https://doi.org/10.1177/1053815119880943

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Research Article

A Parent-Implemented Playdate Intervention for Young Children With Autism and Their Peers

Tracy J. Raulston1 , Sarah G. Hansen2, Rebecca Frantz3, Wendy Machalicek4, and Naima Bhana1

AbstractChildren with autism spectrum disorder (ASD) present with social skills difficulties, which can create barriers for them to develop friendships with their peers. Playdates are a common way that young children practice play and friendship skills in home and community environments. Few studies have trained parents to embed social skills instruction into playdates for children with ASD, and such studies have been comprised of children with mild to moderate needs. In the current study, we employed a concurrent single-case multiple probe across three parent–child–peer triads design to evaluate the effects of training and coaching in a parent-implemented playdate intervention on parental strategy use and cascading effects on child–peer social interactions during playdates. Parents also rated the social validity of the intervention. Results indicated that two of the three parents reached criterion on the strategies quickly, and the third triad required a procedural modification. Challenging behavior appeared to be a barrier to implementation. Implications and future directions are discussed.

Keywordsautism, playdate, parent-implemented, social skills

Children with autism spectrum disorder (ASD) present with social-communication difficulties and repetitive patterns of behavior, including repetitive play, that are present early in develop-ment (American Psychiatric Association, 2013). Children with ASD often have difficulty form-ing relationships with their peers (Webster & Carter, 2007), have poorer quality of friendships, and experience increased loneliness, peer rejection, and bullying in comparison with their typi-cally developing peers (Bauminger & Kasari, 2000; Odom et al., 2006). Deficits fundamental to an ASD diagnosis may interfere with access to benefits from early social opportunities in class-rooms, inclusive settings, and play with same aged peers.

1Pennsylvania State University, University Park, USA2Georgia State University, Atlanta, USA3Northern Arizona University, Flagstaff, USA4University of Oregon, Eugene, USA

Corresponding Author:Tracy J. Raulston, Pennsylvania State University, 125 CEDAR Building, University Park, PA, USA. Email: tjr61@psu.edu

880943 JEIXXX10.1177/1053815119880943Journal of Early InterventionRaulston et al.research-article2019

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Research focused on improving social skills and peer interactions among young children with ASD has identified many effective practices. Recent reviews of practices for social skills in young children with ASD have included the use of social narratives, visual schedules, and milieu teach-ing strategies, among others (Odom, Collet-Klingenberg, Rogers, & Hatton, 2010). Many approaches to improving early social skills for young children with ASD are multicomponent interventions comprised of several effective practices. For example, the Advancing Social Communication and Play (ASAP) intervention has shown gains in child social skills and play skills in the preschool classroom and includes components of milieu teaching (i.e., follow the child’s lead, arranging the environment) and prompting (i.e., scaffolded supports for desired skills; Boyd et al., 2018). Similarly, Joint Attention, Symbolic Play, and Emotional Regulation (JASPER) uses environmental arrangement, prompting, and child-led play to improve joint attention and social engagement (Chang, Shire, Shih, Gelfand, & Kasari, 2016). Further research has used other packages of supported practices, including social narratives to prompt prosocial behavior prior to play (e.g., Hansen et al., 2018), visual supports to plan play (Charlop, Lang, & Rispoli, 2018), and activity-based intervention that capitalizes on natural learning opportunities (e.g., Barton, Choi, & Mauldin, 2019). Parents of children with ASD have been trained and coached to implement social-communication interventions using didactic trainings, role-play, prompting, and performance feedback methods (Ruppert, Machalicek, Hansen, Raulston, & Frantz, 2016).

A breadth of research has focused on evaluating social skills interventions for children with ASD in school settings during recess (Lang et al., 2011) and social skills groups (Leaf, Dotson, Oppenheim-Leaf, Sherman, & Sheldon, 2012). Although these interventions are important, chil-dren also need opportunities to generalize social and play skills with peers across settings, includ-ing homes (Bellini, Peters, Benner, & Hopf, 2007). Although supports have been frequently evaluated for social interaction both at school (Whalon, Conroy, Martinez, & Werch, 2015) and with adult partners (Carnett et al., 2017), as children begin to navigate their own friendships, more support may be needed, including support during playdates.

Because children with ASD present with difficulties with social interaction early on, their parents are ideally situated to embed social skills supports into playdates with peers. Within the literature, playdates have been defined as prearranged play sessions between two children at one of the children’s homes (Frankel & Mintz, 2011). Previous research suggests children with ASD who participate in playdates hosted in their homes generalize important social skills, such as joint engagement, to recess in school settings (Frankel, Gorospe, Chang, & Sugar, 2011).

