet will look at someone and he has to pay attention and then come close to me ….” The game is played standing up. As someone approaches, the puppet starts to argue: “I didn’t look at you at all!” Repeat this several times at random. 3. Lesson summary Today we played with the puppets. They told us things about themselves. Some of the things were wrong and impossible and we tried to convince them that they were wrong.

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Theme 5. Conversation Topics Lesson 13. Skill acquisition/learning stage (Adult mediation setting) Topic: Conversation topics—What do we talk about? Topic selection 1. Review of previous lesson What did we play last time with our friends? What did we talk about while we were playing? What kind of conversation was it? Did everyone agree or did they also argue? 2. Introducing topic Present some small dolls sitting at a table with plates: “Here’s Danny and Tom. They are eating their morning snack.” – – – – – – – – –

Danny, what are you eating? A chocolate sandwich. I am eating Cheerios. But you’re not supposed to bring Cheerios to kindergarten. So what?! It’s the most delicious. I love Cheerios the best. Yes, it tastes great. Once my mom bought Cheerios for me. My mom gives me Cheerios every day. … (and so forth) Okay. I’ve finished eating. I’m going to play now.

Question: What are they talking about? 3. Concepts and definitions WHAT CAN WE TALK ABOUT? WITH FRIENDS WE CAN TALK ABOUT ANYTHING. WE CAN TALK ABOUT WHAT WE ARE DOING AT THE MOMENT. WE CAN TALK ABOUT THINGS THAT HAVE TO DO WITH WHAT WE ARE DOING.

– Give an example: When we eat, we can talk about what we are eating or what we like to eat. – We can talk about something similar that we did once that we remember (for example: When we draw, we can talk about something we drew before). – We can talk about things that interest us and our friends (for example: When playing, we can talk about games that interest us and our friends). – We can talk about things we love to do or about things that make us laugh. – When something happens, we can talk about how we feel.

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4. Activity a. “Let’s listen to the puppets and see what they talk about while they are eating. Show three situations with the puppets: – Puppets are talking about what everyone else is eating and express their opinion on the food. – Puppets tell what food their mother makes for them at home and what they like best to eat. – Puppets talk about something funny that happened to them earlier in the building area. b. “Let’s color this picture.” (Bring 2 coloring pages that are related to the child’s interests). Incorporate a conversation during the activity. Then: “What did we talk about when we were coloring the picture?” c. Let’s make a list of topics that we can talk to friends about while we are eating/crafting/playing. (Make a list with the child using drawings and written words.) 5. Checking understanding a. Assessment 1: “What are the puppets talking about?” Use puppets to present a situation where – Puppets are drawing and talking about what they are drawing and listening to each other – Puppets are sitting at the crafts table and one asks the other for a marker. The friend passes it to him. – Puppets talk about what they did on Saturday. b. Assessment 2: “Is it appropriate to talk about …?” Show the child pictures of children in various activities and say what one of the children in the picture might be saying to start a conversation. The child has to decide if this is an appropriate topic for the conversation.

Picture

Opening sentence

Children playing ball Children sitting and eating Children sliding down a slide Children drawing paintings

“Look what a beautiful painting I painted.” “Yesterday they bought me a new computer.” “I once slid down a slide like this.” “You make soup only from vegetables you buy in the supermarket.”

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6. Review worksheet(s) A picture showing children around a table talking and smiling. “What might the children in the picture be taking about? Are they enjoying the conversation?”. 7. Guidelines for the educational team Draw the child’s attention to various conversation topics that arise between the children and/or the adults in the kindergarten (“What are they talking about? Are they talking about something that matches what they are doing?”) Lesson 14. Skill practice/experiencing stage (Small group setting) Topic: Conversation topics 1. Introduction Let’s choose a topic for a conversation with this spinner (6 topics: food, kindergarten games, after-school activities, TV shows, toys I have at home, something else). We will use this spinner to help choose a topic but then we can also talk about other things that interest us and our friend. 2. Activity Domino game. Try to develop a conversation at first about the domino game and then suggest more topics. 3. Conversation practice during snack time (preferably fruits) Lesson prompts: + Show the flashcard for Listen. • I am participating in the conversation: Talking and listening too. • I need to make sure that my friend is listening to me when I start talking. • We talk about what interests everyone, what we do or something related to the activity. 4. Lesson summary Today we played with the spinner and then we ate together. What did we talk about while we were eating? Did we listen to each other? If we want to talk, we need to make sure that our friend is listening to us. We talk about something that interests me and my friends, talk about what we are doing or things related to what we are doing. Lesson 15. Skill practice/experiencing stage—continued (Small group setting) Topic: Conversation topics

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1. Introduction Welcome the children and present the activities: “Today we will play with clay and you can talk too. Anyone who wants to talk should make sure that his friend is listening. What should we talk about? We will use the spinner to decide what we will talk about first. You can also talk about what we are doing now.” 2. Activity: Crafting + conversation “Let’s make different fruits and vegetables and also a basket (from clay).” Lesson prompts: + show the flashcards for Taking turns. • I am participating in the conversation: Talking and listening too. • I need to make sure that the friend is listening to me when I start talking. • We talk about what interests everyone, what we are doing or something related to the activity. 3. Lesson summary “Today we played together with clay. What did we talk about while we were playing with the clay? Did we listen to each other? If we want to talk, we need to make sure that our friend is listening to us. We talk about something that interests me and my friends, talk about what we are doing or things related to what we are doing.” Theme 6. Conversation Topics while Playing Lesson 16. Skill acquisition/learning stage (Adult mediation setting) Topic: Conversation topics: What do we talk about while playing? 1. Review of previous lesson Reflective judgment: Show the child video clips of the most recent conversation practices. “What do you see in the video? Who started talking? What were you talking about?” 2. Introducing topic: Hand puppets playing together with a train. “Here are Danny and Ron. They want to play together with the train now. First, they will put together the track.” – Danny, you have to connect the red to here. – OK, but you can connect it to here, too. – I connect the white first. Then we will also connect the green.

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… (and so forth) I want to drive the locomotive. You take this car. I don’t want to. Today I want the locomotive. Last time you took the locomotive. Okay, so you’ll take the locomotive, but I’ll start. Then it will be your turn. I want to be first. No, you take the locomotive. I’ll be first. …(continue till the end of the conversation) Okay, we agreed about everything. Now let’s play.

Questions • What are the children doing? • Who started talking first? (You can help the children and repeat: “Danny, you have to connect the red to here.”) • What are they talking about? 3. Concepts and definitions

WHAT CAN YOU TALK ABOUT WHILE PLAYING? TALK ABOUT THE GAME: HOW TO PLAY, WHAT TO DO IN THE GAME

(GIVE

INSTRUCTIONS FOR THE GAME), DETERMINE WHOSE TURN IT IS IN THE GAME, HAND OUT ROLES IN THE GAME: WHAT EVERYONE SHOULD DO. THEN YOU CAN TALK ABOUT OTHER THINGS THAT ARE SIMILAR TO WHAT’S HAPPENING IN THE GAME.

4. Activity a. “We will play with the train, but first we must put together the track.”.... Wait for the child’s instructions ... If he doesn’t give instructions, you can say: “I’m not sure how to connect it ....” • Play and at the end, ask: “What did we talk about while we were playing?” For older children, you can also ask, “What would have happened if we wouldn’t have talked?” b. “Let’s play another game: Let’s put together a puzzle” (choose a level not too difficult for the child). Wait for the child to initiate conversations. If he does not, say: “We can talk too ...” “I don’t know where to put this part ...” “I don’t know what the picture will be in the complete puzzle ...” • Play and at the end, ask: “What did we talk about while we were playing?”For older children, you can also ask, “What would have happened if we wouldn’t have talked?”

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5. Checking understanding a. Assessment 1: “Do the puppets talk the way they are supposed to?” – Present puppets in a situation where 2 children are putting together a puzzle, are talking about what they are making and are listening to each other’s advice. – Present puppets in a situation where children are sitting together and putting together a puzzle, but no conversation develops. There is speaking only when requesting a piece. b. Assessment 2: “Is it appropriate to talk about …?” Show the child pictures of children in various activities and say what one of the children in the picture might be saying to start a conversation. The child has to decide if this is an appropriate topic for the conversation.

Picture Children Children Children Children

Opening sentence playing playing playing playing

with a ball hide and seek on a teeter-totter with clay

“You have a red shirt” “Yesterday they bought me a new computer.” “I’m higher now!” “3 + 3is6”

Questions • What do you talk about when playing? • Do you talk only about what needs to be done in the game? (Not necessarily, you can also talk about things that the game reminds you of). 6. Review worksheet(s) Show a picture with children playing together in a tree house in the yard. “What can the children in the picture talk about? Do they enjoy talking?” 7. Guidelines for the educational team Draw the attention of the children to conversations that take place during playtime (in the different activity corners, in the playground). During the day, before the children are guided by the staff to various activity corners, remind them what topics are appropriate for a conversation and encourage them to talk with their friends while playing.

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Lesson 17. Skill practice/experiencing stage (Small group setting) Topic: Conversation topics (talking during play) 1. Review of previous lesson “We talked about being able to talk to friends in any activity we do. Let’s play a game and we can also talk ...” 2. Introduction “Let’s play ball. How do you want to play? We can play catch. We can roll the ball, we can throw it into a basket. Let’s decide ....” (At the children’s suggestions, encourage them to talk to each other.) Ask: “How will we play? What do we need to do?” 3. Activity a. Play with the ball according to the children’s suggestions. Encourage dialogue between the children about how to play the game. b. Bring a basket (portable, like a large plastic bin). Wait for the children themselves to come up with the idea to change the game. If not self-initiated: “Look what I brought ….” “Who has an idea….?” c. “Now I will bring another ball, but we will play without talking….” d. “And now we will play with another ball, and we will talk to each other.” Bring another type of single ball and encourage children to make suggestions. e. Model how to change the conversation to a similar topic, but not just about the current game (for example: “I’ve seen people playing soccer on TV …”) Questions • • • • •

What did we play? Did we talk while we were playing? What was our conversation about? Did we feel happy when our friend listened to us? When did we understand each other more: In a game with conversation or one without? Point out: Speaking to each other can help us cooperate better when we are playing. • What else did we talk about? (Also about something the game reminded us of: About soccer on TV) 4. Review work sheet(s) Show four pictures: “What can the children in the picture talk about? Who can guess the fastest?

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– – – –

Children playing ball and talking children playing with blocks and talking children climbing up a slide and talking children playing with a puzzle and talking.

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Lesson 18. Skill practice/experiencing stage—continued (Small group setting) Topic: Conversation topics (talking during play) 1. Review of previous lesson: What did we play last time? 2. Introducing topic: A conversation about an activity “Let’s play a game with magnets” (different magnet shapes on a large board). “How do you want to play? We can all put a picture together or we can take turns. Let’s decide ...” (at the children’s suggestions, encourage them to talk to each other) and ask: “How will we play? What do we need to do?” 3. Activity a. Playing with magnets. Encourage conversation related to the subject of the activity and also to the children’s preferences. b. Talk about the activity and the conversation during the activity. Questions • • • •

What did we play? Did we talk during the activity? What was the conversation about? Did we feel happy when our friend listened to us?

4. Review worksheet(s) Show four pictures: “Guess what the children in the picture might be talking about?” – children playing a table game and talking – children playing with blocks and talking – children standing near a teeter totter and talking. 5. Lesson summary Today we played with magnets and talked to our friends. What did we talk about? It is nice to talk about what we are doing and about games we play with friends.

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Theme 7. Initiating a Conversation Lesson 19. Skill acquisition/learning stage (Adult mediation setting) Topic: Initiating a conversation 1. Review of previous lesson “We have talked about different types of conversations. There are conversations where we want to tell something to a friend, conversations to decide together and plan what to play, conversations where we want to convince our friend of something and explain to him why we are right, and conversations where we are arguing with our friends which are sometimes funny and sometimes annoying.” 2. Introducing topic: Initiating a conversation “How do we start a conversation? You can ask a question, or you can say something about what your friend is doing or you can tell him something.” Present some small dolls sitting at a table with a paper in front of them: “Here are Danny and Tom. They are painting a picture in the kindergarten. Let’s see how Tom starts talking to Danny ....” – Danny, what are you drawing? – My house. – I can paint a house too. a. “What else can Tom say to Danny to start a conversation? Let’s hear ...” – Hi Danny, look what I drew … OR MAYBE – Wow, you paint really beautifully…. b. Can Tom start the conversation like this? … – You’re not right … – Why are you crying? Questions • Where are the children? What are they doing? • Who spoke first? (Tom) How did he start the conversation? What did he say at first? • How else did he start the conversation?

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3. Concept and definition HOW DO YOU START TALKING? YOU CAN ASK A QUESTION.

* Show flash card: Asking a question Explanation: You can ask things about: – What your friend is doing (“What are you doing?”), – What your friend likes (if my friend is drawing something then I can ask, “Do you like to draw?”) – About something connected to the activity they are doing (If my friend is drawing I can ask, “What do you know how to draw?”). 4. Activity Show the child five pictures of children in different activities/situations in the kindergarten and ask: “What can you ask the child in the picture to start a conversation?” 5. Concepts and definitions HOW ELSE CAN YOU START A CONVERSATION? WE CAN TELL SOMETHING TO A FRIEND, SHARE WITH HIM SOMETHING WE WANT HIM TO KNOW: WHAT WE THINK (OUR OPINION) OR WHAT WE ARE FEELING.

* Use the flashcard Tell a. What else can you say to a friend? Give some examples: – about what we are doing (“Look, I am painting a sun.”), – about what we did once (“Once I painted a blue sun.”), – about something related to the activity we are doing (while you are drawing, you can say, “At home I have crayons that are better than these.”) – about something that happened to us once (like: “Once I was drawing with a crayon and it broke”), b. How do we share with a friend something we want him to know? Give some examples: – about something we want or like (“I like to draw balloons the most.”) – about what the friend is doing (“Your drawing is really pretty” or “I can also draw what you are drawing.”)

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6. Activity a. What can you tell to…: How can we start a conversation with … (what will we tell him) – – – –

A A A A

friend friend friend friend

who who who who

is is is is

playing with blocks eating an apple painting crying.

b. Let’s color in this picture (bring 2 coloring pages about the child’s interests). Let the child initiate the conversation. If he is not proactive, give him a hint: “How can I start a conversation?” or “Maybe you want to talk to me about something about the drawing…,” and then: Questions • • • •

What were we talking about when we colored the page? Who began talking? What did you say at first? Was it a question or did you tell something?

7. Checking understanding a. Assessment 1: Use puppets to present situations by asking: Can a conversation start like this: Conversation 1: – Danny, did you see what happened to Ronnie? – What happened to her? – She fell in the yard…. (The puppet that is listening expresses interest). Conversation 2: – – – –

I threw it What? I threw it What, I don’t understand. (The puppet shows the frustration of the listener who doesn’t understand).

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Conversation 3: – I want to tell you something. – What? – They bought me a new computer (The puppet that is listening expresses interest). b. Assessment 2: Can Danny start a conversation like this? ... – What is your name? (No!!! Because they are friends and know each other.) – What’s your mother’s name? (No!! They know and it doesn’t fit with what Liam is doing.) – When will they fix the faucet here? (Not related to the situation) 8. Review worksheet(s) A picture of a boy building a block tower. “How can you a conversation with the friend in the picture? What can you tell him?” 9. Guidelines for the educational team Encourage the children to initiate conversations in different everyday situations. Draw the children’s attention to the beginnings of the conversation (“Listen how I start a conversation with …”, “Did you hear how Liam started talking to Danny? What did he say to him at first?”) Lesson 20. Skill practice/experiencing stage (Small group setting) Topic: Initiating a conversation (asking questions and sharing) 1. Review of previous lesson 2. Introduction: Welcome the children and present the activity. “Today we will draw pictures. Anyone can decide on what they want to draw. When you will be drawing, you can talk too. Anyone who wants to talk should make sure that his friend is paying attention. You can start a conversation with a question or you can tell something to your friend, or you can share with him something you want him to know.” (If necessary, direct the topic selection: “You can talk about what you are doing, what your friend is doing, what we like to draw, what we drew once, what we know how to draw, what we feel.”).

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3. Activity Supplies: paper, crayons, markers, glitter, stickers. Later in the conversation, model how to start a new conversation that is not directly related to the drawing activity. For example, you might say, “Listen to something funny … I remembered yesterday I saw a woman in the street….” Lesson prompts: + show the flashcards for Asking a question, Tell • I am participating in the conversation: Talking and listening too. • You can start a conversation with a question or you can tell something to your friend, to share. 4. Conversation practice during snack time (preferably fruits) 5. Lesson summary Today we drew together. What did we talk about while drawing? Did we listen to each other? If you want to talk you have to make sure that your friend is listening. Who started the conversation? How did the conversation start? Lesson 21. Skill practice/experiencing stage—continued (Small group setting) Topic: Initiating a conversation (asking questions and sharing) 1. Review of previous lesson Review content of previous lesson contents (Ask questions to expand the conversation). 2. Activity a. Introduce the activity: “Let’s do a puzzle together (choose a puzzle that isn’t difficult for the children). You can talk too. Anyone who wants to talk should make sure that his friend is listening. You can start a conversation with a question or you can tell something to your friend.” (If necessary, direct the topic selection: “You can talk about something we did before in the kindergarten, you can talk about the puzzle we are doing or about other puzzles that you like.”) Lesson prompts: + show the flashcards for Asking a question, Tell • I am participating in the conversation: Talking and listening too. • You can start a conversation with a question, or you can tell something to your friend. b. Another activity: Playing with small blocks. “Let’s build a city with houses and we’ll also make a road …” (a long piece of Bristol board)

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3. Lesson summary Today we played together with a puzzle and then we played with blocks. What did we talk about while we were playing? Did we listen to each other? If you want to talk you have to make sure that your friend is listening. Who started the conversation? How did the conversation start?’ Theme 8. Developing a Conversation: Asking Questions Lesson 22. Skill acquisition/learning stage (Adult mediation setting) Topic: Developing a conversation: Asking questions 1. Review of previous lesson 2. Introducing topic: Explanation: How does a conversation continue? In a conversation, we can ask appropriate questions. 3. Presenting video Conversation The children are drawing. One child starts talking about a trip he took on Saturday. The other child asks questions. Questions after watching the video: • • • • •

What are the children doing? What was Ron talking about? Did his friend Tom listen to him? What did Tom ask him? Did he ask appropriate questions?

Judging appropriateness: In this conversation, is it appropriate to ask: (give appropriate and inappropriate examples) “What is your neighbor’s name?” “On what floor were you at the hotel?” “What did you eat on the trip?” 4. Concepts and definitions IN A CONVERSATION, TALK ABOUT ONE TOPIC AT A TIME. IF A FRIEND STARTS A CONVERSATION, I CAN ASK HIM QUESTIONS THAT ARE APPROPRIATE FOR THE TOPIC.

