Celeste, Marie

Journal of Visual Impairment & Blindness, 2007, Vol.101(9), p.521-533 [Peer Reviewed Journal]

Abstract: This study evaluated the effectiveness of a social skills intervention plan for a preschool child who is blind and has no additional disabilities. After the plan was implemented, the child demonstrated an increased frequency and range of play behaviors and social interactions.

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Guralnick (1990, p. 282) defined peer-related social competence as the "ability of young children to carry out their interpersonal goals" (for example, gaining entry to play, resolving conflicts, and maintaining play). Children with disabilities often lack the skills that are necessary to establish and engage in positive social relationships (Guralnick, Connor, Hammond, Gottman, & Kinnish, 1996b; McConnell & Odom, 1999; Odom, Zercher, Li, Marquart, & Sandall, 1998). They typically receive fewer positive responses to their social bids, demonstrate less interest in their peers over time, and are more prone to social isolation (Brown & Gordon, 1987). In addition, children with disabilities are rarely sought out as resources by their peers, infrequently serve as role models for other children and are the least preferred play partners of typical children (Guralnick & Groom, 1987).

Review of the literature

The play behaviors of children who are visually impaired have been found to be predominantly exploratory, with more time spent in solitary play (or interacting with adults) than those of sighted children (Skellenger & Hill, 1994; Troster & Brambring, 1993, 1994). These children also engage less frequently in manipulative play or use toys functionally and demonstrate more stereotypic behavior (such as rocking or eye poking) during play (Rettig, 1994; Skellenger & Hill, 1994; Troster & Brambring, 1994), have difficulty initiating and sustaining interactions with their peers (Celeste, 2006), and require adults' facilitation in inclusive play settings to make play meaningful for them (Rettig, 1994; Skellenger & Hill, 1994).

Simply including children with visual impairments in typical settings is not enough to ensure their full membership in classroom or child care communities. Celeste (2006) found that even in "high-quality" environments, with supportive professionals present, children must possess a repertoire of social skills to gain entry into existing dyads and triads and to sustain interactions, so as to be socially independent. She concluded that social competence must be a priority for children who are visually impaired, even those who appear to be developing typically. Social intervention strategies must be introduced in the early preschool years as soon as new classes begin because the literature has reported that as children become more acquainted with one another, they require increasingly sophisticated "entry skills" to gain admittance to and sustain interactions with their peers (Coplan, Gavinski-Molina, Lagace-Seguin, & Wichmann, 2001; Coplan & Rubin, 1998; Coplan, Rubin, Fox, Calkins, & Stewart, 1994; Guralnick, Hammond, & Connor, 2003). It is critical for children who are visually impaired to be taught the social skills that they need to interact effectively with their sighted peers and for professionals to monitor carefully the children's ability to implement these skills successfully. Professionals must identify strategies related to social skills that work, provide consistent support, and follow children longitudinally, since research has indicated that short-term solutions are rarely effective (Sacks, Kekelis, & Gaylord-Ross, 2001).

SOCIAL IMPACT OF INCLUSION

One aim of inclusion is to provide children with disabilities access to social opportunities in regular education classrooms with their nondisabled peers. Several studies, however, have found that children with disabilities experienced a higher proportion of negative social interactions and engaged in more restricted social networks of peers when in mainstream schools than in special settings (Guralnick, 1994; Sacks et al., 2001). Brown and Odom (1995) found that in inclusive early childhood programs, children without disabilities participated in more child--child social behaviors, whereas children with disabilities received more support and attention from adults than did their peers without disabilities. Such experiences do not give children with disabilities sufficient child--child opportunities to develop skills that are necessary to establish and maintain social competencies with their peers (Beeghly & Cicchetti, 1997; Stoneman, 1997). If social integration is a primary goal of inclusion, the physical placement of children with special needs in typical settings is not enough (Brown & Odom, 1995). Intervention efforts must be focused and individual social intervention plans developed to facilitate growth in critical areas, such as peer-related social competence.

SOCIAL SKILLS INTERVENTION

Several strategies, when used in combination, encourage the generalization of social skills (Rettig, 1994). First, interventions should be comprehensive and give children opportunities to demonstrate skills across a variety of environments (Goldstein, English, Sharer, & Kaczmarek, 1997; Guralnick, 1992). Second, the role of adults (family members, caregivers, and teachers) in supporting children's social development must be carefully considered (Skellenger & Hill, 1994). Involvement of family members is essential to maximizing the effectiveness of intervention (Guralnick, 1992; Guralnick & Neville, 1997). Parental involvement in establishing and expanding the peer social networks of children with play dates or monitoring and facilitating play at home results in larger peer social networks and greater social competence for children (Guralnick, 1992; Ladd & Hart, 1992; Parke & Ladd, 1992). However, social skills intervention should not be limited to out-of-school social experiences. It is critical that such interventions be incorporated directly into the school curriculum, which would require the purposeful involvement of teachers at multiple levels (Skellenger & Hill, 1994).

The final and most direct level of intervention incorporates individualized social integration activities and the explicit teaching of social skills (addressing specific areas of need). Social integration activities that contribute to the peer-related social competence of children with visual impairments may include teaching these children to regulate their emotions and to encode and decode emotional cues and providing feedback regarding the rules of social discourse (Isley, O'Neil, Clatfelter, & Parke, 1999; LaFreniere & Dumas, 1992; Parke, Cassidy, Burks, Carson, & Boyum, 1992). Specific social skills that contribute to the ability of children to establish and maintain social interactions with peers, which may need to be explicitly taught, include strategies for gaining entry to peer groups (Black & Hazen, 1990; Ramsey & Lasquade, 1996), resolving conflicts, and maintaining play (Howes, 1988). The remainder of this article evaluates the short-term effectiveness of a social skills intervention plan for a preschool-age child who is blind and has no additional disabilities.