Playdate Interventions in Autism

To our knowledge, only three studies have investigated playdate interventions for children with ASD. Koegel, Werner, Vismara, and Koegel (2005) taught two children with ASD, ages 8 and 9, to interact during playdates with contextual supports. Both children communicated using speech, but had difficulty with pragmatics (functioning approximately 4 years below age level in social-ization) and had no consistent friends. Contextual supports included (a) activities that were hypothesized to be mutually reinforcing to the child with ASD and the typically developing peer, and (b) a graduate student facilitator who set up cooperative arrangements between the children within each activity. For instance, when baking cookies, one child held the measuring cup while the other child poured the ingredient. Children showed increased synchronous reciprocal interac-tions during playdates with contextual support in comparison with playdates without contextual support. A limitation of this study is the ecological validity; a graduate student served as the intervention agent, which does not reflect the natural environment of a typical playdate that would most often be facilitated by a parent. Jull and Mirenda (2011) successfully extended this research by training parents to facilitate similar playdate activities for two preschool-age children with ASD and mild language delays. The typically developing peers were the children’s sibling,

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acting as a peer, and a cousin. Parents were taught to host a contextually supported playdate, using procedures similar to Koegel et al. (2005). Following training, both parent participants were able to implement the contextually supported intervention without researcher support. Furthermore, data suggested an increase in synchronous reciprocal interactions for both partici-pants. Despite improved ecological validity, children’s social and play skills were not formally assessed prior to the intervention in this study. In addition, no procedural fidelity data were col-lected on training procedures. Neither of these studies sought to teach children explicit, observ-able social skills.

The final study was by Frankel and colleagues (2010), wherein a parent training was evalu-ated in a randomized trial. The parent training was a manualized social skills intervention (Children’s Friendship Training; Frankel & Myatt, 2003) for 76 middle-age children (M = approximately 8.5 years old) with high functioning ASD. Forty children were assigned to the treatment condition and 38 to the control condition. The intervention targeted conversation skills, peer entry skills, developing friendship networks, good sportsmanship and hosting skills, and handling teasing. The intervention was successful, with parents in the treatment group reporting superior outcomes on measures of social skills and playdate behavior, and on child measures of loneliness and popularity, in comparison with the control group. A limitation of this study is that child outcomes were measured according to parent report. Furthermore, no data were collected on parents’ treatment fidelity of the intervention. To date, no study has evaluated a parent-imple-mented playdate intervention focused on supporting early social skills for young children with ASD and moderate to complex needs.

The Current Study

The purpose of the current study was to extend previous research by examining a parent-imple-mented multicomponent intervention that involved a social narrative, visual schedule, and milieu teaching strategies within the context of activity-based intervention to support early social skills within the context of playdates for young children who had more complex needs than previously studied. We employed a single-case concurrent multiple probe design to answer the following research questions:

Research Question 1: Can parents be trained and coached to implement a multicomponent intervention with sufficient treatment fidelity?Research Question 2: Will the implementation of this multicomponent intervention produce an increase in total (prompted and spontaneous) (a) child mands to the peer (e.g., verbally requesting an item, game turn, or action to his or her peer), (b) child responses to peer’s mands, (c) peer mands to the child, and (d) peer responses to child mands?Research Question 3: How will parents rate the social validity of this multicomponent play-date intervention?

Method

Following approval from a university institutional review board, parents were recruited from a small city in the Northeast region of the United States via flyer distribution. Parents were eligible to participate if (a) they were the parent of a child with ASD between the ages of 3 to 8 years, (b) their child did not engage in serious challenging behavior (e.g., frequent aggression toward peers), and (c) they were interested in learning strategies to help their child interact with peers during games. Children had a documented special education eligibility or medical diagnosis of ASD, per parent report, with the exception of the child in Triad 2 who was at risk. The first author completed a Childhood Autism Rating Scale, Second Edition (CARS-2; Schopler, Van

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Bourgondien, Wellman, & Love, 2010) to assess each target child’s ASD symptom severity fol-lowed by the Social Behavior and Social Play domain of the Verbal Behavior Milestones and Placement Program (VB-MAPP; Sundberg, 2008) to choose individualized goals for each target child.

A single-case concurrent multiple probe across three triads (parent, target child, and peer) design was employed (Ledford & Gast, 2018). Triads 1 and 2 identified a typically developing peer to invite to participate in playdates. The first author coordinated identifying a similarly-aged peer for Triad 3 upon parent request.

Participants and Setting

Triad 1. Viktor was a 39-year-old European American male. He had a graduate degree. He was the married father of Milo. The family’s annual household income range was US$90,000 or more. Milo was a 6-year-1-month-old (at the beginning of the study) European American boy with ASD. His CARS-2 score was 31.5 (mild-moderate range). He had one-to-one paraprofes-sional support for 40% of the school day and received applied behavior analysis (ABA)-based therapy. He spoke in short sentences and was beginning to mand for information (e.g., ask ques-tions) to adults, not peers. A copy of a full VB-MAPP milestones assessment conducted by his ABA therapists indicated that his skills were emerging in the Level-3 range. Milo’s playdate partner, Ian, was a 6-year-2-month-old (at the beginning of the study) Asian American boy. Milo and Ian had just met at a park prior to the beginning of the study. They did not attend the same school. All sessions took place in the living and dining rooms of Viktor and Milo’s home.