* Show flashcard: Question

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YOU CAN ASK ABOUT PEOPLE—WHO? YOU CAN ASK ABOUT PLACES YOU CAN ASK ABOUT WHAT THEY ARE DOING AND YOU CAN ASK MORE QUESTIONS LIKE WHAT SOMEONE LIKES OR CHOOSES.

* Show flashcards: People—Who? Where? What? 5. Activity a. The facilitator opens with a sentence and asks the child to ask appropriate questions. Assess with the child whether the question he is asking is appropriate for what was said. (This should be in terms of content related to the topic, appropriate to information that has already been given, not asking about what is already known, appropriate to the conversation situation— conversation with an adult). – – – –

I bought a new game. On Saturday I travelled to a beautiful place. I saw a really funny cat outside. I don’t like Spiderman.

b. What can you ask the child? Show pictures of children in different activities and give an opening sentence that one of the characters might say. Show the question flashcards (Who? Where? What?) and for older children also the flashcards (Which? Why?).

Picture

Opening sentence

A A A A

“I am doing a huge puzzle.” “This is the most delicious cake I’ve ever eaten.” “I have no one to play with.” “I like to draw.”

boy playing with a puzzle boy eating some cake boy standing by a teeter-totter child sitting at a table and drawing

6. Checking understanding Through assessment: Are the puppets talking appropriately? 1. Use puppets to illustrate a situation in which 2 children are drawing. One child starts talking and his friend asks inappropriate questions (for example: What are you building? How old is your mother? What do you like to eat? Are you fat or skinny?). 2. A friend asks appropriate questions (what are you drawing? What else do you know how to draw? Who taught you how to draw a cat?).

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Judging appropriateness—exercise: Is it appropriate to ask the question? …. Show the child the pictures from the previous section and ask questions: Picture

Opening sentence

A boy playing with a puzzle

“What are you eating?” “What puzzle is this?” “Is this a delicious cake?” “How much does it cost?” “Who told you a story about teeter-totters?” “Want to play on this together?” “Do you like to draw?” “What do you draw?” “What happened to you?”

A boy eating some cake A boy standing by a teeter-totter A child sitting at a table and drawing

7. Review worksheet(s) A picture of 2 children playing together on a computer. “What can Emma ask Thomas?” 8. Guidelines for the educational team Draw the children’s attention to questions asked by other children and to questions that the adults ask the children. Model questions (“Listen to the question I am asking Danny now …”) Lesson 23. Skill practice/experiencing stage (Small group setting) Topic: Developing a conversation: Asking Questions 1. Introduction: Review the terms “listen,” “taking turns,” “question.” 2. Activity Today, we will paste stickers and you can talk too. (Hand out copies of a picture or prepare pages with the child’s name. Hand out small colored circle stickers.) Anyone who wants to talk should make sure that his friend is listening. Encourage beginning a conversation. If guidance is needed, you can say: “What can you talk about? You can talk about what we are doing…. or something related …”. 3. Crafting + conversation Lesson prompts: + show the flashcards for Listen, Taking turns, Asking a question. • I am participating in the conversation: Talking and listening too. • I need to make sure that my friend is listening to me when I start talking.

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• We talk about what interests everyone, what we are doing or something related to the activity. • During a conversation we should pay attention to what everyone is talking about. • In a conversation I can ask my friend questions that are appropriate for the topic. 4. Lesson summary Today we created with stickers. What did we talk about while we were working? Did we pay attention to each other? How did we end the conversation? Emphasize: If we want to talk we have to make sure that our friend is listening to us. We ask our friend questions that are appropriate for what he is saying. Lesson 24. Skill practice/experiencing stage—continued (Small group setting) Topic: Developing a conversation: Asking Questions 1. Introduction 2. Activity Welcome the children and present the activities: Let’s play with Lego (medium size). Say: “What shall we build? How will we play? Maybe…. And you can talk too. Anyone who wants to talk should make sure that his friend is paying attention.” Encourage beginning a conversation. Encourage a conversation about building with Lego and past experiences with similar games. It is important to remind them that we need to talk first to plan how we will be playing with the Lego. Playing + Conversation: Lesson prompts: + show the flashcards for Listen, Taking turns, Asking a question. • I am participating in the conversation: Talking and listening too. • I need to make sure that my friend is listening to me when I start talking. • We talk about what interests everyone, what we are doing or something related to the activity. • During a conversation we should pay attention to what everyone is talking about. • In a conversation I can ask my friend questions that are appropriate for the topic. 3. Conversation practice during snack time (preferably fruits) 4. Lesson summary Today we played with Lego together. What did we talk about while we were playing? If we want to talk, we have to make sure that our friend is listening to us. We ask our friend questions that are appropriate for what he is saying.

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Theme 9. Developing a Conversation: Adding Content Lesson 25. Skill acquisition/learning stage (Adult mediation setting) Topic: Developing a conversation—Adding content 1. Review of previous lesson “What do you need to do when you want to start a conversation with friends? How do we know if someone is paying attention to us? What do you say to start a conversation?” (Ask a question, tell something or say something about what the friend is doing.) 2. Introducing topic In a conversation, we speak about something, and then we can add new information about the topic, tell stories and share with friends things that happened to us. One has to make sure if the topic is of interest to the friend. Conversation showing a video/puppet: – Danny, do you know? On Saturday I was at the Luna Park. – Really? I was there once. – Yes, I went on a lot of rides. I wasn’t scared at all. My sister is always afraid to go on them. She is such a fraidy-cat. I’m not scared at all. – I’m not afraid either. – At the amusement park I went on the planes all by myself, without my dad. I also went on the train, but it’s not worth it, the train goes really slowly … – I also once went on a train. I was on a real train. I went with my mom to [add city name here]. The real train goes really fast, but it’s not scary, it’s fun. – … and so on. – (Finish) Do you want to come with me to the amusement park next time? – Yes! We’ll go! Questions • • • • •

What are the children doing? What was the first puppet talking about? What did he say? Did his friend listen to him? What did the friend say back? What is the topic of the conversation?

3. Judging appropriateness: Would it be appropriate for Danny to add to this conversation: “I once went to a dentist” or “I once found money in an amusement park” or “They fixed the taps at our house”?

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4. Concepts and definitions A CONVERSATION BEGINS WITH ONE TOPIC. IF A FRIEND STARTS A CONVERSATION AND TELLS SOMETHING, I CAN TELL SOMETHING SIMILAR THAT HAPPENED TO ME, I CAN TELL WHAT I LIKE OR WHAT I FEEL ABOUT THE TOPIC. I NEED TO RESPOND WITH THE SAME TOPIC THAT MY FRIEND IS TALKING ABOUT.

I NEED TO MAKE SURE THAT THE TOPIC IS OF INTEREST TO MY FRIEND AND THAT HE WANTS TO HEAR WHAT I AM SAYING.

HOW DO YOU KNOW IF THE FRIEND WANTS TO HEAR? LOOKING AT HIS FACE, WHETHER HE IS SMILING OR LOOKING AT ME, A SIGN THAT HE WANTS TO HEAR ME.

5. Activity a. Opens with a sentence and asks the child to answer in turn with a similar sentence, and to continue the conversation appropriately. • This morning I drank chocolate milk. • I like to play with Lego. • I saw a really funny cat outside. b. “What can you answer to the child in the picture? How can we continue the conversation?” Show pictures of two children in different activities and give an appropriate opening sentence that one of the children in the picture might say. (I have a fast, pink car/I love vanilla ice cream/I once rode a horse like the horse in the puzzle.) You can add speech bubbles to the pictures.

6. Checking understanding Through assessment: Are the puppets talking appropriately? Use puppets to present situations in which two children are drawing. 1. One begins to speak and his friend responds with sentences that are inappropriate (for example: One child says he loves to paint with gouache and the other says his house is the biggest on the street. Or the first speaker points out that “My clown has a hat with a pompom” and the second speaker repeats exactly the same sentence). 2. The friend responds with relevant sentences (for example: One child tells that his mother taught him how to draw a face, and the second replies that he also knows how to draw faces of clowns, of people, of animals).

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7. Review worksheet(s) A picture with 2 children. The girl is holding a gift. “What can Sheila say to Liam? What can Liam answer?” Let’s add speech bubbles and I’ll write…. In this lesson it should be emphasized that it is important to pay attention to whether we are talking about the same topic as the friend and if what we answer related to what we were told. Pay attention to social appropriateness for the situation and general context. Lesson 26. Skill practice/experiencing stage (Small group setting) Topic: Developing a conversation: Adding content 1. Introduction: Review the topics of the previous lesson. 2. Activity “Today we will make chocolate balls. Who knows how to make them? Anyone who wants to talk should make sure that their friend is paying attention.” Encourage conversation. If you need to direct the conversation: “Have you ever made chocolate balls? Do you like to eat them? Who likes to eat chocolate balls? What other things could we make from the same ingredients?” Natural prompts should be modeled (e.g., “I once made a cake from these kinds of biscuits ….” “I once tried to make chocolate balls but they didn’t taste good, they fell apart …”) and not in the form of questions directed to children. Crafts + Talk: Lesson prompts: show the flashcards for Listen, Taking turns, Telling. • I am participating in the conversation: Talking and listening too. • I need to make sure that my friend is listening to me when I start talking. • We talk about what interests everyone, what we are doing or something related to the activity. • During a conversation, we include our friend and tell them things that happened to us once and are related to the topic. We need to make sure that what I am speaking about is of interest to our friend. 3. Lesson summary Today we made chocolate balls together. What did we talk about while we were making them? Did we listen to each other? We talk about something that interests us and our friends, talk about what we do or things that are related, talk about things that happened to us once and are related to the topic of conversation. In a conversation we add new information that we haven’t said yet. How did our conversation end?

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Lesson 27. Skill practice/experiencing stage—continued (Small group setting) Topic: Developing a conversation: Adding content 1. Introduction: Review of previous lesson. 2. Activity a. Game: Picture Box. “Let’s choose a topic for conversation. We will pick a theme card from this box of picture cards.” (In the box are ten cards, each representing a different topic: Food, games, garden, kindergarten activity areas, TV shows, friends, bicycle + scooter, family, various types of balls, blank card). Encourage conversation. Lesson prompts: + show the flashcards for Listen, Taking turns, Telling • I am participating in the conversation: Talking and listening too. • We talk about what interests everyone, what we are doing or something related to the activity. • During a conversation, we include our friend and tell them things • In a conversation we add information and say new things. b. Play with a pipe construction set while having a conversation. 3. Lesson summary Today we talked about things that appeared on the cards. Then we talked about something that interests us and our friend. We talked about what we were doing or things that were related. We told our friends things that happened to us. We spoke about things that are appropriate to the topic of conversation. Theme 10: Developing a Conversation: Switching Topics Lesson 28. Skill acquisition/learning stage (Adult mediation setting) Topic: Developing a conversation: Switching topics 1. Review of previous lesson Do you remember what we did? What did we talk about with our friends? Did we talk about only one topic? What did you share with your friend? What questions did you ask your friend?

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2. Introducing topic “How does a conversation continue? A conversation can start about one topic and then move on to other topics.” Puppet show. Puppets are eating and talking: “Here are Danny and Ron. They are eating now.” – My mom always gives me chocolate. Morning, noon and evening, she puts chocolate. She once gave me 2 sandwiches with chocolate. Do you want chocolate? – My favorite chocolate bar is (use a popular name of a chocolate bar). My mom always buys them for me. – Yes, they buy me a chocolate bar and also plain milk chocolate. Once I got chocolate coins. – Oh, I once got chocolate coins too. – I also once got these candies that pop in my mouth. – Wait, I have to tell you something else: It kind of spoils your teeth. – True, the doctor told me that … I was at the dentist. – I don’t like going to a dentist, it’s scary. – It’s not scary to me, it really tickles me. – Yeah, I’m not scared either, it’s just annoying. – Well, I’m going to play now … – Yes me too, let’s play together … Questions • What are Danny and Ron doing? • What are they talking about in the beginning? • What were they talking about afterwards? 3. Concepts and definitions AT THE BEGINNING OF THE CONVERSATION ONE TOPIC IS DISCUSSED. IF A FRIEND STARTS A CONVERSATION, I NEED TO LISTEN AND FIND OUT WHAT THE TOPIC IS, I HAVE TO ANSWER ON THE SAME TOPIC. THEN THE CONVERSATION CAN CONTINUE ON A TOPIC RELATED TO THE FIRST TOPIC. THIS ALLOWS YOU TO MAKE A LONGER CONVERSATION OR TALK TO THE FRIEND FOR A LONGER TIME.

YOU CAN CHANGE THE SUBJECT A BIT, TALK ABOUT SOMETHING RELATED OR SOMETHING THAT THE FIRST TOPIC REMINDS US OF. YOU MUST NOTIFY THE FRIEND. YOU CAN SAY: “I WANT TO TELL YOU SOMETHING ELSE THAT HAPPENED TO ME OR SAY,

“IT

REMINDS ME

…”.

* Add the flashcard for Changing topic.

…”

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4. Activity a. “I brought a chocolate coin, like Danny’s chocolate. Have you ever eaten such a coin?” Have a conversation with the children emphasizing how the subject is maintained and then extended, and then can move on to another topic. Some prompts: “When you want to talk about something else you have to announce it and say: I want to tell you something else ….” During the conversation, the adult gives an example of topic transition by using a key phrase such as “It’s like …,” “It’s the same as …,” “It reminds me that once …” b. “Here is a picture I printed from my computer” (picture of a rabbit). “I want to raise a rabbit at home…” Develop a conversation around rabbits – do you like rabbits, do you have a rabbit, did you ever pet a rabbit, and then move on to how to take care of a rabbit, what to feed it, etc.. Later, as the conversation develops, say: “We are talking about raising rabbits. Does it remind you of something similar that we can talk about now?” c. Show another picture (balloons formed into shapes): “I love balloons in shapes. On my birthday, the clown made me a crown out of balloons to put on my head ….” d. Connect-the-dot pages appropriate for the child’s level (1–20 or a–b). Incorporate a conversation during the activity. Twice during the conversation, model how to change the topic of the conversation (for example: “Oh, I remember that …,” “Wait a minute, I want to tell you something …”) Then: “What did we talk about when we did the page?” 5. Checking understanding Through assessment: Use puppets and ask if they are having a proper conversation? 1. Two puppets are drawing and talking about what they are drawing and listening to each other. 2. Two puppets are drawing. They start talking about the subject of the drawings and then one of the children switches to another topic without forewarning in a very inappropriate way. 6. Review worksheet(s) A picture of two children playing with blocks and talking. “Ruth is saying: I can build a tall tower …” (You can add a speech bubble). “What should Danny answer her? What can you say to Ruth? … If Danny wants to tell Ruth about something else, what should he say to her?”.

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7. Guidelines for the educational team Draw the attention of the children to how the subject of a conversation is changed. Model how to change the subject (“Now I want to talk to you about something else ….,” “I have something else to tell you …”). Lesson 29. Skill practice/experiencing stage (Small group setting) Topic: Developing a conversation: Switching topics 1. Introduction: Review of previous lesson. 2. Activity a. “I have dot-to-dot pages (1–10/1–20/a–b). Let’s see what picture we get and color it.” (For children up to ages 4 or 5, use regular coloring pages.) Lesson prompts: + show the flashcards for Conversation, Changing topic • I am participating in the conversation: Talking and listening too. • We talk about what interests everyone, what we are doing or something related to the activity. • During the conversation we need to pay attention to what everyone is talking about. • If you want to talk about something else related to the topic you should announce it to your friend. b. Play Funny Bunny while having a conversation, according to the same reminders. 3. Conversation practice during snack time (preferably fruits). 4. Lesson summary Today we worked with pages and also played Funny Bunny. During the activity we played and talked. We talk about things that interest us and our friends. If we want to switch the topic and talk about something else, we have to notify our friend so that he doesn’t get confused.

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Lesson 30. Skill practice/experiencing stage—continued (Small group setting) Topic: Developing a conversation: Switching topics 1. Introduction: Review of previous lesson. 2. Activity a. Crafting + conversation: Welcome the children and present the activity: “Today we will paint with gouache and paintbrushes. I will paint a sea ….” Let the children draw paintings freely. If necessary, the adult will encourage the beginning of a conversation: “Look at the sea I painted. Does it remind you of anything?” At some point, give a sentence that shows that you want to change the topic and tell about something related that you have been reminded of. Model how to change to a similar subject using the sentences: “This reminds me something …” b. After the children have finished their paintings, take a large Bristol and paste on the paintings to create an “exhibition.” Talk about who you can invite to the exhibition. Lesson prompts: + show the flashcards for Conversation, Changing topic • I am participating in the conversation: Talking and listening too. • We talk about what interests everyone, what we are doing or something related to the activity. • During a conversation we should pay attention to what everyone is talking about. • If you want to talk about something else that is related or you are reminded of, you have to announce it to your friend so that he doesn’t get confused. 3. Lesson summary Today we prepared a painting exhibition. What did we talk about while working? We talked about something that interests us and our friends. If we want to switch the topic of conversation and talk about something else similar, we have to announce this to our friend so that he or she does not get confused. Now let us invite our friends in the kindergarten to see our exhibit. Theme 11. Ending a Conversation Lesson 31. Skill acquisition/learning stage (Adult mediation setting) Topic: How to end a conversation 1. Introduction: Review of previous lesson: We had a conversation with our friends, asked questions and continued the conversation. 2. Introducing topic: “Every conversation has an end. Let’s see how a conversation ends”:

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Puppet Show: – – – – – – –

Hi Danny, have you seen my dog? No, where is he? Here, my sister is holding him. Oh, he is so cute … Yes, he is the cutest dog in the world. I love dogs. Yes, I do and also… AND THEN Danny leaves in the middle of the conversation Ron calls: – Danny, Danny, wait a minute …

• What were the children talking about? • How did the conversation end? • Why does Ron call Danny and say “Wait a minute”? 3. Concepts and definitions A CONVERSATION HAS A BEGINNING, MIDDLE AND END. WE MUST REMEMBER TO END A CONVERSATION. HOW TO END THE CONVERSATION? WE HAVE TO TELL OUR FRIEND THAT NOW WE WANT TO DO SOMETHING ELSE OR WANT TO TALK ABOUT SOMETHING ELSE. SOMETIMES A CONVERSATION ENDS WHEN THE ACTIVITY IS OVER.

