Ratings of Social Functioning and Improvement: Perspectives From Specialists and Paraprofessionals

• In Event: Social Participation: A Multiple-Perspective Approach

Abstract

Social impairments are a core deficit of autism spectrum disorder (ASD; CDC, 2018). Children with ASD tend to experience higher levels of social isolation and poorer friendship quality as compared to their neurotypical peers at school (Author, 2000). In school, many children with ASD receive services from paraprofessionals aimed at improving social skills – however, paraprofessionals often do not have training in evidence based interventions for students with special needs (Rispoli, Neely, Lang, & Ganz, 2011). While several studies have demonstrated change in children’s social engagement at school when intervention is carried out by trained researchers, a more cost effective, ecoculturally sensitive approach is to train paraprofessionals to implement interventions. In one recent study of the Remaking Recess intervention, trained professionals were able to improve children’s social network ratings and reduce isolation on the playground but were unable to improve positive peer social engagement on the playground. In the current pilot study, paraprofessionals received training on Remaking Recess, and how to assess change over the course of the intervention. The main question was whether blinded observers and paraprofessionals would agree on social skill severity and improvement, and whether scores would link to blinded observer’s ratings of peer engagement. Child severity and improvement was measured using the Clinical Global Impressions (CGI; Busner & Targum, 2007) scale. Peer engagement was measured with the Playground Observation of Peer Engagement (POPE; Author, 2005). Twenty-four students across five schools were recruited to participate in an 18-week intervention trial. These children were 5-10 years old (Mage=7.2), 74% male and were largely from low-resourced schools (87% free or reduced lunch). 18 paraprofessionals took part in the intervention, who on average had 6.8 (SD=7.8) years experience working with children with ASD. At baseline, paraprofessionals rated children as having less severe social impairment than the research staff with median ratings of 3 (mild impairment) and 5 (marked impairment) respectively (Kruskal-Wallis Test- 2= 14.72, p-value <.001, df=1). Blind ratings on the POPE were more closely related to research staff’s ratings of severity (r= -.42) than were paraprofessionals ratings (r=.06) at baseline. However, paraprofessionals rated more improvement over the course of the treatment with a median rating of 2 (much improved) compared to a median rating of 3 (minimal improvement) from research staff. These data suggest that paraprofessionals can implement an intervention and observe and assess change in school but that researcher’s ratings may not pick up on that same degree of change in short assessment windows. Measuring social skill in school-based interventions can pose a significant challenge for researchers who take a snapshot of student behavior at pre-determined times. Paraprofessionals can monitor the social behavior of children throughout the day and so have a different lens through which they may be viewing change. It is important to account for these potential differences when selecting appropriate outcome measures in interventions that take place in school.

Authors

• Kyle Sterrett, University of California - Los Angeles

• Natalie Libster, University of California - Los Angeles

• Stephanie Shire, University of Oregon

• Connie Kasari, University of California - Los Angeles