Triad 2. Kelly was a 29-year-old female. She had a bachelor’s degree. She was the married mother of Penelope. The family’s annual household income range was between US$70,000 and US$79,999. Penelope was a 3-year-5-month-old (at the beginning of the study) European Ameri-can girl. She did not have a formal diagnosis of ASD but was considered to be at risk per parent report. Her CARS-2 score was a 33.5 (mild-moderate range). She attended a structured special education preschool classroom and received speech and occupational therapy. She spoke in one- to two-word utterances. Results from the Social Behavior Social Play domain of the VB-MAPP indicated that she initiated physical interactions with peers (Milestone 6) but did not spontane-ously mand to peers (Milestone 7) or spontaneously respond to the mands of peers (Milestone 9). Penelope’s playdate partner, Hayden, was a 4-year-8-month-old (at the beginning of the study) European American girl. Hayden was Penelope’s first cousin and knew her since birth. Hayden had attended preschool for 1 year. All sessions took place at the dining room table of Kelly and Penelope’s home.

Triad 3. Dionne was a 30-year-old African American female. She had a bachelor’s degree. She was the single mother of Andre. The family’s annual household income range was between US$10,000 and US$14,999. Andre was a 6 year-4-month-old (at the beginning of the study) African American boy with ASD. His CARS-2 score was 40 (severe range). He attended a self-contained special education classroom with one-to-one paraprofessional support and received speech therapy. He used some vocal speech (approximately 20 spoken words) and the Prolo-quo2Go® iPadTM application with adult support. Results from the Social Behavior Social Play domain of the VB-MAPP indicated that he did not spontaneously mand to peers (Milestone 7) or spontaneously respond to the mands of peers (Milestone 9). Andre’s playdate partner, Julia, was a 5-year-5-month old (at the beginning of the study) European American girl. She had attended full-day preschool for 2 years. Andre and Julia did not know each other before the study. Sessions took place in the living and dining room of Dionne and Andre’s home for the A and B phases of

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the experiment. During the C phase (i.e., procedural modification), sessions took place at a table in the clubhouse of the apartment complex.

Procedure

Playdates were scheduled two to three times per month throughout baseline and intervention. The parent of the child with ASD was the playdate facilitator (i.e., implemented the intervention). Playdate sessions were approximately 30 to 45 min in duration, which included greetings, getting settled, playing two games, cleaning up, and saying goodbye. For Triad 1, free play continued after the session ended.

Materials. Prior to baseline, each parent was provided a list of games from which to identify a top five. These five games, as well as a few others, were provided during all baseline, coaching, and maintenance sessions. Games were intentionally chosen to specifically allow for multiple oppor-tunities to target mands and responses to mands and not require much problem solving. Specifi-cally, the games had (a) multiple parts/pieces, and (b) a cause and effect ending (e.g., ice cubes fall down). Table 1 displays information about the most commonly chosen games.

Social skills assessment. Prior to baseline, the Social Behavior and Social Play domain from the VB-MAPP (Sundberg, 2008) was administered via parent interview. The VB-MAPP is a curric-ulum-based assessment that helps practitioners choose goals for children’s language and related skills. It is intended for use with young children with ASD and related disabilities. For the pur-poses of the current study, mands were defined as the verbal behaviors a child engages in to indicate that they want something (an item, attention, action, information, etc.) from a peer. Milestones 7 and 9 of the Social Behavior and Social Play domain were chosen as curricular targets that could be embedded into games during playdates for all three children because (a) all

Table 1. Most Common Games Chosen.

GameItems used during

environmental arrangement Description of game

Connect FourTM Red and yellow disks in a clear plastic bag

Players take turns dropping their corresponding colored disks into the 42-slot grid.

Don’t Break the Ice©(Classic, Paw Patrol,

and Frozen versions)

Hammer Players build an ice-skating rink using plastic ice cubes. A figurine is placed on top of ice cubes. Players take turns hammering down the structure; ice cubes fall down eventually causing the figurine to fall down.

Go Fishing Fishing rod Players place small plastic fish into an electronic fishing pond. The fishing pond is turned on and fish open and close their mouths. Players take turns with the fishing rod to catch the fish.

Magnetic Fishing Game

Fishing rod Players take turns with a magnetic fishing rod to catch the magnetic fish and other sea animals and read the names of the sea animals.

Monkeying AroundTM Balancing Game

Monkeys in a clear plastic bag

A plastic tree is set up with magnetic hanging leaves. Players spin a spinner and take turns hanging a specified number of monkeys on the magnetic leaves or other monkeys’ tails. Players continue to take turns until the leaves become off-balance and fall down.

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parents indicated that their children did not demonstrate these skills, (b) both skills were deemed to be pivotal, and (c) these skills were hypothesized to be feasible for parents to embed into com-mon and affordable board games designed for young children. Milestone 7 is “spontaneously mands to peers” and Milestone 9 is “spontaneously responds to the mands from peers.”

Baseline. Baseline sessions were semicontrolled. Parents were asked to play two games and attempt to get their child and the peer to interact during the games. Parents were told they could play the provided games or ones they had available in their home.