4. Activity a. “Let’s sing a song together. When the song is over, we have to lift up the “Ending a conversation” flashcard. (Sing a song familiar from the kindergarten.) b. “Let’s talk about what we see in the picture. When you’re done describing the picture, tell me that you have finished. You can say, ‘That’s it, I’m done with telling.’.” c. Let’s listen to the conversation of these puppets and see how they end the conversation:

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Puppet Show – – – – –

Danny, look what I got … What did you get? My mom bought me a car with a remote control. It’s so fast! I also have the fastest car… Yeah, okay. Now I’m going with my mom to a store to buy batteries. So bye.

Questions • What were the children talking about? • How did the conversation end? What did the boy say at the end? • What else can you say at the end of a conversation? d. How could you end the following conversation: (Present the script and ask what can be said at the end) 1. Children are talking about a funny movie on TV: – – – – – –

Danny, listen to what I watched yesterday? What, on TV? Yes, I saw Phineas and Ferb Oh, I know it. It’s the funniest thing in the world. Yeah! It’s really funny. (So come over to my house and we’ll watch it on TV today.)

2. Children are arguing about blocks: – – – – –

My tower is higher. Wrong, my tower is higher. But I’m putting up a roof now. So I’m putting on a roof now too. (Then both our towers are the tallest)

5. Checking understanding Through assessment: Do the puppets finish the conversation properly? Puppet Show: Two children are talking about prizes they received.

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1. Puppets talk and finish the conversation properly (well, now I want to play in the yard, let’s talk soon …). 2. Puppets are talking but the conversation ends abruptly in the middle when one of the children leaves without ending it properly. 6. Review worksheet(s) “What can you say at the end of the conversation?” Picture 1: Two children sitting at a table, drawing and talking Picture 2: Two children sitting at the top of a slide and talking 7. Guidelines for the educational team During the week, draw the child’s attention to children’s conversations and what they say at the end of the conversation (“Look, Liam told Ron he was going to eat and so their conversation was over …”). Lesson 32. Skill practice/experiencing stage (Small group setting) Topic: Ending a conversation 1. Introduction: Review of previous lesson. 2. Activity a. “I have Lego (or Duplo, no small parts). Let’s build a street with houses.” Allow children to start a conversation while building. As they finish building with the Lego, bring out the puppets and say, “Here are people who live in the houses. They are going to visit each other. Let’s see what they say to each other ...” Give an example of one puppet that goes up to the other: – – – –

Hi, Ronnie, what are you doing? I’m going to buy shoes with my mom right now Oh, I’ve already bought some. Okay, so I’m going, bye.

b. Practice short conversations between puppets. The adult can help by modeling and initiating the conversation and playing one of the characters. c. Allow the children to reflect: How did they end the conversation, what did they say at the end before parting? Lesson summary: We played with puppets and Lego and heard how the puppets talked and finished the conversation before they parted from each other.

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Lesson 33. Skill practice/experiencing stage—continued (Small group setting) Topic: Ending a conversation 1. Introduction: Review of previous lesson. 2. Activity a. “Let’s make puppets from the materials I brought.” (Have on hand toilet paper rolls, circle stickers [for eyes, nose, mouth], pipe cleaners [for limbs]). “While everyone is making their own puppet, we can also talk.” b. After preparing the puppets, demonstrate a “conversation” between the puppets: – – – –

Hello, how are you? Fine. What are you doing? I’m going to the park with my grandmother. Well, then I’ll come with you …

c. Encourage the children to present a short conversation themselves. Emphasize the end of the conversation. 3. Lesson summary We made puppets from different materials and played with them. We heard how the puppets talk and how they end their conversation before parting. Theme 12. Communication Failure in Conversation Lesson 34. Skill acquisition/learning stage (Adult mediation setting) Topic: Communication failure in conversation 1. Review of previous lesson “What did we play and what did we talk about the last lesson? Who started talking? Did you talk about one topic? How did the conversation end - what did you say in the end?” 2. Introducing the topic: “What should you do when you do not understand what is said in the conversation or when you do not understand me. In a conversation sometimes we do not understand.”

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Puppet Show: – – – –

Yesterday I ate a banana at six o’clock. What? What did you eat? I ate a banana with chocolate. Oh, I didn’t hear that it was a banana, I didn’t understand you. Present another situation of communication failure and how it is fixed.

Questions • • • •

What did the boy say? What did his friend ask him? Why did he ask him “What? What did you eat?” What did he answer?

3. Concepts and definitions SOMETIMES IN A CONVERSATION YOU DON’T UNDERSTAND WHAT WAS SAID. WHEN I DO NOT UNDERSTAND OR WHEN I DO NOT HEAR—I HAVE TO ASK:

“WHAT?

WHAT DID YOU SAY?” OR ANOTHER QUESTION TO HELP UNDERSTAND.

* Show flashcard: I don’t understand. Additional explanations: If my friend doesn’t understand me and asks me “What?” and I must answer him. I can repeat what I said. Or I can say what I said with other words, in a longer sentence. 4. Activity a. “I’ll say something. If you don’t understand me, ask a question.” The facilitator says sentences, some of them understandable and some of them incomprehensible or illogical, such as “I ate a sandwich with a dog.” b. “Now you tell me what you like to play in kindergarten. If I don’t understand something - I’ll ask you. You will need to explain to me in sentences that are a little longer, so I can understand you.” 5. Checking understanding Through assessment: Do the puppets say the proper things? Present puppets in the following situations: 1. Two children playing with blocks. One child starts talking and his friend doesn’t understand and asks for clarification. The first speaker ignores him.

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2. Two children playing with blocks. One child starts talking and his friend doesn’t understand and asks for clarification. The speaker clarifies pragmatically. Practicing Appropriateness: The puppets will say something. If you do not understand, ask them and they will answer. You tell me if they answered correctly or not. Puppet says: – I ate a shoe with mustard …. – I ate … (muttering, unclear speech). Occasionally, “fix” the failure having by having the puppet says something unrelated that does not correct the failure (such as: repeating the part that was understood, etc.). 6. Lesson summary: Review the topic. 7. Guidelines for the educational team During the week, intentionally initiate some communication failures (situations in which the message to the child is unclear—through speaking that is too quiet, a partial message, confusing instructions, etc.) and then make ask the child whether he understood what we said or not. Encourage the child to say he did not understand and to ask for clarification again. Also, occasionally give the child feedback that we didn’t understand him (“What? I did not hear what you said … “I do not understand what you said …,” “Which one…?”) and emphasize this until the child responds appropriately (repeats what he said, explains his words, repeats some of his words). Lesson 35. Skill practice/experiencing stage (Small group setting) Topic: Communication failure in conversation 1. Introduction: Review of previous lesson. 2. Activity a. Pipe construction game + encouraging conversation. “Anyone who wants to talk should pay attention to see if his friend is listening. What should we talk about? Let’s choose a topic from the Spinner. We will take turns to talk. If someone doesn’t understand something, they need to ask and the friend needs to answer.” If necessary, the facilitator will participate in the conversation and say something incomprehensible and wait for the child(ren) to ask for clarification. Also, the adult will occasionally turn to the child who is speaking and

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say he/she does not understand (and ask for clarification). Give feedback to clarify if the child responded properly to clarify the misunderstanding. Lesson prompts: + show the flashcards for Listen, Taking turns, Asking a question, I don’t understand • I am participating in the conversation: Talking and listening too. • We talk about what interests everyone, what we are doing or something related to the activity. • During a conversation we should pay attention to what everyone is talking about. • If I don’t understand—I have to ask. If someone doesn’t understand me and asks me—I have to answer. b. Lotto Game “Who Has?”: Play this according to the rules of the game, but incorporate some incomprehensible speech, and create situations of communication failure for practice. 3. Lesson summary Today we played together with pipes and then in the game “Who Has?” What did we talk about during the game? We talked about something that interests us and our friends. If someone doesn’t understand what we say during a conversation, we have to explain. (Suggestion: Occasionally say something unclear or illogical and encourage the child to ask for clarification. Occasionally, ask the child to clarify what he said.) Lesson 36. Skill practice/experiencing stage—continued (Small group setting) Topic: Communication failure in conversation 1. Introduction: Review of previous lesson. 2. Activity a. “Today I brought some rubber stamps. You can see what they on a piece of paper and even do a complete picture with them. Let’s try to use them and talk too. Anyone who wants to talk should make sure that his friend is listening. If you don’t understand something in the conversation –you have to ask.” Encourage conversation. If the topic needs guiding, you can start the conversation from the content of the activity you are doing and then encourage a conversation that will share the children’s experiences in related activities. Occasionally, say something that is unclear or illogical and encourage the child to ask for clarification. Occasionally ask the child to clarify what he said.

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3. Activity: Crafting + conversation Lesson prompts: + show the flashcards for Conversation, Asking a question, I don’t understand • • • • •

I am participating in the conversation: Talking and listening too. I need to make sure that the friend is listening to me as I start talking. Talk about what interests everyone, what we do or something related to activity. In conversation we take turns to speak. If I don’t understand—I have to ask. If someone doesn’t understand me and asks me—I have to answer.

4. Lesson summary Today we used stamps to make a picture together. What did we talk about while working? Did we listen to each other? If we want to talk, we must make sure that our friend is listening to us. If we don’t understand something, we need to ask. If someone does not understand us, we have to say it again or use different words and explain it to them until they understand us. Theme 13. Summary of The Conversation Intervention Lesson 37. Skill acquisition/learning stage (Adult mediation setting) Topic: Summary of the topic “conversation” 1. Introduction “This is our last meeting... We learned a lot about conversation. What did we learn?” Encourage the child to name topics, such as: “We learned how to start a conversation.” Show the child all the flashcards we used during the activity (Conversation, Listen, I don’t understand, Asking a question, Sharing, Ending a conversation, Conversation failure. • We learned that we can talk about all kinds of things with our friends. What can we talk to our friends about? Encourage the child to answer and then take out the topic spinner. • We learned that you can talk to friends in all kinds of places. Where? • We learned that you can talk to friends at all kinds of times. When? • We learned that it is worth talking to friends. Why? (Because then they cooperate better, because then they want to play with me, because then they understand me better, because then it’s more fun for me to laugh together with them, because then they tell me all kinds of things …)

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2. Activity a. “Today we will play detectives: We will quietly go out of the room and look at the kindergarten children with binoculars. Let’s see if we can discover children having conversations and quietly listen to what they are saying. We’ll use this chart to help us remember what we saw in our detectives’ observation.” (“You will tell me what to write in the chart.”)

Who’s talking

Where are they?

What are they talking about?

Are they having fun? Why are they talking?

. . .

. . .

. . .

. . .

b. After the “detective game” in the kindergarten, return to the therapy room and go over the information in the table. Emphasize the ideas of enjoyment of conversation and the reason for conversation (e.g., “They talked because they wanted to decide how to play the game.”) 3. Lesson summary We learned a lot about conversation and also saw our friends having conversations. If children themselves were filmed and shown, it can be reminded. When we participate in a conversation, our friends want to be with us and understand us better. Lesson 38. Skill practice/experiencing stage (Small group setting) Topic: Summary of the conversation intervention 1. Introduction “We have two more lessons to finish our conversation activities. Today we will make a box of memories. First we will make the box and then we will write greetings to each other and put them inside the box. “Let’s paint this wooden box with gouache and then decorate it. It can be a very nice box, it can be used for all kinds of things…. While working, we can talk. Anyone who wants to talk should make sure that his friend is paying attention. Encourage conversations: (What can be done with the box? How do we paint a box like this? Can you think of a similar experience of something you made in the past?) Later, encourage changing to other topics (Do the boxes remind us of something else we once made…, etc.)

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2. Activity: Preparing and decorating the boxes. When the boxes are finished, the adult brings little note cards and asks everyone to write something nice for their friend in honor of the end of this group activity. Give the children an example of a suitable greeting, such as: I enjoyed playing with you in the group/I enjoyed talking to you because you are funny/I like to play with you and want us to keep playing together. Start by giving one example and if the children have difficulty thinking of others, give more. For younger children, let them choose one of our examples. 3. Lesson summary Put the notes in the box and talk about what you did today. Remind the children and develop a conversation about the other creative activities you did together during the sessions. Lesson 39. Skill practice/experiencing stage—continued (Small group setting) Topic: Summary of the conversation intervention and farewells 1. Introduction “This is our last session together ... When we met, we did all kinds of things. Who remembers what we did?” Try to encourage conversation about: What did you enjoy doing? What do you like to do with friends? What did we talk about in our sessions? 2. Activity a. Let’s watch your video: Let’s see what we did together. What did we talk about? Providing feedback to children about the different parts of the conversations. b. Play a board game that the children choose. c. Refreshments. d. Distribution of “conversation medals” to children who participated in conversations and games and to encourage continued conversations between friends!

Part III

PPSI Empirical Basis and Psychoeducational Implications

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The PPSI’s Planning, Development, and Empirical Evaluation

How Did We Develop and Empirically Test the PPSI? As elaborated here in this chapter, the PPSI intervention project undertaken by Prof. Nirit Bauminger-Zviely’s ARI Laboratory in the School of Education at Bar-Ilan University involved six stages of planning, design, refinement, and different empirical evaluations in order to develop an evidence-based curriculum. As published recently in the Journal of Autism and Developmental Disorders (Bauminger-Zviely et al., 2020) and detailed below, the intervention’s development culminated in a comprehensive empirical RCT evaluation of the final PPSI version’s efficacy. This RCT supported the PPSI’s validity as a scientifically rigorous intervention model. However, that empirical basis for the curriculum was preceded by several important stages of planning and formative evaluation that guided the protocol’s development and contributed to its strength. To provide a deeper understanding of the model’s evolution, this chapter describes in detail the very extensive multi-stage process by which we systematically designed and developed the PPSI curriculum and then empirically tested it. As presented below, the whole integrative process underlying the PPSI’s development included six stages: (1) an extensive literature review; (2) a large-scale exploratory survey of active practitioners in the area of peer engagement for preschoolers with ASD; (3) the protocol’s initial design consisting of three component curricula (interaction, play, and conversation); (4) assessing the PPSI content areas’ ecological validity and effectiveness through focus groups and a 6-month pilot study, leading to refinements of the PPSI protocol and its implementation; (5) empirical validation of the final version’s implementation in 23 preschools via a scientifically rigorous multi-method study (Bauminger-Zviely et al., 2020) examining the three curricula’s relative effectiveness and generalizability; and (6) evaluation of the intervention’s social validity and impact.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 N. Bauminger-Zviely et al., Preschool Peer Social Intervention in Autism Spectrum Disorder, Social Interaction in Learning and Development, https://doi.org/10.1007/978-3-030-79080-6_8

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The PPSI development and evaluation team included three doctoral students (the second, third, and fourth authors of this book) who, respectively, developed the PPSI interaction curriculum (Eytan & Bauminger-Zviely, 2013), the PPSI play curriculum (Hoshmand & Bauminger-Zviely, 2013a), and the PPSI conversation curriculum (Rajwan Ben-Shlomo & Bauminger-Zviely, 2013a). Next, the PPSI intervention project’s planning, development, and empirical evaluation stages are detailed.

Stage 1: Extensive Literature Review To begin the planning stage for developing the PPSI model, our research team executed an extensive review of the available scientific literature on diverse aspects of peer engagement and social interventions in early childhood, spanning both the typical and atypical trajectories of development. These literatures are described systematically in Chaps. 1 and 2 for peer typical and atypical peer engagement, respectively, and in Chap. 3 for social interventions. Our methodical literature review focused on previous research and conceptualizations of the major social engagement challenges facing young children with ASD, and how their social-communicative skills may differ from their typically developing counterparts. Overall, this literature review of typical and atypical child development in diverse skills for peer engagement and relationships—whether during collaborative games and activities, during simple or complex play, while communicating verbally and nonverbally, while trying to approach their same-age peers or responding to peers’ initiations, and so on—enabled us to pinpoint the three major building blocks at the heart of peer relations, which became the main components of our PPSI program: interaction, play, and conversation. Thus, in this planning stage, our comprehensive literature review helped to provide reliable and exhaustive theoretical grounding for our three PPSI curricula corresponding with the authentic social needs characterizing preschool population with ASD. We also searched carefully for prior effective early interventions targeting preschoolers with ASD in any of these major “building blocks” of social engagement. This comprehensive search yielded a paucity of evidence-based manualized peer interventions for naturalistic settings that would holistically target the various social building blocks enabling enjoyable and fruitful peer relations in these young children (see Chap. 3). Next, our research team thoroughly scoured the literature to identify existing techniques, strategies, and procedures that were previously found to be effective in social interventions for preschoolers with ASD, as reviewed in Chaps. 3 and 4. Thus, this stage of literature review helped to establish evidence-based principles and techniques for incorporation into the PPSI protocol.

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Stage 2: Survey of Active Practitioners Alongside our research team’s thorough literature search at the initial stages of planning for our novel PPSI intervention, we sought to uncover the voices of active practitioners who were already in the field attempting to improve the social skills of preschoolers with ASD. We aimed to ensure that our evidence-based intervention would offer a good fit with existing psychoeducational professionals and settings. Toward this end, we conducted a large empirical survey study to learn about the current knowledge and needs of inservice professionals who work with young children with ASD (ages 3–6 years) in the area of facilitating preschoolers’ ability to engage socially with peers (Eytan, 2013). Specifically, this survey sought to systematically assess the specific social characteristics of these young children, the challenges and knowledge lacunae facing practitioners in preschools, and the settings’ current implementation of peer relationship activities according to firsthand reporting by a wide range of these early interventionists. Thus, using interviews and questionnaires, 52 early special education educators were asked to: (a) describe the treatments that they provided in their preschools that were specifically oriented toward the facilitation of peer exchanges, (b) report on the training that they had previously received in this area, and (c) define their basic needs as practitioners in the field. The findings of this exploratory survey revealed that active, practicing educators’ responses were very consistent. Regarding treatments, despite the fact that 82% defined peer exchanges as a core area of challenge for the children in their preschools, fewer than half of the educators affirmed maintaining any program specifically oriented toward fostering peer engagement. They pinpointed the dearth of such peer-to-peer manuals or protocols affording implementation within the preschool setting. Regarding training, the surveyed educators underscored that they lacked any direct training oriented specifically toward promoting such peer exchanges. Regarding practitioners’ areas of need, educators identified some major lacunae in their existing knowledge with regard to all three of the core areas of peer engagement that our extensive literature search identified as the major building blocks of peer social engagement—interaction, play, and conversation. Namely, our survey participants expressed major knowledge gaps in how to help these young children with ASD to initiate an interaction, to perform collaborative and coordinated activities with peers, to develop complex and productive peer play as well as pretend play, and to talk with peers appropriately and effectively. Moreover, the survey participants reported that they did not possess adequate knowledge about how to help these children develop their social cognition and emotional understanding, namely, in areas such as social constructs, concepts, and norms as well as the children’s understanding of their own emotions and others’ emotions and mental experiences.