Data collection. After greetings and setting up, data were collected for 15 min of the playdates on (a) parent treatment fidelity, (b) child spontaneous and prompted mands to the peer, (c) child spontaneous and prompted responses to peer’s mands, (d) peer’s spontaneous and prompted mands, and (e) peer’s spontaneous and prompted responses to child’s mands. Both prompted and spontaneous mands (child and peer), responses to the peer’s mands (in the case of the child with ASD initiating), and responses to child’s mands (in the case of the peer initiating) were recorded using separate frequency counts. The response was marked as prompted if the parent prompted the response; it did not matter if the parent prompted the mand (i.e., the beginning of the interac-tion) or not. In other words, responses were treated as new behaviors and could be coded as spontaneous (no adult prompting) or supported by the parent regardless of whether the initial mand was spontaneous or prompted. Data were collected using paper-pencil method either in vivo or via video. All sessions were video-recorded using an iPadTM.

Parent treatment fidelity. Parent treatment fidelity data consisted of an 18-step task analysis. Par-ents were asked to play two games during the session. Two antecedent-based strategies (reads social narrative and completes visual schedule) were only assessed at the beginning of the playdate session. Next, the following four milieu teaching strategies were assessed for the first trial of each game (i.e., twice each playdate session): (a) verbally models or reminds about manding at the beginning of the game; (b) implements a two-step, least-to-most prompting hierarchy with Step 1 being a direct verbal prompt (e.g., “Ask Hayden for the rod.”) and Step 2 being an echoic prompt (“Say, ‘Pass the rod.’”) for their child to mand to the peer; and (c) implements a 3- to 5-s time delay between prompts. Finally, four prompting and reinforcement strategies were assessed throughout (i.e., the entire duration and not just the first trial) each game (i.e., twice each playdate session): (a) prompts peer to share with child if needed, (b) prompts peer to mand to the child if needed, (c) prompts child to share with peer if needed, and (d) praises sharing of child or peer. Parents received credit for these four steps by using them any-time during each game. A percentage of steps completed correctly and independently was calculated and graphed for visual analysis. If the coach prompted the parent to implement a strategy during the session, this was not counted as independent. However, if the parent then demonstrated the skill cor-rectly and without a prompt from the coach during the next game, it was counted as independent once.

Mands and responses. Mands were defined as the child/peer verbally emitting an intelligible request or reject (at least one-word utterance). For Andre, instances where he used the Prolo-quo2Go® application to activate voice output were recorded. The child/peer had to be looking toward the direction, have his or her body facing toward, or say the name of the other child/peer. We did not record instances when the child/peer clearly manded to the parent (i.e., looking in the direction, having body turned toward, or saying the name of the parent). Mands were recorded using a frequency count (Cooper, Heron, & Heward, 2007). Responses to mands were defined as the child/peer verbally or nonverbally responding to the peer or child’s mand. Examples are instances where the child/peer handed an item (e.g., game spinner or missing piece) to the other child after it was requested (nonverbal response) or answered questions the other child asked (verbal response). Responses to mands were recorded using a frequency count.

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Interobserver agreement (IOA). IOA data were collected for a mean of 26% of baseline ses-sions (range = 20%-33%), 28.57% of coaching sessions (range = 20%-29%), and 33% of maintenance sessions across the three triads using a randomized selection of videos. For parent treatment fidelity, item-by-item IOA was calculated by dividing the number of agree-ments by agreements plus disagreements and multiplying by 100 to obtain a percent of agreement (Ledford & Gast, 2018). For Viktor, parent treatment fidelity IOA was a mean of 94% (range = 89%-100%). For Kelly, parent treatment fidelity was a mean of 92% (range = 86%-100%). For Dionne, parent treatment fidelity IOA was a mean 92% (range = 86%-100%). For child and peer frequency of mands and responses to peer mands, gross agreement IOA was calculated by dividing the smaller frequency by the greater frequency and multiply-ing by 100 to obtain a percent of agreement. For Milo, IOA was a mean of 95% (range = 82%-100%) for mands and 91% (range = 83%-100%) for responses to peer mands. For Ian, IOA was a mean of 95% (range = 91%-100%) for mands and 95% (range = 91%-100%) for responses to peer mands. For Penelope, IOA was a mean of 90% (range = 70%-100%) for mands and 97% (range = 90%-100%) for responses to peer mands. For Hayden, IOA was a mean of 95% (range = 86%-100%) for mands and 86% (range = 70%-100%) for responses to peer mands. For Andre, IOA was a mean of 85% (range = 75%-100%) for mands and 87% (range = 60%-100%) for responses to peer mands. For Julia, IOA was a mean of 87% (range = 60%-100%) for mands and 92% (range = 75%-100%) for responses to peer mands. When IOA fell below 80%, the first author retrained the fifth author using nonrandomly selected videos.

Training and Protocol

Following baseline, the first author trained each parent at three staggered time points. The first author had a doctoral degree in special education, was a board certified behavior analyst, and a certified special education and early childhood generalist teacher with 13 years of experience working with families of children with ASD. The training involved (a) didactic instruction using a PowerPointTM presentation with information on the strategies included in the multicomponent intervention, (b) role-play with games including performance feedback for each strategy, (c) time for questions and answers, and (d) additional opportunities to practice if the parent desired to do so. Each parent was provided with one training, approximately 1 hr in duration. Training treat-ment fidelity data were collected for the first training session (Viktor). Treatment fidelity was 100%.

The multicomponent playdate intervention protocol involved (a) two antecedent strategies (social narrative and visual schedule), and (b) four milieu strategies (environmental arrangement, prompting, time delay, and reinforcement). At the end of the training, a parent-friendly version of the protocol (brief color-coded list on 2 × 3 in. laminated cardstock) was given to the parent for his or her reference during the session.

Antecedent strategies. The social narratives were individualized for each triad. Still photographs were captured using screenshots from baseline videos to personalize each narrative. Narratives were created using PowerPointTM. The narratives included call outs with example actions that the child and peer could demonstrate targeted at the child’s verbal level (e.g., “When you want a turn, you can ask your friend” with the text in the call out showing “I want a turn.”). The narratives were brief (between four and seven pages), printed in color on 8.5 × 11 in. paper, and stapled on the left-hand side. The parent was taught to read the narrative to both children at the beginning of the session. Next, the parent was taught to complete the visual schedule with both children. The visual schedules were printed on cardstock, cut to 3.5 × 6.5 in., and glued on a small manila envelope

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(6 × 9 in.) with two rows. Each row had two visual representations of rectangles with Velcro® inside. The visual schedule was glued to an envelope that housed square photograph cards of the games and each child’s photograph. The parent was trained to use gradual guidance to teach each child to place his or her photo on the top row, alternating which child chose first (e.g., “Last time you chose the first game, so let’s let Hayden choose first this time”). Next, each child chose a game photograph card and placed it under his or her photo. A final visual cue included a star that indi-cated free play (e.g., watch television or run around the house or outside together).

Milieu strategies. Following reading the social narrative and completing the visual schedule, the parent was taught to (a) model or remind the children to mand to each other (e.g., “We’re going to play the fishing game. Remember to ask each other for the pole”), (b) implement an environ-mental arrangement strategy if possible (e.g., if playing the fishing game, purposefully have only one fishing pole available and handing it to the peer to contrive motivation for the child with ASD to mand to the peer), and (c) implement a two-step prompting hierarchy with a 3- to 5-s time delay, involving a direct verbal prompt (e.g., “Ask Ian to pass the pole”) and an echoic prompt (e.g., “Say, ‘Ian, pass the pole, please’”) for their child with ASD only. The parent was also taught to prompt the peer and child to share (i.e., pass the requested items) if needed (e.g., if the child resisted letting go of or handing over a requested item), prompt the peer to mand if needed (to create balanced turn-taking), and praise both children for sharing.

Procedural modification. Due to the emergence of challenging behavior (e.g., Andre running away from the game, banging his hand on walls, or aggressing toward his mother), a procedural modi-fication was instituted on the eighth playdate session. The modifications included reducing the number of steps on the task analysis (e.g., changing the least-to-most prompting to graduated guidance for the mand to his peer). In addition, the location of the playdates was changed to Dionne’s apartment building clubhouse, which had a picnic style table with attached benches. Edible reinforcers were added, both noncontingently (prior to and throughout the games) and contingently (for sitting on the bench and participating in the game). The edibles were chosen based on a brief interview-based indirect preference assessment given to both children’s parents. Edibles included fresh berries, apple juice boxes, miniature cookies, and M&M’s®.

Coaching and Maintenance

Coaching sessions began following training. The first author coached the parents to implement the strategies outlined on a treatment fidelity task analysis. Coaching involved (a) reviewing the steps of the protocol with the parent prior to the beginning of the session, using the parent-friendly laminated, color-coded list of the steps (described above), which took approximately 5 to 10 min; (b) providing clarification (e.g., when a parent asked how to implement the time delay, the coach modeled the strategy and provided the parent with a rationale) and answering the care-giver’s questions before beginning the session; and (c) providing positive and corrective feed-back during or at end of the session. The reason that feedback was given during or at the end of the session (i.e., delayed performance feedback) was to avoid disrupting the flow of the game between the two children, thus increasing the likelihood that both children were having fun. The coach used her clinical judgment to guide decisions about when to intervene and when to wait. For example, if the parent made an error during the first game, she verbally corrected the parent. If they made the same error during the next game, she waited until the end of the session to model and role-play the skill with the parent. Then, she primed the parent at the beginning of the next session to precorrect common errors based on the previous sessions. The coach described at least two strategies that the parent implemented correctly and one strategy to improve next time, which

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was then incorporated into the priming portion of the next session (e.g., “Remember to wait at least 3 seconds before moving to the ‘say’ prompt,” in instances where parents implemented time delay incorrectly). The final coaching component involved the provision of clarification and answers to the parent’s questions at the end of the session. Parents were given the opportunity to roleplay strategies if desired. The delayed performance feedback portion of coaching took approximately 10 to 15 min for Triads 1 and 2 and 20 min for Triad 3.

All of the aforementioned coaching elements were completed at each data point in the coach-ing phase. Coaching fidelity data were collected for 29% (n = 5) of coaching sessions across all three triads via video by an independent observer. Mean coaching fidelity was 95.83% (range = 75%-100%). The coaching phase ended once the parent reached 80% or higher treatment fidelity across four of five playdate sessions. Following the coaching phase, parents completed a 14-item questionnaire assessing the acceptability and feasibility of the program modified from the Treatment Acceptability Rating Form–Revised (TARF-R) by paper-pencil method (Reimers & Wacker, 1988). During maintenance sessions, parents were asked to complete the protocol with-out any priming or feedback from a coach. Triad 3 did not participate in the maintenance phase because of safety and ethical concerns (see the “Discussion” section).