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Stage 3: Protocol’s Initial Design Stage Following the previous two planning stages, our research team at Bauminger-Zviely’s ARI Lab developed an initial PPSI protocol. Our comprehensive literature review and survey study strongly guided our protocol design choices. Thus, as described in detail in Chap. 4, we decided to: structure the PPSI protocol as three separate curricula (interaction, play, and conversation) that would be conducive to intervention personalization; implement our program ecologically in young children’s naturalistic setting (the preschool); utilize a CBT-based psychoeducational model and developmentally appropriate activities; emphasize peer-peer modeling in small groups, with the mediation of an adult; integrate both learning and experiencing stages for skill acquisition and practice; and mobilize the visual strengths of children with ASD. Hence, we designed our PPSI intervention while espousing a holistic perspective of social relations and striving to adopt recommendations from available past evidence-based protocols in the field to mitigate social-communicative symptoms associated with ASD. Our initial PPSI protocol representing a comprehensive and integrative early social intervention model for peer engagement was ready, comprising three in-depth content curricula on spontaneous peer interaction, social play and social pretend play, and peer conversation of preschoolers with ASD,

Stage 4: Protocol’s Formative Evaluation Through Pilot Study and Focus Groups We next continued to gradually adjust and modify the protocol as needed through formative evaluation via pilot research on its initial implementation accompanied by focus groups. To conduct formative assessment of the three initially designed content curricula for interaction, play, and conversation, we examined their utility in a pilot case-study held in each of three preschools and through focus groups of early educators and speech therapists. These methods led to a series of refinements yielding the final PPSI protocol at the end of this stage. During the pilot case-study, each of the three curricula (interaction, play, or conversation) was implemented by one PPSI facilitator, a senior therapist, targeting one preschooler with ASD for a 6-month duration in three sessions per week. One weekly acquisition session was held between the ASD child and the PPSI facilitator. Two weekly practice sessions were held in small mixed peer groups (comprising the target child with ASD and two typically developing age-mates), directed by the facilitator. The three PPSI facilitators (each leading one of the three curricula) received close guidance and supervision from a member of our research team, who visited the preschools every second week, observed an intervention session, provided feedback to the facilitators, and gave instructions for the upcoming two weeks. To further ensure adherence to the novel protocol, each facilitator also completed a fidelity questionnaire every week.

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Based on facilitators’ pretest and posttest reports and on the research team’s observations, as well as on the child’s head teacher reports, this qualitative pilot case-study indicated that each of the three participating children with ASD showed clear improvement in their trained PPSI content domain (e.g., increased participation in social interactions, improved initiations of conversation, growth in play complexity). According to reports by the children’s PPSI facilitators and head preschool teachers, the best improvement was indeed noted in the trained PPSI domain, but improvement was also evident for the children’s overall social participation in the various peer activities in the preschool. To provide formative assessment of the protocol, the three pilot-study facilitators and the three head teachers in these preschools each provided detailed feedback about their implementation of their assigned PPSI curriculum. Their comments were discussed thoroughly with the research team, and changes to the protocol were made accordingly. Alongside the pilot study, our research team also conducted focus groups of early educators and speech therapists, where we read the three curricula with them and asked for their systematic feedback. We then implemented the suggested changes to the PPSI protocol based on the expertise of these professionals in the field. Overall, the formative assessments collected from the pilot study and the focus groups verified the basic operationalization of the PPSI structure and techniques within the preschool setting such as the integration of typical peers and the sessions’ frequency and type (two small mixed peer groups and one adult-mediated individual session per week). Furthermore, the formative evaluation process enabled verification of the appropriateness of the various games and activities that were part of the peer sessions, as well as the necessity of the visual aids during intervention. Some of the PPSI contents were revised to increase clarity and strengthen ecological validity, and some activities suggested by the focus groups were added. Those modifications increased the PPSI protocol’s clarity and usability. Thus, at the completion of the aforementioned stages (i.e., literature review, survey study, pilot study, and focus groups), we had developed the final full PPSI protocol (described in Chap. 4 and presented fully in Chaps. 5, 6 and 7). We were now ready for our next evaluation stage—a randomized controlled trial (RCT) evaluation study of the full protocol, as described next.

Stage 5: Full Protocol’s Empirical RCT Evaluation Once the full holistic protocol for the PPSI’s three content areas was completed, we conducted a rigorous RCT evaluation study based on the intervention’s implementation in 23 different preschools around Israel (see Bauminger-Zviely et al., 2020 for study’s full description and results). In this RCT study, the targeted participants were 65 high-functioning preschoolers with ASD (having an IQ over 75), and 46 typically developing age-mates who participated as collaborators in the intervention’s 28 small social groups. Each participating preschool received only

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one PPSI content domain (interaction, play, or conversation) and conducted the intervention in 1–2 small groups sharing the same content domain. The typically developing age-mates were recruited from regular preschools nearby the targeted special preschools, based on regular preschool educators’ reports that these children had no identified disability of any kind, similar chronological age as the nearby target children with ASD (3.5–6 years), and adequate social and behavioral capabilities without behavioral difficulties. Data were collected only on the study participants with ASD due to the Ministry of Education’s restrictions on data collection from the typical age-mate collaborators. Using a randomized block design, the 23 participating special education preschools were randomly assigned to four study groups (interaction, play, conversation, or treatment-as-usual, a waitlisted control group) along two recruitment years, including a division between three geographical regions in proportion to the number of children with ASD and special education preschools recruited per region. The RCT research team at Bauminger-Zviely’s ARI Laboratory included the three aforementioned PhD students and intervention developers (Eytan, Hoshmand, and Rajwan Ben–Shlomo) as well as three MA students attending an ASD specialization graduate program at Bar-Ilan University’s School of Education who served as intervention evaluators. Preschools’ assignment to the four study groups was masked from these intervention evaluators (two special education experts in ASD and a speech therapist). The Association for Children at Risk provided funding to support the PPSI’s implementation in preschools across Israel.

Study Aims The major aim of our RCT study was to examine the efficacy of the novel manualized preschool-based peer-to-peer social intervention for increasing the ability of preschoolers with ASD to socially engage (interact, converse, play) with peers. More specifically, we aimed to test the direct efficacy of each of the three PPSI curricula as well as each curriculum’s generalization to other domains and settings. Direct treatment efficacy. We examined within-group differences in each of the four study groups by comparing peer engagement assessment measures collected at the pretest baseline (at Time 1, before intervention) versus peer engagement measures collected at posttest, immediately after the 6-month treatment (Time 2). We also examined whether the four groups’ peer engagement measures would differ after treatment (at Time 2 while controlling for Time 1). Generalization. We were interested if the preschoolers would generalize the trained skills in interaction, play, or conversation: (a) to the other two untrained content domains (e.g., if the “play” intervention group would exhibit improvement in untrained pragmatic “conversation” skills or untrained collaborative “interaction” skills); (b) to other settings (i.e., to everyday preschool activities); and (c) to overall adaptive capabilities and socialization scores—contents that were not directly taught in the PPSI.

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Intervention Setting and Structure Trained on-site facilitators in the 23 special education preschools led implementation of one of the three manualized PPSI intervention curricula (interaction, play, or conversation) over a 6-month period, in three 45-min sessions per week held in a quiet separate room. One session per week—the learning/acquisition stage—comprised a structured learning activity for that week's social construct, such as a short video clip or role-playing puppets demonstrating the learned target behavior, delivered via a dyadic child–adult session mediated to the child with ASD by the PPSI facilitator. The other two sessions per week—comprising the experiencing/practice stage—enabled hands-on practice of that week’s learned social construct in a consistent small mixed peer group (n = 3–4), consisting of one or two children with ASD and two peers with typical development. Each week’s target behavior was practiced via this same peer group’s play with toys, joint activity with crafts, conversation while eating snacks, and so on. The two weekly practice sessions were held consistently in a single setting: of the 28 mixed small groups, 17 met in the special education preschool and 11 met in the regular preschool. For more description of the PPSI’s two-stage integrative structure, comprising skill acquisition via adult mediation (conceptual learning stage) and skill practice with peers (experiencing and performing stage), see Chap. 4.

Multi-Method Assessment of Intervention Efficacy In line with our study aims of examining direct intervention effects and generalization to untrained settings and domains, we administered the same set of assessments both at pretest (before intervention) and at posttest (immediately after the 6-month treatment). Our PPSI assessment tools consisted of direct observations and ratings by adult informants—the PPSI intervention facilitator and the head preschool educator, who was uninvolved in the PPSI intervention program. Direct observation of children’s peer engagement. Videotapes of target participants’ free-play and snack-time situations within children’s assigned small groups were analyzed using three coding measures, to assess the children’s play complexity, interactive-conversation pragmatics and quality, and communicative conversation qualities. These assessments enabled within-group analysis of pretest to posttest gains, between-group comparison following intervention, and analysis of interventions’ generalization to untrained skills. First, to evaluate the play complexity for participants’ directly observed social play and social pretend play, based on Howes’s (1980) and Howes and Matheson's (1992) Peer Play Scale, we analyzed 15 min of the videotaped free play using the hierarchical Social Play Observation scale (Hoshmand & Bauminger-Zviely, 2013b). The small groups received the same toy set at both time points (Times 1 and 2), including abstract toys (e.g., rings, sticks, blocks) and concrete toys such as dolls, animals, birthday party items (e.g., candles, cake), bath items (e.g., mini hairbrush, shampoo, bathtub), kitchen items (e.g., mini cooking pot, cutlery,

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vegetables, fruits), doctor toys (e.g., plastic stethoscope, thermometer, bandage), and transportation toys (e.g., cars, traffic signs). While observing preschoolers’ play behaviors using the Social Play Observation scale, the intervention evaluators marked the highest play level that the child obtained across the 15-min. observation time. Each coding scale (social play and social pretend play) included scores from 1 to 5 representing a developmental sequence from non-interactive parallel play with no social exchange, to contingent social exchange, to reciprocal and complementary exchanges (see Table 1.1 in Chap. 1 for detailed description of play stages). Next, to evaluate participants’ directly observed interaction and conversation quality, we analyzed 25 min of videotaped peer engagement (the same aforementioned 15 min of free play, evaluated together with an additional 10 min of snack time, when the group received snacks and a set of toys including plastic food items, transportation toys, animals, and plastic fences). The free play and snack time scenarios were combined due to non-significant between-scenario differences, and children’s conversational acts during these scenarios were transcribed verbatim by a speech therapist. To assess directly observed interactive-conversation pragmatics and quality, the 25-min data set was coded using the Pragmatic Rating Scale—Young (PRS-Y; Bauminger-Zviely et al., 2014, based on Landa, et al., 1992). The PRS-Y included 27 pragmatic behaviors comprising three subscales: (1) pragmatic behaviors, 15 items on topic management and reciprocity; (2) speech and prosodic behaviors, 8 items on the speaker's production; and (3) paralinguistic behaviors, 4 items on physical behaviors that accompany speech. Each of the PRS-Y behaviors was coded on a 3-point scale: 0 = almost never occurs; 1 = occurs sometimes but does not seriously interfere with conversational flow; and 2 = occurs almost always, seriously interfering with conversational flow. Higher scores (the mean for the entire 25-min. interaction) indicated a poorer pragmatic functioning that reflected atypicalities reported to be characteristic of autism. The 25-min data set was coded again to assess directly observed communicative-conversation qualities (Adams, 2002; Paul et al., 2009). The five identified major communicative-conversation qualities included the child’s: behaviors to obtain the listener’s attention; behaviors to initiate new content; responsiveness to the existing ongoing conversation; ability to preserve/maintain an ongoing conversation; and expansion of the current conversation topic. Each participant's conversational turn (utterance) was coded on a 5-point scale from 1 (one or fewer conversational components) to 5 (inclusion of all 5 conversational components). A mean score was calculated across both social situations to signify the quality of the participant’s observed conversation, with higher scores indicating better quality. Ratings by adult informants of the PPSI’s direct effects and generalization. Each child’s pretest-to-posttest improvement in trained PPSI skills was also evaluated by written questionnaires completed by two adult informants. The assigned intervention facilitator and the preschool’s uninvolved head educator each assessed participants’ spontaneous display of the targeted interactive-conversational and play behaviors as manifested in everyday non-mediated indoor and outdoor peer social

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situations in the preschool. In addition, to assess generalization of trained skills to untrained PPSI content domains and to untrained settings, we traced pre-post changes in the targeted preschoolers’ spontaneous display of skills from the other two treatment domains that had not been trained as manifested in everyday preschool activities (e.g., the Conversation group’s generalization from trained language-conversation skills to untrained play skills in non-PPSI preschool social situations). Moreover, to assess preschoolers’ generalization of trained skills to overall adaptive capabilities and socialization scores, both adult informants completed another written questionnaire assessing adaptive behavior. Thus, altogether, two informant questionnaires were used to examine peer engagement, and one informant questionnaire was utilized to examine overall adaptive and social functioning in our study participants. The Social Play Questionnaire (Hoshmand & Bauminger-Zviely, 2013c), the Social Conversation Questionnaire (Rajwan Ben-Shlomo & Bauminger-Zviely, 2013b), and the Vineland Adaptive Behavior Scales-II: Teacher Rating Form (Sparrow et al., 2005) were each completed by the PPSI facilitator and by the head educator twice, both before and after the intervention. The Social Play Questionnaire included 43 items on which adult informants assessed the targeted preschoolers’ play complexity out of five possible levels (see Table 1.1), rated on a 5-point Likert scale from 1 (does not exist at all) to 5 (exists consistently in participant's play repertoire), with 22 items assessing social play and 21 items assessing social pretend play. Due to moderate to high correlations found between levels 2 and 3 and between levels 4 and 5, our analyses ended up with only three play levels: basic, mid, and high. For social play, these levels comprised parallel (basic), parallel aware and simple (mid), and complementary and reciprocal (high) play complexity. For social pretend play, these levels comprised solitary (basic), coordinated and associative (mid), and cooperative and complex (high) play complexity. The Social Conversation Questionnaire included 23 items comprising three subscales: speaker, listener, and conversation functioning. The adult informants evaluated the quality of the targeted preschoolers’ active participation via initiating/responding in peer conversation during various preschool activities like meals, creative activities, and play, rated on a 5-point Likert scale from 1 (behavior does not exist) to 5 (behavior exists consistently). The Vineland Adaptive Behavior Scales-II: Teacher Rating Form was utilized to tap adult informants’ assessments of the targeted preschoolers’ adaptive behavior (composite score) and socialization (using the standard score and its subdomains of interpersonal, play, and coping). Lower Vineland scores indicated lower adult assessments of children’s social functioning.

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Study Results We next summarize the main results of this RCT study in terms of direct treatment effects and generalization effects for setting and content. We provide here a summary of the main results and several graphs to demonstrate the main trends that emerged from this empirical evaluation of the PPSI intervention. The details on this RCT study, including the description of data analyses and detailed tables presenting all the data, are available in Bauminger-Zviely et al. (2020). Observations of peer engagement. The PPSI group participants who received the “play” curriculum showed significant pretest-to-posttest improvement on the Social Play Observation scale, both for their observed social play and social pretend play. On their observed social play, as seen in Fig. 8.1a, the improvement noted from the pretest (mean score of 3.00, range: 2.86–3.14) to the posttest (mean: 3.75, range: 3.38–4.11) indicated that before the play intervention children started at level 2 (parallel aware) or had begun level 3 (simple social play), and after intervention they had progressed to the beginning of level 4 (interactive-complementary play). On their observed social pretend play, as seen in Fig. 8.2a, at baseline they revealed a mean of 2.00 (range: 1.54–2.46), indicating level 2 or solitary play directed toward others, and after intervention they progressed to a posttest mean of 3.20 (range: 2.50–3.90), indicating level 3 (simple and associative pretend play) and scores close to level 4 (cooperative pretend play). Between-group findings at Time 2 also demonstrated a significant advantage for the “play” intervention group over both the “conversation” intervention group and the control group in their observed social play (see Fig. 8.1b) and an advantage over all three of the other study groups in their observed social pretend play (see Fig. 8.2b). The “interaction” intervention group also showed an almost-significant trend toward improvement from pretest to posttest (p = 0.060) for observed social

Fig. 8.1b: The four groups’ change

Fig. 8.1a: The “play” group’s change

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Fig. 8.1 Pre-post change in observed social play complexity

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Fig. 8.2a: The “play” group’s change

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Fig. 8.2 Pre-post change in observed social pretend play complexity

play (see Fig. 8.2b). However, overall, the “play” group showed the best improvement on the hierarchical Social Play Observation scale, as expected. As can be seen in Fig. 8.3a, the “conversation” group showed significant improvement in their observed pragmatic and paralinguistic functioning (on the PRS-Y) as well as higher observed conversation quality after treatment (see Fig. 8.3b). Likewise, the “interaction” group showed significant improvement in their observed pragmatic and paralinguistic functioning (on the PRS-Y) (see Fig. 8.3a). In contrast, the control group showed a deterioration at the posttest in all their observed pragmatics categories (PSR-Y) and in their observed conversation quality (see Fig. 8.3a and b). Between-group findings at Time 2 also demonstrated that the control group showed significantly poorer observed pragmatic outcomes compared to all three of the intervention groups. Surprisingly, the “play” intervention group also evidenced a decrease in observed conversation quality at the posttest interval. As expected, at Time 2 the “conversation” group showed the highest scores in observed conversation quality compared to all other groups (see Fig. 8.3a and b). This pattern of findings seems to suggest that in order to obtain a significant change in the quality of peer talk, preschoolers with ASD appear to need direct intervention oriented explicitly toward this goal. Facilitator’s reports on peer engagement. The facilitators were an important data informant to complement the direct observations in order to assess spontaneous peer engagement in the preschool beyond the mediated PPSI activities. Preschoolers’ pre-post improvement was noted for all intervention groups, according to within-group analysis of the therapists’ ratings on the Social Play Questionnaire. According to the facilitator’s report, the “play” group showed improvement on 5 out of the 6 play stages after intervention (except for the lowest social play level— parallel play). Facilitators rated the “interaction” group too as showing improvement on 5 out of the 6 stages (except for the mid social play level—parallel aware and

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Fig. 8.3a: Pragmacs

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Fig. 8.3 Pre-post change in observed social conversation (during free play & snack)

simple). However, facilitators assessed the “conversation” group as showing significant improvement only on the mid social play level and assessed the control group as showing a decrease from pretest to posttest in their scores on cooperative and complex play (the highest level of pretend play). Regarding between-group analysis of facilitator-rated play levels after the intervention, facilitators reported that the “play” group demonstrated the highest improvement on the mid and high levels of social and social pretend play compared to the other three groups. Facilitators reported the control group as showing the least improvement compared to the other three groups on the highest social play level and the mid and high social pretend play levels (for detailed results on facilitator reports, see Bauminger-Zviely et al., 2020). On the Social Conversation Questionnaire, the facilitators reported significant pre-post improvement for all three categories of speaker, listener, and conversation functioning for the “conversation” group; improvement in the speaker and listener categories for the “play” group; and improvement only in the listener category for the “interaction” group. Facilitators assessed the control group as showing lower scores in the conversation functioning category at the posttest compared to the pretest. Regarding between-group analysis of therapist-rated posttest scores on the Social Conversation Questionnaire, the “conversation” group showed the highest improvement in the conversation functioning category versus all groups, and the control group showed the least improvement on the speaker and quality categories (see Bauminger-Zviely et al., 2020 for details). Generalization: Uninvolved educators’ reports on extra-group interactive play and conversation. Although both informants rated participants’ social engagement at pretest and posttest, only the uninvolved head educators were regarded as full informants on generalization because they were masked to intervention curricula and to the evaluated children’s intervention group assignment. The preschool educators were not actively involved in the PPSI implementation, and they

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reported about preschoolers’ improvements in play and conversation as manifested during participation in various preschool activities outside of the intervention group. Findings from these informants’ Social Play Questionnaire reports revealed pre-post improvement for all intervention groups on the highest level of social play (complementary and reciprocal, see Fig. 8.4a) as well as on the mid and high levels of social pretend play (coordinated and simple associative and cooperative and complex, respectively, see Fig. 8.4b). The uninvolved educators did not report the control group as improving on any of the Social Play Questionnaire levels. Between-group differences in head teachers’ play assessments at Time 2 revealed a significant advantage for the “play” group over all other groups on social play’s level 3 and on social pretend play’s levels 2 and 3 (see Fig. 8.4a and b). Like the facilitators’ reports, the head educators’ reports indicated pre-post improvement on all three of the Social Conversation Questionnaire categories (speaker, listener, functioning) for the “conversation” group and on the speaker and listener categories for the “play” group (see Fig. 8.4c). This finding provides more support for the important role of language within play activities. Between-group differences at Time 2 for the educator-rated Social Conversation Questionnaire scores revealed that the control group showed significantly poorer speaker skills compared to the three intervention groups as well as poorer listener and conversation quality skills compared to the “conversation” and the “play” groups (see Fig. 8.4c). Generalization to participants’ adaptive behavior (Vineland). Both the facilitators and the educators reported pre-post improvement on the Vineland scale’s composite adaptive score for the “play” group, and the head educators additionally assessed the “interaction” group as showing pre-post improvement on the Vineland adaptive composite scale (see Fig. 8.4d for educator’s results).