Results

Figure 1 displays the results of parent treatment fidelity. In the baseline phase, all three parents scored low on the strategies on the playdate task analysis. Upon introduction of the coaching phase, an immediate increase in level was observed for Viktor, which was replicated at a different point in time (i.e., staggered) for Kelly. Viktor and Kelly met criterion (scores above 80% correct for four out of five playdate sessions) in five playdate sessions. Although an increase in level was also observed at a third point in time for Dionne, indicating a total of three basic effects, treat-ment fidelity was low in the coaching phase (M = 40%). A procedural modification was insti-tuted after three playdate sessions, resulting in an immediate increase in level. Dionne met criterion in six playdate sessions.

Milo and Ian

In baseline, Milo spontaneously manded to Ian an average of 0.3 times per session (range = 0-1) and an average of 0.3 times per session (range = 0-1) with adult prompting. Milo responded to Ian’s mands zero times. Ian spontaneously manded to Milo an average of 0.3 times per session (range = 0-1) and zero times with adult prompting. Ian spontaneously responded to Milo’s mands an average of 0.3 times per session (range = 0-1) and zero times with adult prompting.

During coaching, Milo spontaneously manded to Ian an average of one time per session (range = 0-4) and an average of 11 times (range = 8-18) with adult prompting. Milo spontaneously responded to Ian’s mands an average of 7.6 times per session (range = 3-11) and an average of 2.8 times (range = 0-5) with adult prompting. Ian spontaneously manded to Milo an average of 1.2 times per session (range = 0-4) and an average of 10.4 times (range = 5-15) with adult prompting. Ian spontaneously responded to Milo’s mands an average of 10.4 times (range = 8-14) and zero times with adult prompting.

During maintenance, Milo spontaneously manded to Ian an average of 0.7 times per session (range = 0-2) and an average of 10 times (range = 6-12) with adult prompting. Milo spontane-ously responded to Ian’s mands an average of 7.3 times per session (range = 3-12) and an average of 3.3 times (range = 2-6) with adult prompting. Ian spontaneously manded to Milo an average of 2.7 times per session (range = 1-6) and an average of 8.7 times (range = 4-14) with adult prompt-ing. Ian spontaneously responded to Milo’s mands an average of 9.3 times per session (range = 6-11) and an average of 0.7 times (range = 0-2) with adult prompting (see Figure 2).

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Penelope and Hayden

In baseline, Penelope manded to Hayden zero times. Penelope spontaneously responded to Hayden’s mands an average of 0.2 times per session (range = 0-1) and zero times with adult prompting. Hayden spontaneously manded to Penelope an average of 0.8 times per session (range = 0-2) and zero times with prompting.

During coaching, Penelope spontaneously manded to Hayden zero times per session and an average of eight times (range = 5-13) with prompting. Penelope spontaneously responded to Hayden’s mands an average of 1.2 times per session (range = 0-2) and an average of 1.8 times (range = 0-4) with adult prompting. Hayden spontaneously manded to Penelope an average of 1.6 times per session (range = 0-3) and an average of 3.4 times (range = 0-6) with prompting. Hayden spontaneously responded to Penelope’s mands an average of 6.6 times per session (range = 4-8) and an average of 0.4 times (range = 0-1) with prompting.

Figure 1. Results of parent treatment fidelity.

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During maintenance, Penelope spontaneously manded to Hayden zero times and an average of 12.7 times (range = 8-20) with prompting. Penelope spontaneously responded to Hayden’s mands an average of two times per session (range = 1-3) and an average of four times (range = 2-5) with prompting. Hayden spontaneously manded to Penelope an average of one time per ses-sion (range = 0-2) and an average of 6.3 times (range = 5-8) with prompting. Hayden spontane-ously responded to Penelope’s mands an average of seven times per session (range = 3-9) and an average of 1.3 times (range = 0-2) with prompting (see Figure 3).

Andre and Julia

In baseline, Andre manded to Julia zero times. Julia manded to Andre zero times. During coach-ing, Andre spontaneously manded to Julia zero times per session and an average of 3.3 times per

Figure 2. The mean frequency of mands and responses to mands for the child and peer in Triad 1 across the baseline (BL), coaching, and maintenance phases.Note. The gray bar represents BL, the slashed bar represents coaching and the black bar represents maintenance.

12 Journal of Early Intervention 00(0)

session (range = 2-5) with adult prompting. Andre spontaneously responded to Juila’s mands zero times per session and an average of 1.3 times (range = 0-3) with adult prompting. Julia spontaneously manded to Andre zero times per session and an average of two times per session (range = 1-3) with adult prompting. Julia spontaneously responded to Andre’s mands an average of 1.3 times per session (range = 0-2) and one time per session with adult prompting.

During the coaching plus modifications phase, Andre spontaneously manded to Julia an aver-age of 0.25 times per session (range = 0-1) and 3.8 times (range = 0-9) with adult prompting. Andre spontaneously responded to Juila’s mands an average of 0.5 times per session (range = 0-2) and 4.5 times (range = 2-6) with adult prompting. Julia spontaneously manded to Andre an average of two times per session (range = 0-4) and 6.5 times (range = 2-15) with adult prompt-ing. Julia spontaneously responded to Andre’s mands an average of two times per session (range = 0-3) and 0.5 times (range = 0-1) with adult support (see Figure 4).

Figure 3. The mean frequency of mands and responses to mands for the child and peer in Triad 2 across the baseline (BL), coaching, and maintenance phases.Note. The gray bar represents BL, the slashed bar represents coaching and the black bar represents maintenance.

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Social Validity

Using a modified TARF-R, parents rated items on a 5-point Likert-type scale. Each parent ranked the intervention positively with mean ratings of 4.62 (range = 4.29-4.86), 4.78 (range = 4.33-5.00), and 4.67 (range = 4.25-5.00), for the acceptability, effectiveness, and disadvantages of the intervention, respectively.

Discussion

We evaluated the effects of training and coaching in a parent-implemented multicomponent intervention on parent strategy use within the context of playdates held in home settings. Our primary dependent variable was parent treatment fidelity, and our secondary dependent variables

Figure 4. The mean frequency of mands and responses to mands for the child and peer in Triad 1 across the baseline (BL), coaching, and coaching + modifications phases.Note. The gray bar represents BL, the slashed bar represents coaching and the black bar with white polka dots represents modifications.

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were prompted and spontaneous child and peer mands and responses to each other’s mands dur-ing the playdate. In addition, we measured social validity from the parents’ perspective. Two of the three parents met the treatment fidelity criterion quickly and were successful in employing strategies (e.g., prompting and praise) to support social interactions between their child and a peer. These results maintained in the absence of coaching. For the third triad, a procedural modi-fication was necessary. The current study extends the literature by investigating a parent-imple-mented intervention for peer-to-peer social interactions in children with ASD. Previous literature has been sparse in both peer-mediated research for young children with ASD (Hansen, Blakely, Dolata, Raulston, & Machalicek, 2014; Katz & Girolametto, 2013) and intervention for playdates in the home, which have been reported by parents as a particular challenge for young children with ASD (Bauminger & Shulman, 2003; Laugeson, Frankel, Mogil, & Dillon, 2009; Petrina, Carter, & Stephenson, 2015). Main findings indicate initial viability of the multicomponent inter-vention on parental strategy use and promising cascading effects on supported child and peer mands as well as responses (e.g., taking game turns). These results suggest that parents can be trained and coached to support social communication during playdates in their natural home set-ting, which is encouraging as social opportunities may be more limited for children with lower levels of vocal language (Anderson, Locke, Kretzmann, Kasari, & AIR-B Network, 2016; Locke, Williams, Shih, & Kasari, 2017).

Of the limited playdate intervention literature available, only two studies utilized parents as interventionists (i.e., Frankel et al., 2011; Jull & Mirenda, 2011). The current study featured younger children with more complex needs (e.g., challenging behavior and more significant language impairments) and used activity-based intervention to target pivotal social skills. Skills taught to young children within natural contexts by natural change agents may be more resilient to barriers to generalization (Zwaigenbaum et al., 2015). During the coaching phase, parents tended to direct verbal reminders (e.g., “Remember, if you want a turn in the game, ask.”) and prompts (e.g., “Say, ‘It’s my turn.’”) to their children, and needed additional priming and feed-back from the coach to also remind and prompt the peer. Given that the peers did not have devel-opmental delays or disabilities, one might assume that they would not need prompting. However, all three peers needed reminders and encouragement to verbally interact with the child with ASD. Overall, the children with ASD did not engage in many spontaneous mands (i.e., most were prompted) in the coaching and maintenance phases as compared with the peers. Interestingly, spontaneous responses to mands emerged during coaching for Milo and Penelope as well as all peers without parents implementing any systematic prompt fading procedures. Andre required prompts for almost all mands and responses, which could have been due to his social motivation, ASD symptom severity, or other factors. Given that our results indicate that children with ASD may require consistent prompts to mand to peers and peer participants may also require prompts, at least initially, it is valuable to complete this type of intervention early when increased parental support between children is more socially acceptable.

Some games naturally have more opportunities for mands. For example, when playing games such as Don’t Break the IceTM with the environmental arrangement strategy of only including one hammer, after one child hammers down an ice cube, there is a natural teaching opportunity for the other child to ask for a turn with the hammer. Other games have less obvious features to cue the children to request attention (e.g., “Look at this!”) or actions to from a peer (e.g., “Get the blue monkey.”). For example, in a game such as Monkeying AroundTM balancing game, there is not an obvious item to environmentally arrange. Instead, we coached the parents to use plastic baggies to hold the monkeys and prompted the child to hold and wait until his or her peer asked for them. Then, the parent prompted the children to mand for the monkeys from each other. Once each player had their monkeys, they then requested a turn or manded to their peer to take a turn with the spinner (e.g., “It’s your turn, Penelope!”). Not all mands to a peer require an overt (i.e., observable) response from their peer. For example, when a child says, “It’s my turn,” there is not

Raulston et al. 15

necessarily something for the peer to hand over. The response is more of an absence of behavior (e.g., waiting and allowing the peer to take a turn). In such instances, we did not code a response on the peer’s part. Furthermore, “It’s my turn” might actually serve as a comment and partial mand for peer attention (e.g., desire for the peer to look at the game). Nonetheless, it is a valuable verbal interaction with a peer. Finally, all three parents rated the acceptability, feasibility, and effectiveness of the intervention favorably with means scores for each category above 4.5 out of a 5-point Likert-type scale, providing evidence for the social validity of this multicomponent intervention.