PLAY Fig. 8.4a : Complementary & reciprocal social play

Fig. 8.4b: Cooperave & complex pretend play

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Discussion of Empirical RCT Findings Several main conclusions can be drawn based on the results of the RCT study examining the efficacy of the PPSI intervention as implemented broadly in 23 preschools. First, overall, children in each of the three intervention groups demonstrated improvement over time in various important aspects of peer engagement. For example, the “conversation” group showed robust and consistent improvement in conversation quality according to direct observations and to facilitators’’ and educators’ reports. The children who received the “conversation” curriculum were observed as showing better attending skills during interactions, greater abilities to initiate conversation, more adequate responses to peers, and, most importantly, a better ability to maintain, expand, and develop conversations with peers. This last skill is considered to be very challenging even for young children with typical development and definitely for many children with ASD. As said, this improvement was verified by the facilitators and the uninvolved educator. The “play” group showed substantial and consistent growth in the complexity of their social and social pretend play, not only according to the hierarchical scale for measuring observed social behavior but also according to therapists’ and educators’ reports. The children’s observed social play behaviors before and after treatment revealed significant improvement from simple/aware parallel play to interactive-complementary play. Even more remarkable improvement was noticed in their observed social pretend play behaviors, which developed from the lowest solitary pretend acts related to and coordinated with peers toward the simple associated pretend play and even up to cooperative pretend play. As said, those increases were also verified by the facilitator and the educator. Conversational and play skills are the building blocks of efficient social interaction with peers (Coplan & Arbeau, 2009). Indeed, the “interaction” group showed improvement on both the play and conversation measures. All in all, children's more general interactive skills such as prosocial capabilities, as promoted in the “interaction” intervention, led to better performance in some of their social conversational and play capabilities. However, according to both observations and facilitators’ reports, this group did not surpass either of the other intervention groups on play or conversation measures at Time 2. These findings may be related to our measurement procedure, which did not include an observation of children's spontaneous interactions with their peers during ordinary preschool activities. Another conclusion that can be drawn from this RCT study’s outcomes is that children in the treatment-as-usual control group did not progress over time and on some measures even regressed over time (e.g., on all pragmatic PRS-Y categories, observed and reported conversational quality and functioning, highest reported social play level). Moreover, for many measures, the between-group analysis indicated that the control group performed less well at Time 2 (after the 6-month intervention period) than all the other groups. Some examples of this lowest functioning include: their highest social play level and all their social pretend play levels according to the facilitator-rated Social Play Questionnaire, their observed

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PRS-Y pragmatics, and their facilitator-rated Social Conversation Questionnaire’s speaker and conversation functioning categories. The poor within-group (pre-post) and between-group performance of the waitlisted treatment-as-usual control group appears to suggest that peer interaction skills may not develop spontaneously in these preschoolers with ASD, reinforcing the need to undertake specific interventions. An important implication of the current RCT study findings is that despite the fact that children in each of the intervention groups made the most robust improvement in their targeted area of learning, we also found some generalization from one peer-engagement domain to another. For example, the “interaction” group improved on observed pragmatic skills (PRS-Y); the “play” group improved on conversation skills (speaker and listener) according to the facilitators reports on the Social Conversation Questionnaire; and the “conversation” group improved their social play at level 2 (simple social play) according to the facilitator’s reports on the Social Play Questionnaire. Moreover, children also demonstrated generalization to untrained domains of adaptive skills. For example, the “play” group improved in their overall adaptive behavior scores according to both educator and facilitator reports on the Vineland, and the “interaction” group improved in the adaptive domain according to educators. These areas of generalization can be expected due to the interconnections existing between the three domains of peer engagement. Such spillover effects can be encouraging to PPSI facilitators who select a consecutive sequence for implementing the three curricula, in that the untrained domains may enjoy some gains while awaiting their turn as a focus for intervention with individual children. However, our RCT’s results do not support a single intervention as an integral solution for all three building blocks of peer engagement because, overall, children did not achieve the desired degree of improvement in the untrained domains.

Stage 6: Evaluation of PPSI’s Social Validity and Social Impact The final stage for developing and evaluating our PPSI intervention was to examine its social validity and impact, both of which were determined to be high. The social validity of an intervention is evaluated by taking into consideration: (1) the objectivity of the intervention’s evaluation procedure, (2) the intervention goal’s relevance to its recipients’ lives, (3) the intervention’s effectiveness in rendering significant changes to recipients’ lives, and (4) the intervention’s feasibility and usability for the facilitator and the child’s ecological environment (e.g., Callahane et al., 2008; Foster & Mash, 1999; Katz & Girolametto, 2013, 2015). In the case of the PPSI, the intervention protocol met all of these criteria, verifying its high social validity as follows.

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(1) Objectivity: External blind evaluators of the PPSI’s results contributed to objectivity of the intervention’s evaluation process and strengthened the soundness of its results. To be noted, the PPSI’s coders were masked to study aims and to participants’ group assignments (intervention/control). (2) Relevance: The PPSI protocol development processes, as described in detail in this chapter, attest to the intervention’s relevancy and adequacy. Regarding the child, the PPSI’s goals and contents were founded on the identification of the peer engagement needs in young children with ASD vis-à-vis peer engagement in typical development and adopted relevant feasible techniques that exist in the field. Regarding the facilitator, the PPSI was developed together with psychoeducational staff initially through our preliminary empirical survey, continuing with focus groups, and ending in our pilot study. These stages all provided the ability to closely monitor the feasibility of the PPSI for various preschool educational settings as well as the relevancy of its content to preschoolers with ASD. Moreover, during the RCT study to assess the PPSI protocol, our research team monitored the intervention’s implementation by observing real-time sessions to monitor therapists’ adherence to the assigned protocol, noting any deviations, and providing feedback and guidance to the facilitators in biweekly fidelity meetings. As part of this process, each PPSI facilitator completed a 2-page fidelity questionnaire once weekly reporting any changes they made in implementing five components of the intervention (equipment, activities’ arrangement and duration, instructions given to children, and other changes) and why. One page referred to that week’s social construct learning/acquisition session, and the other page referred to the ensuing two mixed peer-group practice sessions. The research team reviewed and discussed these weekly fidelity questionnaires with each therapist in their biweekly fidelity meetings. At the same time, to learn about challenges that facilitators experienced while implementing the PPSI intervention, the biweekly meetings attended to the facilitators’ ongoing feedback about implementation processes. One of the major issues raised by facilitators was related to the intervention’s pace and the child’s progress. Some children needed more rehearsals, while others acquired skills faster, which holds important implications for tailoring the PPSI to each child’s individual social profile (see recommendations regarding ways to evaluate the child’s profile, set intervention goals, and plan accordingly in Chap. 9). The facilitators also completed a feedback questionnaire after the 6-month PPSI implementation reporting on its relevance, feasibility, and effectiveness. Facilitators’ reports were high overall on all three dimensions, as seen in the following excerpts:

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• I now know how to set treatment goals in the social peer engagement realm…. and I feel more confident in doing so now. • The child has undergone an impressive process, and he has gradually built up skills for adequate peer engagement experiences… I see he is interacting more often with his peers. • After the intervention he started calling me by my name when he wanted my attention… he didn’t do that before. • It’s important for me to say that, in the group, the children experienced a feeling of togetherness with one another… They were happy to meet, to run, hide, and make silly things with each other… I saw a lot of shared fun. • I see more flexibility and openness in various social situations… more tolerance to other peers’ actions and needs, more joining in play activities in the preschool. • Before the intervention, she always talked without waiting for the other child’s response. Now she treats others more carefully and she is more attentive to others’ reactions or questions. • Even his peers with typical development seemed to enjoy taking part in the fun group activities. Thus, the PPSI protocol was thoroughly tested for feasibility, usability, and effectiveness in various checks conducted both during and after termination of the treatment, thereby testifying to its social validity. (3) Effectiveness: Evidence of generalization of the PPSI intervention’s results to untargeted daily preschool activities was reported by each preschool’s head educator. The head preschool teachers were not involved in treatment and were masked to the evaluated children’s intervention group assignment. Thus, the head teachers’ reports demonstrated the children's transfer of learned peer engagement skills to the broader preschool environment. The RCT results discussed above in this chapter also revealed that the participating preschoolers transferred skills from one peer engagement domain to another and that participation in the PPSI intervention contributed to children’s overall adaptive capabilities. These findings substantiate the protocol’s effectiveness and highlight the interconnectivity between the three peer-engagement domains, as elaborated in Chap. 7. (4) Ecological feasibility and usability: Lastly, according to Barry et al. (2003), effective and valid social intervention should include mediation in different social environments, should involve the main socializing agents of the child, and should use adult–child mediation strategies as well as peer mediation in dyads and small social groups. The PPSI program meets all these requirements, as an ecological intervention that takes place in the child’s natural educational environment, is led by the child’s own psychoeducational staff, and incorporates the child’s natural social agents—peer age-mates—either with ASD or with typical development. This program, when implemented within the preschool, provides an inclusive framework for improving social functioning and does not focus solely on mitigating the symptoms of ASD. In this way, it promotes the integrative social functioning of the child.

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Another source of support for the PPSI’s feasibility and usability derives from its successful clinical implementation in tens of preschools. We have already completed the first round of PPSI training for 50 psychoeducational staff members in preschools for young children with ASD and are currently conducting a second training round for an additional 50 facilitators. Thus, currently, the first group of 50 trained early interventionists have already begun to successfully integrate the PPSI into individual psychoeducational programs under close supervision. These active in-service PPSI implementors have reported on their impressions about the practical potential impact of the program, thus contributing further to the social validity and impact of the intervention: The repetitive and structured learning of each of the domains in a consistent setting, with the same typically developing partners, three times a week, was very significant for the children. This is what makes the learning and practice effective and meaningful and helps the children integrate successfully into their peer group. The specific definitions and statements for each skill as detailed in the program were accurate, concise, and written in language appropriate to the age of the children. Because the definitions were supplied to us as part of the program's protocol, we were able to repeat them like a mantra over and over again, exactly as stated and without having to think, on our part, about how to explain it to the children. There is a double benefit here: First, the facilitator doesn’t have to hesitate each time and to think how to explain the concept and, second, the child hears the exact same explanation over and over again until the definition is internalized. I found this to be a huge advantage. Receiving the intervention guide as a package, which combines all three programs together, gave me a more complete view of the program. Furthermore, constructing the program according to themes that make up the required skills helped me to see how the analysis of each skill led to its acquisition and how later it is integrated into overall social functioning. The visual aids, the precise statements, the suggestions for an activity or game adapted to the acquired skill, all contributed a lot to me as an educator working with the children on promoting their social abilities. Helping them generalize the learned skills is challenging when working with children with ASD. As their preschool teacher, who spends a considerable part of the children’s day with them, I make sure to speak to them using the language that they have learned in the program and to use some of the visual aids and statements in the preschool’s daily routines (like circle time, meals, and some group activities). We also shared this information with the other members of the psychoeducational staff so that they could use this language and the various statements during the therapy in the preschool. Another advantage of offering the program in the preschool and not in a clinical setting is the ability to continue to facilitate the various information over time for the child, even after completion of the program. This program was offered to three children in the preschool, all of whom were high functioning but with very different individual profiles. Each had a different

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need from the program. This presented us with the challenge of which topics to choose from each program area that would address all three. In retrospect, I think that this challenge actually contributed to the children and enhanced the program, since, given our experience in the field, we gave each of them the opportunity to gain experience with the skills they needed in order to improve. However, it also gave each one the opportunity to take pride in those areas in which they were strong, so that they were able to contribute and lead the group in those areas. If the program had been tailored for one child only, we would certainly have focused only on their problems.

Conclusions The planning, development, design, formative evaluation, and empirical assessment of the PPSI program supported our major aim to improve children’s peer-engagement capabilities through interaction, play, and conversation. Strengthening these young children’s ability to interact, play, and converse more effectively with their peers is of utmost importance to reduce the risk of poor social adaptation outcomes, both today during preschool and all along these children’s development (e.g., Hay et al., 2009; Vaughn et al., 2016). Overall, the results of the RCT study are encouraging, highlighting the unique contribution of each PPSI content domain (interaction, play, and conversation) to children’s social engagement with peers but also demonstrating the interconnections among the various domains. Three hours per week dedicated specifically to peer-peer engagement produced valuable and meaningful changes in the interactive, play, and conversational capabilities of these young children with ASD, suggesting the value of integrating peer-delivered training into early intervention models. It appears, though, that each of the content domains is needed to create an optimal holistic peer program that supports peer engagement in this age group. Thus, the integration of the various domains is of importance while implementing the intervention into educational-clinical settings. Due to the heterogeneity of the social functioning profile in ASD, PPSI facilitators may take advantage of the three separate extensively targeted content domains in order to design an individualized, tailored intervention for each child. As described in detail in Chap. 4 and as expanded in Chap. 9, facilitators may apply the different content curricula either sequentially or simultaneously to fit each individual child’s specific peer engagement needs. The upcoming chapter expands on implementation of the PPSI in educational settings, including details on facilitator training and supervision, guidelines for evaluation procedures to set appropriate intervention goals, as well as strategies for constructing intervention plans and monitoring the PPSI’s effectiveness for each child.

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References Adams, C. (2002). Practitioner review: The assessment of language pragmatics. Journal of Child Psychology and Psychiatry and Allied Disciplines, 43, 973–987. Barry, T. D., Klinger, L. G., Lee, J. M., Palardy, N., Gilmore, T., & Bodin, S. D. (2003). Examining the effectiveness of an outpatient clinic–based social skills group for high-functioning children with autism. Journal of Autism and Developmental Disorders, 33, 685–701. Bauminger-Zviely, N., Eytan, D., & Hoshmand., S., & Rajwan Ben-Shlomo, O. . (2020). Preschool Peer Social Intervention (PPSI): Study outcomes. Journal of Autism and Developmental Disorders, 50, 844–863. https://doi.org/10.1007/s10803-019-04316-2 Callahan, K., Henson, R. K., & Cowan, A. K. (2008). Social validation of evidence-based practices in autism by parents, teachers, and administrators. Journal of Autism and Developmental Disorders, 38, 678–692. Coplan, R., & Arbeau, K. A. (2009). Peer interactions and play in early childhood. In K. H. Rubin, W. M. Bukowski, M. William, & B. Laursen (Eds.), Handbook of peer interactions, relationships, and groups: Social, emotional, and personality development in context (pp. 143– 161). Guilford Press. Eytan, D., & Bauminger-Zviely, N. (2013). Social interaction curriculum manual [Unpublished manual]. Bar- Ilan University. Eytan, D. (2013). Needs assessment of preschool teachers working with children on the autism spectrum [Unpublished master’s thesis]. Bar-Ilan University. Foster, S. L., & Mash, E. J. (1999). Assessing social validity in clinical treatment research: Issues and procedures. Journal of Consulting and Clinical Psychology, 67, 308–319. Hay, D. F., Caplan, M., & Nash, A. (2009). The beginnings of peer relations. In K. H. Rubin, W. M. Bukowski, & B. Laursen (Eds.), Social, emotional, and personality development in context: Handbook of peer interactions, relationships, and groups (pp. 121–142). Guilford Press. Hoshmand, S., & Bauminger-Zviely, N. (2013). SPQ—social play questionnaire [Unpublished protocol]. Bar-Ilan University. Hoshmand, S., & Bauminger-Zviely, N. (2013). SPO—social play observation [Unpublished protocol]. Bar-Ilan University. Hoshmand, S., & Bauminger-Zviely, N. (2013). Social play curriculum manual [Unpublished manual]. Bar- Ilan University. Howes, C. (1980). Peer play scale as an index of complexity of peer interaction. Developmental Psychology, 16, 371–372. https://doi.org/10.1037/0012-1649.16.4.371 Howes, C., & Matheson, C. C. (1992). Sequences in the development of competent play with peers: Social pretend play. Developmental Psychology, 28, 961–974. https://doi.org/10.1037/ 0012-1649.28.5.961 Katz, E., & Girolammetto, L. (2013). Peer- mediated intervention for preschoolers with ASD implemented in early childhood education settings. Topics in Early Child Special Education, 33, 133–143. Katz, E., & Girolammetto, L. (2015). Peer- mediated intervention for preschoolers with ASD: Effects on responses and initiations. International Journal of Speech-Language Pathology, 17, 565–576. Landa, R., Piven, J., Wzorek, M., Gayle, J., Chase, G., & Folstein, S. (1992). Social language use in parents of autistic individuals. Psychological Medicine, 22, 245–254. Paul, R., Orlovski, S. M., Marcinko- Chuba, H., & Volkmar, F. (2009). Conversional behaviors in youth with high functioning ASD and Asperger syndrome. Journal of Autism Developmental Disorders, 39, 115–125. Rajwan-Ben-Shlomo, O., & Bauminger-Zviely, N. (2013b). SCQ—social conversation questionnaire [Unpublished protocol]. School of Education, Bar-Ilan University. Rajwan-Ben-Shlomo, O., & Bauminger-Zviely, N. (2013a). Social conversation curriculum manual [Unpublished manual]. School of Education, Bar- Ilan University.