Limitations

Multiple factors impeded our ability to collect three continuous data probes before introducing the coaching phase for Triads 1 and 3. First, having more than two to three playdates in a month is not realistic for all families. For example, there were logistical challenges of coordinating two busy families’ schedules for Triad 1. Second, for Triad 3, Andre began to engage in challenging behavior beginning in Session 3, including aggressing toward his mother and himself. Because of this, the first author felt ethically responsible to begin coaching after one probe prior to the B phase. Due to the stability of the baseline data patterns, we believe these applied decisions did not overly compromise the internal validity of our findings. In addition, Andre continued to engage in variable rates of challenging behavior for some sessions, but not all, which triggered his moth-er’s stress. To ensure the safety and emotional comfort of the participants, a maintenance phase was not instituted for Triad 3. Specifically, the first author did not feel ethically comfortable removing coaching supports.

Data collection for this study was further constrained within the offered activities. The games used in this intervention were selected because of their feasibility for activity-based intervention (i.e., multiple parts and featured turn-taking to allow for multiple requests within typical play). Despite their utility, these games are not an accurate representation of the range of activities par-ents could facilitate during a typical playdate, such as gross motor games (e.g., hide and seek) or other less constrained activities (i.e., imaginative play or building activities). Finally, regarding the treatment fidelity checklist, the social narrative and visual schedule were not provided during baseline; therefore, parents would have had to create their own materials to receive credit for those strategies. Moreover, three of the steps on the checklist (prompting both children to share and the peer to mand) were conceptualized to be required only if needed (e.g., if the child resisted letting go of or handing over a requested item). If this step was not needed, the parent was given credit, which may have inflated the treatment fidelity score.

Implications and Future Directions

These initial promising results provide impetus for future research and directions for practice. It is evident that early developing skills such as turn-taking and requests can be considered pivotal and may allow for children to access more reinforcing opportunities in their future. Future research should examine various play skills in playdate contexts (e.g., commenting, imaginative play, and playscape play) as well as potential earlier behaviors helpful for manding to peers such as imitation, joint attention, and joint engagement. As children’s ability to communicate devel-ops, more independence from parents (e.g., spontaneous child behaviors) following initial inter-vention should be evaluated further.

Parental self-efficacy may be an important component to consider in future research. For the third triad, a procedural modification was required to reach criterion on treatment fidelity as well as a level change in child and peer behaviors. Barriers to implementation for Triad 3 included child (a) challenging behavior, (b) greater ASD symptom severity, and (c) lower language skills.

16 Journal of Early Intervention 00(0)

There is a persistent lack of research on social skills among children who have complex needs (Biggs, Carter, Bumble, Barnes, & Mazur, 2018), including parent perceptions of friendships, playdates, and other social opportunities. Parental preference should also be considered. Parent ideas about how a playdate should look would also likely contribute to the acceptability of an intervention in the playdate context. For example, Dionne indicated she was in favor of snacks and juice being included in the procedural modification as it made it more similar to her idea of what a playdate should be. Future research should involve qualitative investigations of parent perspectives of key components of playdates.

Parental comfort level should also be considered, particularly for parents who may not have a history of setting up playdates for their child. Investigations of malleable protective factors (e.g., accessing informal social supports) could help identify ways to empower parents. For example, sup-porting parents to (a) identify potential playdate partners from their child’s natural environment (e.g., neighborhood park, school, and church), (b) schedule playdates, and (c) identify activities would be useful requisite skills to embedding social skills instruction during the playdate. Furthermore, access to a community of parent support would likely promote more varied friendships for children as well as potentially reduce parental stress or anxiety around their child in social situations.

Regarding social validity, future research may consider incorporating behavioral measures (e.g., affect ratings) to complement parental report or having masked raters report on the social significance of outcomes. Furthermore, although homes are certainly socially valid settings for playdate-related research, other contexts where children often play or interact outside of their school day should be evaluated. Similar studies should be conducted in or across other typical environments, such as outdoor parks and common birthday party settings (e.g., indoor trampoline parks). Providing the necessary training to parents of peers may allow for playdates to take place at the peer’s home. Finally, the link between home playdates and school should be further inves-tigated. For example, examination of the potential added benefit to preteaching playdate skills in the classroom context prior to generalizing to playdates would be an interesting area of inquiry.

Acknowledgments

We would like to thank the families who participated in this study. We would also like to thank Angeline Felber, Salena Babb, and Emily Laubscher for their help with video taping and data collection.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publi-cation of this article: The first author received financial support from The College of Education, Pennsylvania State University for this research.

ORCID iD

Tracy J. Raulston https://orcid.org/0000-0003-3166-7716

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