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Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales: Survey form (2nd ed.). AGS. Vaughn, B. E., Santos, A. J., Monteiro, L., Shin, N., Daniel, J. R., Krzysik, L., & Pinto, A. (2016). Social engagement and adaptive functioning during early childhood: Identifying and distinguishing among subgroups differing with regard to social engagement. Developmental Psychology, 52(9), 1422–1434. https://doi.org/10.1037/dev0000142

9

Implementation of the PPSI in Psychoeducational Settings

How Can We Begin to Implement the PPSI Protocol in Our Educational Setting? This book has provided a comprehensive presentation of the PPSI intervention model’s theoretical framework, rationales, conceptual basis, underlying principles, empirical evidence, and the three detailed curricula comprising the holistic PPSI intervention program for preschoolers (and kindergartners) with ASD. Now, with this background and these tools in hand, the current chapter offers constructive guidelines to help interested parties carry out the needed steps for applying the presented PPSI model in practice, as best matching their particular educational setting, its optimal change agents, and the targeted preschoolers with ASD. As delineated in Chaps. 5, 6 and 7 the holistic PPSI model contains three clearly distinct, specialized PPSI curricula—to promote social interaction, social play and social pretend play, and social conversation. This separation enables a broad range of personalized implementation possibilities, running the gamut from application of only some selected curricular structures to comprehensive delivery of the full holistic protocol. Importantly, this three-part configuration allows PPSI facilitators to tailor the intervention to each child’s individual needs for peer engagement. The current chapter furnishes some guidelines for undertaking the necessary systematic evaluation of each child that will help establish the child’s social profile; determine whether the three curricular units should be implemented consecutively, one domain at a time, or simultaneously while combining contents from more than one domain; and set the child’s specific social goals. Importantly, this considerable flexibility in applying the three PPSI curricula also permits the on-site facilitators in each educational setting to design its clinical implementation approach as best corresponding with its priorities, budget, personnel, and time resources. A key advantage of the PPSI program is its embedment into young children's daily educational program in their preschool, with their natural social partners, as facilitated by a familiar educator or therapist who has undergone appropriate © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 N. Bauminger-Zviely et al., Preschool Peer Social Intervention in Autism Spectrum Disorder, Social Interaction in Learning and Development, https://doi.org/10.1007/978-3-030-79080-6_9

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training. This ecological integration of the intervention into natural everyday life allows the preschoolers with ASD to learn the needed social skills with a familiar adult and then to practice those new skills with familiar peers in a safe social environment. This chapter discusses how to select facilitators and provide them with PPSI training and how to select optimal peers for participation in the small-group skill practice sessions. Moreover, the naturalistic setting also increases the likelihood that the participating children with ASD will be able to transfer their learned skills to other day-to-day activities in the preschool or at home that were not specifically targeted by the PPSI or to skills that were not directly learned in the PPSI curricula. In this chapter, we will provide suggestions for monitoring the child’s areas of improvement and for expanding the PPSI’s impact to the wider educational program and to the home environment. Overall, the PPSI protocol’s recommended application model for young children with ASD in preschool educational settings includes the following steps, as outlined in the current chapter: • Recruit intervention facilitators and deliver a comprehensive PPSI training program. • Carry out a systematic, focused evaluation process of the child’s social functioning and peer engagement profile based on direct observations, staff reports, and parent reports. • Determine a social intervention plan based on the individual child’s identified social profile, which adapts the PPSI protocol by designing a personally tailored intervention for the child that delivers the various PPSI curricula in full or partially, either sequentially or simultaneously, to fit each child’s low, intermediate, or high social profile. • Set corresponding social therapeutic goals for the child based on the personalized intervention plan, prioritizing the most urgent needs, possibly in collaboration with the child’s therapeutic team, preschool staff, and parents. • Monitor the child’s progress during the PPSI intervention and peer-engagement gains at the treatment’s end, while monitoring the program’s reception in the child’s educational setting. • Promote diffusion of the PPSI intervention into the child’s educational and home settings, especially by fostering generalization and transfer via its inclusion in the child’s ongoing preschool activities.

Intervention Facilitators’ Recruitment and PPSI Training The PPSI psychoeducational facilitator can be a motivated therapist or educator from a range of disciplines. Appropriate PPSI facilitators may include speech and language therapists, occupational therapists, psychologists, dance/art/music psychotherapists, special educators, and social workers. Thus, the facilitator role is

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intended for recognized therapists from the health professions and for educators who hold at least a bachelor's degree in the field of education. However, two important criteria can help select optimal facilitators to undergo training and implement the program: First, the facilitator should be an on-site professional in the target child’s own preschool (or kindergarten), due to the fact that the PPSI was designed specifically to be delivered by a familiar adult in the child’s educational setting. Second, the PPSI facilitator should have experience in working with young children with ASD. Familiarity and prior experience with the child’s own setting and age group promotes the PPSI facilitator’s success in implementing the intervention and in helping the child transfer skills from the narrower intervention context (e.g., the small peer-group practice setting) to the broader preschool environment. Implementation of the PPSI intervention protocol is preceded by a systematic training program for the psychoeducational staff who will be operating the model in the educational system. Information about PPSI national and international training programs, including in-person and virtual workshops, can be found on BaumingerZviely’s ARI Laboratory website: https://www2.biu.ac.il/BaumingerASDLab/. Training includes studying the evidence-based theoretical background for the PPSI intervention and its supervised implementation within the child’s educational setting. Specifically, the PPSI training plan comprehensively includes all of the following components: (a)

(b)

(c)

Theoretical and Empirical Underpinnings. The facilitator trainees receive the conceptual basis, principles, and rationales underlying the PPSI, including the literature review on social functioning characteristics and peer engagement needs demonstrated by young children with typical development and their counterparts with ASD. Training presents the PPSI intervention’s: (a) ecological naturalistic setting, (b) CBT-based psychoeducational model, (c) developmentally appropriate activities, (d) two-stage integrative structure including skill acquisition/learning and skill practice/experiencing, (e) emphasis on peer-peer modeling, (f) adult mediation, (g) mobilization of the visual strengths of children with ASD, and (h) holistic model comprising the three major interrelated content areas—interaction, play, and conversation— as conducive to skill assessment and intervention personalization. Child Evaluation Tools. The facilitator trainees learn how to conduct systematic mixed-method evaluation procedures to assess each individual child's social-communicative profile, tapping each of the three major building blocks of peer engagement: social interaction, play, and conversation. Guidance in Tailoring the PPSI to Each Child and Preschool. Trainees learn how to adapt the various PPSI curricular contents, structures, and techniques to the individual child’s social profile and goals and to the affordances and constraints of the child’s particular preschool setting. Thus, the personalized PPSI program tailored to each child with ASD may differentially structure the delivery (sequentially or simultaneously) of the interaction, play, and conversation curricula and may focus on all or only on some of the relevant aspects of each separate curriculum. To recall:

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(ii)

(iii)

(d)

(e)

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The PPSI social interaction curriculum covers the key building blocks making up peers’ social interactions, focusing on initiating, developing, and maintaining social interaction with peers while emphasizing peer sharing, prosocial skills, and conflict resolution capabilities (Chap. 5). The PPSI social play and social pretend play curriculum covers the key building blocks making up the ability to play with peers, based on a structured developmental model of social play and social pretend play (Chap. 6). The PPSI social conversation curriculum covers the key building blocks making up age-appropriate conversational skills, focusing on turn-taking mechanisms, cooperative dialogue, and conversational genres such as interpersonal conversation, argumentative discourse, and activity talk while teaching the children to initiate, develop, and end their conversation in each genre (Chap. 7). Support in Goal Setting. Trainees learn to set feasible, specific intervention goals that correspond with each child’s evaluated social-communicative profile. Expert Supervision. Ongoing supervision and guidance from expert trainers accompany the facilitator trainees’ hands-on experiences as they actually begin to implement the personalized PPSI intervention plans that they have designed, to selected target children with ASD in their preschools. Active Learning and Peer Support. The training program incorporates facilitator trainees’ active participation in workshops, which includes trainees’ presentation of case studies, ongoing group discussions, and colleague feedback on the actual practical implementation of the PPSI intervention in the preschools.

Evaluation Procedures to Assess the Child’s Social-Communicative Functioning Profile Related to Peer Engagement To determine each child’s individual social-communication profile upon which that child’s personalized PPSI intervention will be designed and implemented, several evaluation procedures should be conducted. Most importantly, the child’s assigned facilitator should evaluate the child’s social functioning characteristics by closely and systematically observing the child during a variety of spontaneous, unmediated interactions with peers in the preschool. The PPSI facilitator should perform open observations of the target child’s peer exchanges along multiple and diverse situations that occur naturally in the education setting, including both indoor free-play activities (e.g., free time, play or craft “corners,” mealtime) as well as outdoor (playground) free-play activities in the preschool. Observations should focus on shared interaction, play, and conversation exchanges that occur in groups containing at least two age-mates other than the selected child, as well as on the child’s dyadic social experiences. Only free-play situations should be observed, not

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teacher-led activities, to allow accurate naturalistic evaluation of children’s spontaneous behavior in unstructured peer contexts. The facilitator can use the assessment guidelines and tools described below in Tables 9.1, 9.2, and 9.3, respectively, to help structure and pinpoint the child’s observation procedures in relation to each of the three building blocks of peer engagement: interaction, play and conversation. Beyond direct observation, the PPSI facilitator can also collect supplementary data on peer engagement capabilities from the child’s head preschool teacher, other preschool staff members, and parents. Such complementary sources of information on the child’s social and communication patterns can help pinpoint particular areas of need and can help the facilitator clarify specific behaviors that were observed with peers in the indoor and outdoor small-group activities. Taken together, all data collected from the different sources will provide the facilitator with broad information on the child’s skills and difficulties in each of the three building blocks of peer engagement, to guide the facilitator’s design of a personalized intervention and corresponding intervention goals.

Evaluation of Peer-Interaction Behaviors While observing the child’s peer engagement behaviors during unmediated interactions with peers and while conducting data collection from complementary sources, facilitators should focus on evaluating several main behaviors within the PPSI domain of social interaction: positive, functional, and non-adaptive behaviors. Table 9.1 presents the PPSI evaluation tool (Bauminger-Zviely et al., 2019) for assessing the child’s frequency of social interactive behaviors, rated on a 5-point Likert scale. Next, each of these peer interaction behaviors to be evaluated is briefly described. Table 9.1 Evaluation of the frequency of child’s peer social interaction behaviors Observed peer interaction behavior

1

2

Frequency 3

4

5

Does not occur at all

Rarely occurs

Occurs half the time

Often occurs

Occurs consistently

A. Positive social-interaction behaviors Goal-directed cooperative behaviors Sharing and joint attention behaviors Prosocial behaviors Emotional expressiveness— variety and adequacy B. Functional social peer-interaction behaviors C. Non-adaptive behaviors Note Derived from the PPSI–Peer Evaluation Scale (PPSI-PES; Bauminger-Zviely et al., 2019)

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Positive social interaction. The facilitator should evaluate the extent to which the child exhibits verbal and nonverbal social behaviors that lead to an effective social process with peers—behaviors that serve to start or maintain social interaction. Positive interactive behaviors include several subcomponents that should be evaluated separately: (a) Goal-directed behaviors include cooperative behaviors directly related to performance of a joint task/activity, such as shared planning (“put the blue block first and then the red”), directives and guiding of the joint activity (“put this here”), sharing information (“the doll is hungry”), description (“I make soup now”), and observing another child’s actions. (b) Sharing behaviors refer to experiences or emotions when the child offers to share their objects with another child or accepts another child’s offer, or the child tells peers about an experience or asks them about their experience (“I like to ride a bike - do you also like to?”). Joint attention behaviors are also important here, when the child makes a reference to an object/event by looking at the object, then at the peer, and then back to the object/event or when the child follows the peer’s gaze with or without speech or gesture, turning the face or eyes toward the target direction. (c) Prosocial behaviors are behaviors that reflect the child’s awareness and responses to another child’s distress or needs, and behaviors that demonstrate concern, involvement, and caring toward another child. For example, giving the peer an object that provides comfort or that the peer needs, providing help and also asking for help, giving up a toy or a turn to a peer during joint play, encouraging a peer (“you can do it”), showing sympathy and empathetic statements (don’t cry”), apologizing, and compromising (“okay, you play first and I’ll go after”). (d) Emotional expressiveness refers: to the variety of facial expressions exhibited— the range of appropriate facial communication expressed toward the peer; and to expressions’ quality—the extent to which the emotional response corresponds with the situation or with the peer’s state of mind. Functional social peer-interaction behaviors. The second major peer-interaction component that the facilitator should evaluate is children’s merely functional social behaviors. “Functional” behaviors refer to the child’s actions that indicate social intention toward peers, but with minimal social enactment, such as close proximity to children without initiating a positive social interaction, imitating a peer’s action without active participation or contribution, and gazing at peers but not making eye contact with them. Functional behaviors also include those that are characteristic of the ASD syndrome, such as functional echolalia or idiosyncratic language to express interests or ideas. Non-adaptive behaviors. Finally, the facilitator should evaluate the extent to which the child exhibits unpleasant peer-interaction behaviors or inappropriate social behaviors that may decrease the likelihood of developing adequate social

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interaction. These may include avoidant behaviors (looking away), stereotypical repetitive behaviors, or showing adverse interactions with or without aggression.

Evaluation of Social Play and Social Pretend Play Behaviors While conducting data collection from direct open observations of the target child’s unmediated play interactions with peers and from complementary sources, facilitators should evaluate the frequency and highest achieved stage of the child’s social and social pretend play behaviors along the hierarchical progression of play development stages outlined by Howes (1980; Howes et al., 1992) as well as the quality of the child’s repertoire of specific play skills. As described next, Table 9.2 presents the evaluation tool for assessing the PPSI play domain (Bauminger-Zviely et al., 2019), describing the child's frequency, highest stage, and quality of peer play behaviors to be assessed by the facilitator in order to optimally design the child’s PPSI intervention. Frequencies of play behaviors. Using direct observation and other information sources, the facilitator should evaluate the frequency at which the child exhibits play behaviors with peers during free-play situations, according to the Howes’s hierarchical developmental model as detailed in Chap. 1 (Howes, 1980; Howes et al., 1992, see Table 1.1). Specifically, the facilitator should evaluate the frequency of the child’s observed play behaviors characterizing each of the five main stages of social play development (parallel, parallel aware, simple, interactive-complementary, and reciprocal) and each of the five main stages of social pretend play development (solitary, solitary directed to a partner, coordinated, simple social and associative, cooperative, and complex play), rated on a 5-point Likert frequency scale as seen in the top section of Table 9.2. Highest achieved stage of play behavior. Utilizing the Howes hierarchical developmental model, the facilitator should also identify the highest and most complex play level that the child demonstrates. Thus, the facilitator should locate both the highest achieved stage of social play and the highest achieved stage of social pretend play (ranging from 1 as lowest to 5 as highest developmental stage) that were observed during the child’s evaluation procedure (see top right of Table 9.2). The integration of the child’s play frequency together with the child’s highest play level will assist in personalizing the child’s social play intervention and in setting corresponding therapeutic play-related goals. Quality of play behaviors. To determine the quality of the child’s social-communicative skill repertoire during social play and social pretend play with peers, the facilitator should evaluate eight different areas of play-relevant social behavior. These include: awareness of and proximity to other children, orientation of social overtures toward peers, degree of involvement and participation in peer play, motivation for peer play, ability to play social games, quality and content in cooperative pretend social play, meta-communication about the play during pretend play, and types of social roles observed during social pretend play. As seen in the bottom section of Table 9.2, the quality of social and social pretend

Plays alone at a distance from other peers

Shares objects with peers

1. Awareness of and proximity to other children

2. Orientation of social overtures toward peers

Play skill

Observed peer play behavior

(5) Complex

(4) Cooperative

(3) Simple social and associative

(2) Coordinated

(1) Solitary directed to a partner

B. Social pretend play

Does not occur at all

1 Often occurs

4 Occurs consistently

5

Actively offers and receives objects from peers

Converses with peers

Plays in close proximity to Plays alone but in close proximity to other children, peers with same objects and with signs of awareness and games interest in peers

Exchanges objects with peers

Gazes at other peers

Plays together with Pays attention to other peer’s actions other children during their play and imitates them

(continued)

Each skill’s sum quality score (1–5 per row)

Highest developmental stage achieved (mark stage once for A and once for B)

Quality of play skills (Circle all behaviors in each row reflecting child's observed behaviors for that play skill, with each circled behavior receiving a score of 1)

Occurs half the time

3

Frequency of play behaviors Rarely occurs

2

9

(5) Reciprocal play

(4) Interactive-complementary play

(3) Simple social play

(2) Parallel aware play

(1) Parallel play

A. Social play

Hierarchical developmental play stage

Observed peer play behavior

Table 9.2 Evaluation of the frequency, highest stage, and quality of child’s peer play behaviors

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Can play complex social games with no official rules

Reverses roles in play

Suggests and plays in Proposes own creative accordance to planned suggestions and expansion for play with a peer partner scripts

Plays in collaboration with peers

Fictional roles

8. Types of social roles

Role reversed imaginary roles

Plans play activities in collaboration with other children

Note. Derived from the PPSI-PES (Bauminger-Zviely et al., 2019)

Negotiates with peers on play topics, assigning roles, game rules, and scripts

7. Meta-communication about the play during pretend play Identity/symbolic roles

Complementary roles

Parallel roles

Performs pre-planning of play with peers

Can follow basic Can follow more complex scripts that simple scripts and include several steps play accordingly

Suggests scripts for pretend Suggests ideas and play topics for pretend play

Plays in a variety of topics with peers, mostly the child’s own personal everyday life situations

Plays only board games with rules

Joins in or responds positively to peers’ suggestions for shared play

Initiates social play with peers

Joins other peers’ suggestions for play and expands on them

Plays complex social games Plays simple social with rules games with rules

Takes turns in the game

Plays rough-and-tumble games and silly motoric games

Shows involvement in pleasurable play with a group of peers

Quality of play skills (Circle all behaviors in each row reflecting child's observed behaviors for that play skill, with each circled behavior receiving a score of 1)

Plays in a variety of topics 6. Quality and content in Plays in complex joint pretend social play abstract and imaginary with peers, including broader contexts related to scripts with peers the community

5. Ability to play social games in groups

4. Motivation for peer play

Shows reciprocity 3. Degree of during play with a involvement and participation in peer play peer or a group of peers

Observed peer play behavior

Table 9.2 (continued) Each skill’s sum quality score (1–5 per row)

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play is assessed by summing all relevant behaviors that the child exhibits during peer play exchanges regarding each of the eight assessed play skills.

Evaluation of Social Conversational Behavior Facilitators should focus on evaluating several main behaviors within the PPSI domain of peer social conversation, while observing the child’s spontaneous peer talk during unmediated social engagement situations (e.g., during meals, on the playground) and while conducting data collection from complementary sources. These central conversational behaviors include the child’s participation in peer conversations where conversational mechanisms are maintained; adjustment of utterances to achieve cooperative dialogue; and participation in a variety of age-appropriate conversational genres. Table 9.3 presents the PPSI evaluation tool (Bauminger-Zviely et al., 2019) for assessing the child's frequency of social conversation behaviors, rated on a 5-point Likert scale. Next, each of these peer talk behaviors to be evaluated is briefly described. Table 9.3 Evaluation of the frequency of child’s peer social conversation behaviors Observed peer conversation behavior

1

2

Does not occur at all

Rarely occurs

Frequency 3 Occurs half the time

4

5

Often occurs

Occurs consistently

A. Participating in conversation and maintaining conversation mechanisms Appropriately initiates conversation with peers Appropriately responds to conversation with peers Preserves turns in a conversation—takes and gives turns, keeps turns’ timing Attains a peer’s attention and/or pays attention to a peer’s talk B. Adjusting utterances to achieve cooperative dialogue Adjusts utterances to a peer partner according to the situation/partner and builds common ground with the peer Adjust utterances to a peer partner according to the topic, context, and speech load (continued)

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Table 9.3 (continued) Observed peer conversation behavior

1

2

Does not occur at all

Rarely occurs

Frequency 3 Occurs half the time

4

5

Often occurs

Occurs consistently

Adds information, develops, and/or elaborates on the conversation's topic appropriately Can negotiate with and persuade peers C. Variety of participation in conversational genres Participates in activity talk while playing or while interacting in an activity Participates in social talk —“interpersonal sharing” of personal experiences and feelings Participates in argumentative conversation by expressing verbal disagreement with an interlocutor, persuading, trying to prove he/she is right, or discussing a topic from different viewpoints Note. Derived from the PPSI-PES (Bauminger-Zviely et al., 2019)

Participating in conversation and its mechanisms. The facilitator should first evaluate the extent to which the child spontaneously becomes involved in peer conversations and reveals the ability to maintain verbal turn-taking mechanisms. This includes initiating and responding to an appropriate conversation with peers in the child’s natural surroundings, taking turns in a conversation, and regularly paying attention to other preschool children. Adjusting utterances to achieve cooperative dialogue. The second major peer-conversation component that the facilitator should evaluate is children’s ability to adjust their verbal utterances in order to develop, maintain, and preserve peer dialogue of adequate quality. This includes assessment of the child’s behavior indicating adaptions to the conversational partner, to the topic under discussion, and to the context, as well as the child’s proposal of relevant topics that may continue the dialogue and attempts to build on the peers’ responses and create a flowing conversation. Participation in diverse age-appropriate conversational genres. Evaluation of the child’s variety of conversational genres indicates types of talk situations that may need specific intervention. The major age-appropriate conversational genres for preschoolers include activity talk, which is related to play activity or other

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interactive social activity; social talk, which includes “interpersonal sharing” of personal experiences and feelings; and argumentative conversations, which express disagreement between interlocutors and discuss different perspectives of the same topic.

Constructing the Child’s Social-Communication Profile for Interaction, Play, and Conversation Upon completion of the comprehensive information collection process—entailing direct observations and the staff’s and parents’ reports—the PPSI facilitator is ready to begin constructing a detailed, fine-grain profile reflecting the child’s specific social-communicative behaviors. At this point, as a crucial step before personalizing the intervention protocol and setting intervention goals, the facilitator can easily and systematically calculate each child’s functioning level in the various categories and components of functioning as well as overall summed scores for each of the three PPSI domains (interaction, play, and conversation). Specifically, using Tables 9.1, 9.2, and 9.3, the evaluation of each separate category/component yields a score ranging from 1 to 5. Thus, on each skill or behavior, the child’s functioning can be classified as one of three possible levels: low (scoring 1–2), intermediate (scoring 3), or high (scoring 4–5), as presented on Table 9.4. Moreover, a full social profile can be determined for the child, by

Table 9.4 Constructing the child’s social-communication profile levels in interaction, play, and conversation domains PPSI peer engagement domain

Description of the social behavior

Social interaction

Mean frequency scores: Positive social interaction behaviors 1–2 Functional behaviors 1–2 Non-adaptive behaviors 4–5 Mean frequency: Social play 1–2 Social pretend 1–2 play Highest play stage Social play 1–2 achieved: Social pretend 1–2 play Sum of behaviors’ quality in each play skill: 1. Awareness of and proximity to other 1–2 children 2. Orientation of social overtures toward 1–2 peers 3. Degree of involvement and 1–2 participation in peer play 4. Motivation for peer play 1–2

Social play and pretend play

Social profile level Low Intermediate High 3 3 3 3 3

4–5 4–5 1–2 4–5 4–5

3 3

4–5 4–5

3

4–5

3

4–5

3

4–5

3

4–5 (continued)

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Table 9.4 (continued) PPSI peer engagement domain

Social conversation

Description of the social behavior

Social profile level Low Intermediate High

5. Ability to play social games in groups 1–2

3

4–5

6. Quality and content in joint pretend social play 7. Meta-communication about the play during pretend play Types of social roles Mean frequency scores: Participating in conversation and maintaining its mechanisms Cooperative dialogue quality Conversational genres: Activity talk Social (interpersonal sharing) talk Argumentative talk

1–2

3

4–5

1–2

3

4–5

1–2

3

4–5

1–2

3

4–5

1–2

3

4–5

1–2 1–2 1–2

3 3 3

4–5 4–5 4–5

summing all the behaviors evaluated in each of the three PPSI peer engagement domains, thereby providing a holistic picture of the child’s areas of strength and difficulty and helping guide the facilitator’s decision-making with regard to selecting sequential or simultaneous curricular design and setting specific goals. To be noted, children can show a mixed social profile, for example demonstrating a high social play profile (scoring 4–5), an intermediate social interaction profile (scoring 3), and a low social conversation profile (scoring 1–2). Treatment priorities and foci can then be personalized based on the child’s three-domain social profile level.

How Do We Adapt the PPSI Program to Fit the Specific Child’s Needs? The extensiveness and comprehensiveness of each of the three separate PPSI curricula making up the PPSI protocol enable the facilitator to design a tailored, individualized intervention that will fit each child’s own unique peer-engagement needs. Based on growing holistic expertise in all three key domains of interaction, play, and conversation, the PPSI facilitator can generate treatment priorities, sequencing, and goals for each child. As said, the PPSI three intervention domains can be implemented sequentially or simultaneously. The child’s individual social profile will determine treatment priorities—namely, whether there is one more urgent domain (exhibiting a very low social profile level) that should be delivered prior to the others and in a more intensively focused way. Alternatively, another child’s more homogeneous social profile may clearly suggest the need to integrate

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Table 9.5 Recommended PPSI protocol lessons according to child's social profile level Child’s Lessons from the PPSI social interaction curriculum profile level

Lessons from the PPSI play Lessons from the PPSI curriculum conversation curriculum

Basic/low

Lessons 1–3, 20–21: concept clarification of play, shared peer play, playing alone and playing together, and “pretending” Lessons 4–6: parallel aware play Lessons 7–11: simple social play Lessons 22–30: coordinated social pretend play, simple social pretend play, and associative play

Lessons 1–9: concept clarification of joint cooperative activity, learning how to initiate and join a joint activity

Intermediate Lessons 10–12, 16–21: sharing resources and objects, using prosocial skills such as giving in, compromising, helping

High

Lessons 13–15, 22–36: sharing ideas, prosocial skills like encouragement, sympathy, comfort, conflict resolution, and forgiveness

Lessons 12–18: interactive-complementary play and reciprocal play Lessons 31–36: cooperative and complex social pretend play

Summary lessons

Lessons 37–39

Lessons 19, 37–42

Lessons 1–6, 19–21, 31– 33: concept clarification of social conversation, conversation rules, initiating and closing a conversation Lessons 7–9, 13–18: conversational genres including interpersonal conversation, activity talk, and appropriate topics while playing together Lessons 22–30, 34–36: conversational topics, developing, elaborating, and maintaining a conversation, correcting conversational failure, and participating in argumentative conversation Lessons 34–36

contents from more than one curriculum. For example, the facilitator can design a personalized intervention protocol that concentrates on play skills while also promoting conversation skills, or one that focuses on social interaction skills while also fostering appropriate play behaviors. Table 9.5 describes recommended lessons to be integrated according to child's social profile level. Next, we provide some examples of how to use an integrated synchronous PPSI model that includes components from the three PPSI peer-engagement domains.

Adaptations for the Child with a Low-Level Social Profile For a child whose social profile demonstrates a low, basic level of social functioning and overall difficulty in peer engagement spanning all three PPSI areas, we recommend working on a combination of contents from the three PPSI curricula. The intervention for such a child would combine support for the child’s knowledge building and practical experiencing of behaviors related to initiating and responding to interactions with peers, initiating and responding to conversations with peers, and

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play activities that promote the child’s awareness of the presence and play of other children. For children with an overall low social profile, an important basic concept to emphasize during the learning and practice stages would be the distinction between an activity that one can perform on one’s own versus an activity that is best performed with a peer, such as playing together or talking to someone. For practice, important goals would be to initiate an interaction with a peer for a shared activity or to initiate a simple basic conversation such as inviting another child to play. In a like manner, it can be worthwhile to work with this child on practicing how to respond to a peer, whether during basic interactions, initial conversations, or when invited to play. To be noted, the components of initiation and responsiveness should relate to all three PPSI domains—interaction, play, and conversation. For example, the intervention design for children with a low overall social profile could combine Lessons 4–6 from the Interaction protocol (focusing on initiation of social interaction); Lessons 1–3 from the Play protocol (focusing on playing alone and playing together); and Lessons 1–6 from the Conversation protocol (focusing on initiating a conversation). The small-group practice sessions will offer activities that enable practicing in all three areas, and the repetitive theme (e.g., initiations) experienced in different engagement contexts simultaneously or in close succession will help deepen and broaden the learning process.

Adaptations for the Child with an Intermediate-Level Social Profile For a child functioning at a moderate social profile level and whose main difficulty involves initiating social play and conducting pre-play conversations that focus on planning the game, a personalized program can be formed that combines components from the three PPSI peer-engagement areas that relate to this functional level. Specifically, such an intervention would emphasize content that supports forming knowledge about and applying social behaviors that relate to others and developing the enjoyment that can come from sharing in a social interaction, playing together, or having a conversation with one or more peers. According to the child’s social profile, relevant content should be selected from all three areas and might include participation in activities, playing with a peer, taking turns, sharing game resources, playing according to the rules of the game—all at a level of complexity appropriate to the child. This could also include building up the child’s awareness and knowledge about the types of conversational types and which types are appropriate for planning and playing these activities. In this case, small-group practice might include a conversation activity that is designed to precede a game for the purpose of planning. Such planning talk should include the children's decision about which roles they will take during the upcoming play and should reference the rules of the game. This conversation presents a “crossroads” between the components of conversation skills (suggesting ideas, practicing different conversational types such as activity talk and

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argumentative conversation) and the skills and essential components required for participating in simple social play. If the child is ready, it can also relate to the skills required for interactive-complementary social play, which include preliminary organization of the play using appropriate language, adopting different roles while playing, and paying attention to what others are doing. After a preliminary discussion in the small peer group about the aforementioned concepts (e.g. participation in a play activity and activity talk), an activity can be held to enable the children to practice the principles of interactive-complementary play. These include determining and upholding rules, maintaining reciprocity, and performing role switching during the game. At times, during the activity, the adult facilitator may do well to artificially create situations where the children will have to resolve disputes, share resources, or negotiate about their desires in the game, while giving in and compromising. These components are presented in the social interaction part of the program. At the end of the activity, a conversation mediated by the adult can be held to summarize and discuss how the children played, referring for example to what they enjoyed, reviewing the narrative that they used to guide their play, discussing how they developed the play, and asking how they would like to play the next time. At this stage, such discussion permits children’s practice of specific conversational goals such as expressing personal opinions, sharing experiences, and so forth.

Adaptations for the Child with a High-Level Social Profile Combining the three PPSI areas is also beneficial for the child who presents a high social profile level but has difficulties in preserving, sharing, and expanding ideas in conversation or in social play and social pretend play. These skills can be facilitated by the learning/acquisition sessions held with the facilitator, which can encourage the child to acquire knowledge and practice new concepts in the safety of the one-on-one session with the familiar adult. Constructs of importance for such children include sharing ideas in conversations in general and in pre-game activity conversations in particular, preserving shared meaning during conversations and social pretend play, and coping with situations of conflict that arise during complex social play and social pretend play. During the small peer-group meetings for a targeted child with a high social profile, emphasis should be placed on children’s joint planning of pretend play activity while clarifying peers’ ideas and reaching agreement. The planning component enables practice of game activity talk as well as argumentative conversation. The play activity will then take place according to the ideas consolidated during the preliminary planning talk, and it will involve the need for children to solve problems that arise during play (including some artificially created by the facilitator). Finally, the facilitator will mediate a concluding conversation about the game and the play experience, emphasizing sharing of feelings, ideas, and experiences as well as the strategies used to resolve conflicts.

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Setting Explicit Social Intervention Goals for the Personalized PPSI Protocol Constructed to Fit the Child’s Social Profile Facilitators will next determine specific intervention goals for each category and component of the interaction, play, and conversation domains that facilitators have selected in order to construct the child’s individualized PPSI protocol on the basis of the child’s low, intermediate, and high social-communication profile. Tables 9.6, 9.7, and 9.8, respectively, provide examples of feasible, specific intervention objectives for all categories and components within the three PPSI peer engagement domains: interaction, play, and conversation.

Table 9.6 Intervention objectives to promote social peer-interaction skills Targeted interactive skills

Sample goals

Sharing behaviors (e.g., resources and objects, The child will … emotions and thoughts, and joint attention) 1. … share games/objects/snacks with peers 2. … draw the attention of a peer toward something that interests/engages him/her 3. … share with a peer something that he/she likes/experienced/wants Prosocial behaviors (e.g., compromising, The child will … giving in, helping, encouraging, sympathizing, 1. … offer help to a peer comforting, apologizing) 2. … ask for help from a friend 3. … allow a peer to use a game/object that she/he also wants 4. … offer a compromise strategy such as majority rules/ “eeinie meenie”/ taking turns, etc 5. … encourage a friend 6. … compliment a friend 7. … comfort a friend who expresses difficulty or pain 8. … apologize if he/she hurt another child Emotional expressiveness—variety and The child will … adequacy 1. … respond appropriately to a peer’s emotional expression 2. … express pleasure by smiling or laughing during a fun cooperative activity with friends 3. … share laughter with friends 4. … show signs of distress when failing 5. … cry or show signs of distress when someone physically hurts him/her or is not nice to him/her 6. … direct a concerned look toward a friend who is showing signs of distress (continued)

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Table 9.6 (continued) Targeted interactive skills

Sample goals

The child will … 1. … offer a peer a part of a toy or other object 2. … ask a peer questions to obtain missing information 3. … answer a peer’s questions, 4. … verbally describe to peers what he/she is doing 5. … play while watching peers Functional interaction (e.g., physical proximity, The child will … verbal imitation, nonverbal imitation, 1. … play next to other peers functional echolalia) 2. … verbally imitate peer group members 3. … mimic the activities of other children in the group Non-adaptive behaviors (e.g., stereotypical The child will… behavior, non-functional echolalia) 1. …functionally participate in group activities 2. … respond verbally (but not aggressively) during an argument or quarrel 3. … include peers in his/her play 4. … actively participate in cooperative activities with peers

Goal-directed, cooperative behaviors (e.g., suggests/responds to action, requests/offers information, describes an activity, observes another child)

Table 9.7 Intervention objectives to promote peer social play and social pretend play Targeted play skills along developmental stages Social play Stage 1. Parallel play

Stage 2. Parallel aware play

Sample goals

The child will … 1. … play independently while in physical proximity to other children playing 2. … engage in a similar or identical activity to other children at play (type of game/toy/activity) The child will … 1. … develop awareness of other children's play and show observation and imitation skills relating to others 2. … perform activities in accordance with other children 3. … play games that require attention to what other peers are doing (continued)

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Table 9.7 (continued) Targeted play skills along developmental stages

Sample goals

Stage 3. Simple social play

The child will … 1. … play in close proximity to other children and together with them 2. … be involved in rough-and-tumble play with other children 3. … increase level of involvement during social play and other fun activities with other children 4. … experience shared enjoyment when playing with other children 5. … show the ability to share focus on the same activity with other children 6. … direct social behaviors toward others (taking turns, sharing, exchanging toys, talking, giving and receiving), 7. … play simple social and group games with other children The child will … 1. … join/initiate/respond to cooperative social play 2. … initiate/respond to suggestions and expansions while playing with a partner 3. … reverse roles in cooperative play and take on complementary roles 4. … play with each other in a reciprocal manner 5. … play in collaboration with other children 6. … play simple social games according to rules 7. … maintain the duration of interaction between children with respect to play 8. … play board games with another child without the mediation of an adult The child will … 1. … play complex social games with other children 2. … offer meta-communication about the game 3. … play according to a plan developed together with other children

Stage 4. Interactive-complementary play

Stage 5. Reciprocal social play

Social pretend play Stage 1. Solitary play

The child will … 1. … learn the concept of “pretend” and perform sequences of actions as if with real toys 2. … increase the variety of characters and participants in pretend play (continued)

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Table 9.7 (continued) Targeted play skills along developmental stages

Sample goals

Stage 2. Solitary play directed to a partner

The child will … 1. … play in coordination with another child based on a shared meaning for an object The child will … 1. … perform pretend complementary acts and imitate acts of pretend situations 2. … create shared pretend meanings for objects with other children 3. … interact with other children in a make-believe game focused on objects 4. … play with other children according to scripts that reconstruct everyday life situations using real and symbolic objects 5. … play in parallel pretend roles The child will … 1. … play according to the scripts played by other children 2. … cooperatively build scripts for play with other children 3. … show ability to diversify and develop scripts (regarding stages in the script and variety of pretend play themes) 4. … take on complementary dramatic pretend roles when playing with other children 5. … show ability to reverse roles when pretend playing with other children 6. … play according to scripts that include social and community elements The child will … 1. … play identity roles and show ability to change identities 2. … meta-communicate about the pretend play (planning and organizing the game, proposing themes and ideas, proposing scripts, negotiating roles, structuring the game) 3. … show ability to mentally think about the pretend play 4. … play by investigating and coping with other children on emotional issues that concern the child 5. … play according to imaginary and abstract scripts

Stage 3. Coordinated and simple social and associative play

Stage 4. Cooperative play

Stage 5. Complex play

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Table 9.8 Intervention objectives to promote social conversation and peer talk Targeted conversation skills

Sample goals

Participating in conversation and maintaining its mechanisms

The child will … 1. … initiate a conversation with peers by asking for their attention through calling their names, while keeping appropriate physical distance from them and showing adequate facial expression and eye contact during conversation 2. … obtain the attention of conversational peer partners before the interaction begins by initiating an interaction and waiting for their response using eye contact, gaze, or verbalization 3. … react to calling of his/her name or to other children's conversational initiatives by looking, using appropriate body position, and verbally responding (“yes,” “what?” etc.) 4. … participate in a conversation that includes several turns 5. … take a turn in the conversation and identify when it is his/her turn to participate in the conversation, demonstrating appropriate timing for entering the conversation (avoiding overlaps or inappropriate delay) 6. … allow the conversational partner to take their turn during the conversation, identify cues on the part of the partner for wanting a turn, and refrain from dominating the conversation 7. … initiate a conversation with diverse partners 8. … end a conversation appropriately (having taken full advantage of the conversation, or as a result of hints given by the partner) and use appropriate utterances to end the conversation

Dialogue cooperation quality and conversational genres

The child will … 1. … bring up topics of conversation relevant to the context, situation, and partners 2. … provide information during the conversation in accordance with the partner's prior knowledge 3. … give appropriate feedback based on the partner’s expression and in a manner appropriate to the content 4. … provide new information (avoiding repetition of information already said during the conversation by the child or the partners) 5. … participate in activity talk during play/meal/activity time in the preschool’s daily routine 6. … participate in an argumentative conversation like negotiating for a toy or a turn in a game, persuading others to give in, persuading others to agree with him/her 7. … participate in a social conversation comprising interpersonal sharing of an experience or event, stating feelings about the event, showing interest in others’ experiences, or expressing opinions about the experiences of others

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PPSI Setting, Structure, and Peer Characteristics Based on the child’s social profile, intervention goals, and preschool affordances and requirements, the PPSI facilitator will determine the optimal intervention plan for the target child, including consideration of the appropriate settings, structure, and involvement of peers with typical development. The PPSI contents and structures not only should be adapted to the needs of the target children with ASD, as has been the focus of the current chapter, but also should take into account the specific characteristics and requirements of the educational setting and its psychoeducational staff, including those of the PPSI facilitator. The success of the PPSI program’s integration into the educational setting will be a result of a good fit between the educational characteristics and the PPSI requirements. PPSI small-group setting. The appropriate setting for intervention targeting the preschooler with ASD refers to whether the peer practice/experiencing stage of treatment will be delivered in a dyad or small group context and whether the child’s peers will be role models and mediators with typical development or other children with ASD. As reported in Chap. 8, the PPSI program was comprehensively designed and empirically examined in a mixed-group setting, where the peer practice stage of intervention was conducted in a small group comprising two children with typical development and between one and two preschoolers with ASD. Thus, for example, if the characteristics of the educational setting do not enable inclusion, then the PPSI intervention can be also implemented with a non-mixed group (solely preschoolers with ASD). Moreover, in our empirical study, we only recruited children who were cognitively able (IQ > 75). Due to the large heterogeneity in cognitive functioning characterizing children on the spectrum, we recognize that the clinical implementation of the PPSI may require some modifications to meet the needs of children who are less cognitively able. One possible adaptation of the PPSI setting in this regard can be to work in peer dyads instead of a group, if the child’s attention skills or mentalization capabilities are less developed. During our clinical workshops, in Israel, we were successful at providing those modifications to the PPSI protocol to fit to a broader spectrum of young children with ASD. Those required modifications can be determined by consulting the child’s psychoeducational team and parents. PPSI structure. The recommended structure of the PPSI protocol includes three 45-min sessions per week held in a quiet separate room in the preschool. One session per week comprises an experiential learning activity to promote the child’s acquisition of that week’s social construct in a one-on-one session with the facilitator. The other two sessions per week enable practice and experiencing of that week’s learned social construct in small peer groups under the facilitator’s guidance (unless dyads are called for as mentioned above). The peer group consists of the same 3–4 children across the whole PPSI intervention because familiarity enables the development of rapport during group work and thus may lead to better treatment results. If presented in full, each of the treatment curricula (interaction, play, and conversation) provide three weekly lessons over a 6-month duration; however, if

PPSI Setting, Structure, and Peer Characteristics

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more repetitions are necessary (e.g., when children demonstrate a very low social profile in some areas), the delivery period for each content curriculum may last longer. We recommend that the child’s personalized PPSI intervention plan should be incorporated into the child’s yearly educational program. Role of peers with typical development. The most important issue for the facilitator to bear in mind when planning the incorporation of typically developing peers into a child’s PPSI intervention is that the ongoing activities conducted in the mixed-group setting should be fun and enjoyable experiences for both the target child with ASD and for the typically developing age-mates. Thus, the small peer group’s social activities and tasks should be designed to fit the participating children’s interests and preferences. In a mixed PPSI setting (that includes a child with ASD and typical peers together), the role of the typical peers is to participate as social partners in all group activities. Their participation provides authentic modeling of how to adapt social behavior to diverse peer-engagement situations. The typically developing children should not be provided with specific instructions other than inviting their cooperation around the sets of activities organized by the facilitator, according to the various social goals to converse, interact, or play, with an emphasis on fun group activities. It is important to ensure that the typical peer group members should not have any serious difficulties such as a conduct disorder or diagnosed attention deficits that may reduce their ability to act as spontaneous social change agents. The typical peers should also be of a similar age to the preschooler with ASD and preferably of the same sex, to enhance the similarity of the peer modeling. They should exhibit at least average social competence capabilities as can be expected from children their age, to permit them to act as reliable peer partners. The key point to remember is that the facilitator is responsible for the well-being of those preschoolers with typical development as much as for the progress of the child with ASD. Based on our extensive experience in selecting and operating small peer groups in educational settings throughout Israel, this awareness on the part of the facilitator is a key component to the successful integration of the typically developing children into the PPSI intervention groups.

Ongoing Evaluation During and After Intervention An important aspect of the facilitator’s role is to continue to examine the PPSI implementation’s effectiveness for the child’s peer-engagement skills, both throughout the entire intervention period and also following the protocol’s completion. First, during the intervention’s implementation, the child’s progress should be consistently monitored and validated by the PPSI facilitator. By continually reevaluating the effectiveness of the designed personalized intervention protocol, the facilitator may identify the need to modify selected goals, increase repetitions, skip less urgent activities, and so forth. Specifically, throughout the PPSI intervention, the child’s progress in the following areas should be monitored:

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• Acquisition of social concepts and their application both in the small group and in general in the preschool environment • Level and adequacy of social participation in the peer group • New social skills that have been acquired and partial skills that have improved • Social skills that still need to be improved • Generalization and transformation of skills that were acquired in the small group and now have been exhibited in the wider preschool environment. Ongoing evaluation of these areas during the PPSI intervention period can be conducted via informal or formal observation by the facilitator or by enlisting another preschool staff member as an objective observer. Monitoring of generalization and transfer can also be discussed in staff meetings in the preschool, and parents can be asked for feedback about possible changes at home in peer exchanges with siblings, neighbors, extended family, and so on. Upon completion of the PPSI program, the facilitator should perform a post-intervention evaluation of the child’s gains in peer-engagement skills in order to identify the child’s continuing areas of difficulty or specific goals that require more practice, which will need follow-up attention from the preschool or later school psychoeducational staff. This evaluation at the end of the PPSI intervention should assess the child’s progress in the following major ways. First, the child’s abilities for social interaction, social play and social pretend play, and social conversation should be measured using the same evaluation procedure that was used at the beginning of the intervention. Second, the facilitator should evaluate the child’s degree of improvement and generalization of skills based on the goals set at the beginning of the program. Also, the facilitator could be advised to write up a final evaluation summary for the head teacher, the parents, or both. This summary could incorporate a list of the intervention strategies to which this particular child responded most effectively (and enjoyed most), as well as the child’s continuing areas of difficulty and their possible implications. This official or informal document could also serve later educators and specialists—giving them specific practical tools for when they design their future work practices with this child. In addition to monitoring the child’s ongoing progress in peer engagement skills during the intervention and the child’s gains at the end of the intervention, the PPSI’s implementation should also be accompanied by the PPSI facilitator’s ongoing monitoring of the preschool environment. Specifically, throughout the intervention period, the facilitator should occasionally assess the levels of cooperation and satisfaction experienced by those involved in the program. Feedback from the preschool staff should be invited to examine what problems arose during the intervention’s implementation and to obtain recommendations for changes. Implementation of the PPSI within the child’s educational setting will be optimal when it is welcomed and integrated effectively by the preschool’s psychoeducational staff, and such feedback can help create a good fit between the needs of the educational setting, the needs of the child, and the PPSI requirements.

Diffusion of the PPSI Intervention into the Child’s …

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Diffusion of the PPSI Intervention into the Child’s Educational and Home Settings On the whole, the PPSI is primarily an ecological intervention with strong roots in the child’s own naturalistic educational setting. How can we further extend the benefits of the PPSI into the preschool and home environments? To promote children’s generalization of skills learned within the PPSI program to their other major social contexts—the broader preschool and the home—the intervention facilitator can take several important steps. Overall, the facilitator can extend the PPSI intervention into the day-to-day life of the preschool, that is to say, beyond the specific intervention sessions themselves, by sharing the intervention contents and goals with other psychoeducational staff and trying to find ways to connect it to other educational activities in the preschool. It is important that the skills taught in the PPSI program be practiced throughout the child’s day, including at home, to increase the program’s social validity and obtain generalization of the skills that were taught. Here are several recommendations of how to achieve this extension of the PPSI to other environments. Forming social playgroups in the preschool. We recommend that in addition to the PPSI’s intervention-focused small peer groups, other social playgroups can be formed in the preschool to facilitate spontaneous peer-engagement experiences. This allows continuity for the group activities initiated in the PPSI intervention group. These social groups can include children with similar needs or can emphasize heterogeneity, addressing children with different social needs. Playgroups can include peers who did not take part in the PPSI intervention so that the child with ASD can generalize newly learned social interaction, social play, and social conversation skills. To maximize generalization, these groups should be led by the PPSI facilitator in collaboration with another preschool psychoeducational staff member. Involving the parents. Parents should be kept informed about and involved in the contents of the PPSI intervention. This can be facilitated by providing information sheets weekly to parents with information on the topics learned that week as well as suggested activities and games to practice at home, using the tools and language of the program. In addition, parents should be provided with workshops that will guide them in how to further apply and practice the skills learned in the PPSI intervention at home. For example, applying the same PPSI terminology to help smooth the child’s transfer of skills, parents can encourage social conversation during family mealtime, invite a friend to play at the house, mediate for the child during various social situations in the playground or community center, and more. Involving the preschool psychoeducational staff. The child’s intervention goals, as targeted via concept learning and various games and activities practiced in the PPSI program, should be passed on to the preschool psychoeducational staff so that they can continue practicing the explicit goals set for the child and thus increase the intervention intensity and achieve generalization. In addition, the PPSI facilitator can give specific practical tools to the preschool’s head teacher or other

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predetermined staff, suggesting possible weekly activities that can be performed with the child in the broader preschool. Suggested weekly assignments from the facilitator, communicated either verbally or in writing via worksheets, visual aids, and instructions, can help the preschool staff focus on the social concept learned that week during the PPSI skill acquisition session, including examples of how to apply the lesson and practice the goal with the other children in the preschool who are not in the small PPSI practice group. Facilitator modeling for the preschool staff. In addition to delivering the PPSI protocol’s skill acquisition sessions with the child and mediating the PPSI small peer-group skill practice sessions, the PPSI facilitator can sometimes conduct individual “learning sessions” for the child in the preschool environment itself. This type of intervention enhances the child's skills in the natural social environment and also models for the rest of the staff how to implement the child's social goals in daily life in the preschool. Such learning sessions, based on those social concepts learned in the PPSI intervention that week, can be carried out by mediating for the child and practicing those concepts with the child in the different preschool environments such as during free play indoors, while playing in the yard, or during mealtime. This allows the child to generalize what has been learned to those other social contexts. For example, skills taught for social conversation can be extended into mealtime situations. During yard play or free play, the facilitator can promote the child’s practice of the skills involved in joining a group, choosing a game, and so on. By conducting such sessions, the PPSI facilitator thus not only fosters the child’s skill generalization but also serves as a role model for the preschool staff members of how to practice the child's social goals. Coordinating between the child’s special and regular educational settings. If the child attends a regular preschool some days of the week, we recommend that the PPSI facilitator also continue to lead the child’s social processes in the regular preschool so as to create a therapeutic continuum between the special-education preschool and the integrated preschool. Importantly, the PPSI facilitator should share the social goals and skills taught during the implementation of the PPSI in the special education setting with the educational staff at the regular preschool, to help connect the two settings’ scaffolding of the child’s social objectives and experiences. Utilizing the PPSI visual aids in the preschool. The visual aids used in the PPSI should be made available for use in the preschool environment to help the child generalize the skills learned in the program. For example, peers who were not involved directly in the PPSI may help remind the child with ASD to take advantage of the visual clues or supports during structured and unstructured preschool activities, thereby prompting social exchanges. Moreover, the other preschoolers may themselves enjoy these visual and/or audiovisual stimuli (e.g., illustrations, symbols, photos, video clips), and the visual aids may mobilize the child’s relatively strong visual processing capabilities, which can increase the child’s social acceptance.

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Conclusions In this final chapter of the book, we focused on the logistics for the psychoeducational implementation model for the PPSI program, outlining the practical steps that interested parties may follow in order to effectively plan, execute, evaluate, and generalize this intervention in their educational settings. We described the important initial stages of on-site intervention facilitators’ recruitment and thorough training. Next, we detailed the comprehensive guidelines for systematically evaluating each child’s social-communication profile in order to set individual goals and priorities for that child’s interaction, play, and conversation skills. Next, we outlined ways to create a personalized PPSI intervention plan that corresponds with the child’s social profile and selected social goals, by adapting the three PPSI curricula to the child’s low, intermediate, or high social profile and deciding on a sequential presentation of domains or a multi-level simultaneous presentation of the three content domains. It was also emphasized that the implementation of the PPSI should be monitored throughout the intervention and at its ending, both regarding the child’s peer-engagement gains and regarding the program’s reception in the broader preschool. The pace and progress of the intervention plan is highly dependent on each child’s individual learning curve regarding the targeted social skills. An important point that we noted is the interconnection between the child’s individual program— including its child–adult social learning and peer-group social practice experiences —and the child’s broader preschool and home environment. Open communication by the facilitator with other school psychoeducational staff and with the parents at home, entailing communication about intervention goals and contents as well as sharing and modeling of activities and techniques, will result in better diffusion of the program into the educational and home settings, promoting generalization of skills on the part of the child and confidence-building for the child’s surroundings.

Final Words Peer engagement is one of the major challenges facing young children with ASD and one that can render a strong impact on their quality of life. For preschoolers who have difficulties in mastering many building blocks associated with social-communicative functioning, their attempts to decipher how to interact, play, and converse with same-age peers are commonly very effortful. Thus, the PPSI ecological intervention aims to help these children develop the social skills capabilities and knowledge they need in order to achieve more fruitful and enjoyable social exchanges with peers. Moreover, the PPSI offers a unique set of practical tools for the child’s natural educational staff, who often experience a sense of uncertainty when trying to remediate their young students’ social adjustment and who sometimes witness these mainstreamed children’s considerable challenges in integrating into the preschool social milieu. The PPSI’s systematic, comprehensive repertoire of structured, goal-directed activities affords flexibility and precision in

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matching the needs of the child, the on-site facilitator, the child’s natural social agents (age-mate peers either with ASD or with typical development), and the broader preschool setting. Early intervention in the crucial domains of peer engagement can qualitatively change the social lives of these young children, not only currently in their preschool years but even more so for their future abilities to form more satisfying, fuller peer relationships. Peer engagement holds important implications for many diverse aspects of children’s development—including linguistic, cognitive, social, and emotional capabilities, not to mention children’s everyday well-being. We hope that the readers of this book will increasingly embrace the PPSI principles and practices, will continue to conduct and disseminate this intervention, and will answer the call to empirically scrutinize its outcomes—until eventually the PPSI can become part of the individual educational plan and become integrated into the early intervention program for preschoolers with ASD across the board.

References Bauminger-Zviely, N., Eytan, D., Hoshmand, S., & Rajwan Ben-Shlomo, O. (2019). The PPSI-PES: The preschool peer social intervention—peer evaluation scale to assess young children’s social-communication profile during unmediated peer engagement, focusing on interaction, play, and conversations [Unpublished protocol]. School of Education, Bar-Ilan University. Howes, C. (1980). Peer play scale as an index of complexity of peer interaction. Developmental Psychology, 16, 371–372. https://doi.org/10.1037/0012-1649.16.4.371 Howes, C., Unger, O. A., & Matheson, C. C. (1992). The collaborative construction of pretend: Social pretend play functions. State University of New York Press.

Appendix

Supplementary Visual Aids for PPSI Protocol For direct access to visual aids that facilitators can utilize to support delivery of the three PPSI curricula, see the corresponding web link on the Prof. Bauminger-Zviely’s Autism Research and Intervention Laboratory-The ARI Lab website, as follow: https://www.biu.ac.il/BaumingerASDLab/book/b_filesprotected.html. These visual aids are password protected. To access the materials, insert the password “baulab123” when prompted.

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 N. Bauminger-Zviely et al., Preschool Peer Social Intervention in Autism Spectrum Disorder, Social Interaction in Learning and Development, https://doi.org/10.1007/978-3-030-79080-6

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