Method

The participant's developmental and adaptive status, play behaviors, and social interactions were examined at the beginning of the school year (Celeste, 2006). Immediately following this initial evaluation, I, in collaboration with the child's classroom teachers, child care provider, and parents, developed an individualized social skillsintervention plan. I am a certified teacher of students with visual impairments and a licensed orientation and mobility instructor, and I have served in that capacity with the participant since she was 6 months of age.

The plan was designed to meet the participant's social intervention needs. It was based on Brown, Odom, and Conroy's (2001) hierarchy for promoting peer interactions and was implemented over the course of the school year in the preschool, child care, and home settings. The methods that were used to evaluate the participant's postintervention play behaviors and social interactions included structured play observations (during "free play") in the classroom and in the child care settings.

PARTICIPANT

The participant was an African American-Hispanic girl aged 4 years, 6 months, who was blind as a result of Peter' s anomaly with secondary glaucoma and had no neurological or physical handicaps. She had severely reduced vision in her left eye and no vision in her right eye. She held items within 2 inches of her left eye (nasally) for viewing and was unable to track identified playmates or adults beyond arm's reach. Although the participant executed routes to desired objectives within familiar environments indoors and outdoors, she was unable to explore her surroundings visually. As was previously reported (Celeste, 2006), her developmental and adaptive statuses were assessed before the onset of intervention, at which time the participant demonstrated skills that were at or above her age level in the cognitive, gross motor, and communication domains on both the Battelle Developmental Inventory (Newborg, Stock, Wnek, Guidibaldi, & Svinicki, 1988) and the Oregon Preschool Scale for Blind and Visually Impaired Children (Brown, Simmons, & Methvin, 1991). On the Vineland Adaptive Behavior Scales, classroom edition (Sparrow, Balla, & Cicchetti, 1983), the participant scored below her chronological age level in the socialization domain, with moderately low functioning in each of the subdomains of interpersonal relationships, play, and personal and coping skills.

SETTINGS

Preschool

The participant attended an independent preschool program half-days (from 8:30 a.m. to 11:30 a.m.) five mornings per week. The class consisted of 18 4-year-old children (7 boys and 11 girls), and the teacher-to-student ratio was 1:9. The two teachers were both experienced, holding advanced degrees in early childhood educationand early childhood special education. The children in the class were diverse in their developmental levels, special needs, ethnicities, and races. Three of the children were familiar to the participant from the previous school year.

The preschool classroom was arranged to facilitate solitary, small-group, and large-group activities. It included a fine-motor area with beads and puzzles, a light table with related materials, a fully equipped art area with easels, areading nook (with braille-adapted books), a writing center (including materials for producing braille), and a housekeeping area. The daily schedule included free-play activities, "circle time," "choice time," and a snack and then either a motor, library, art, or music activity.

As part of their preschool curriculum, the children were exposed to responsive, age-appropriate classroom discussions that addressed the concept of disability. The teachers responded to the children's questions about visual impairment and encouraged the participant to describe her visual limitations to her peers. Although I facilitated the participant's participation in classroom activities and provided instruction in compensatory skill areas, care was taken to include the participant's sighted peers in most activities.

Child care

To extend her social opportunities, the participant's parents enrolled her in a community after-school child care program from 11:30 a.m. to 4:00 p.m. (Monday to Friday), in which she had access to an additional cohort of peers, aged 2 to 8. The program was organized around activity centers (such as housekeeping, building, and fine-motor activities) with a variety of manipulatives, board games, and developmentally appropriate toys.

INSTRUMENTATION

Structured play observations

The participant's play behaviors and social peer interactions were observed (during free play) before and after the implementation of the social skills intervention program. At each interval, observations were conducted in the preschool (60 minutes) and child care (40 minutes) settings for a total of 100 minutes (10 minutes per session) over a 2-week period.

The pre- and postintervention observations used a modified version of the observation schedule (60 minutes of free play over a 2-week period in 1-minute intervals). They also used the observational instrumentation used by Guralnick et al. (2003) and Guralnick et al. (1996a), whose studies described the play behavior and social interactions of young children with developmental delays in preschool settings. It should be noted that the observation schedule that I used included twice the amount of observation time as in the previous studies.

The recorded observations were analyzed using the Play Observation Scale (POS) described by Rubin (2001) and the Individual Social Behavior Scale (ISBS) developed by Guralnick and Groom (1987). I developed a single, "blended" coding sheet, divided to be used for recording in 10 1-minute intervals. Using a stopwatch, I timed the intervals, observing and then recording the predominant play or nonplay behavior (as indicated by the POS) and all the peer interaction behaviors (as indicated by the ISBS). The recording time between intervals ranged from 5 to 15 seconds. An analysis of the data included primarily descriptive statistics (frequencies, percentages, means, and standard deviations), and nonparametric tests (chi square).

SOCIAL SKILLS INTERVENTION PLAN

At the beginning of the school year, the participant's developmental and adaptive status, play behaviors, and social interactions were evaluated (and reported) (Celeste, 2006). Immediately following the evaluation, an intervention plan was designed to meet her individual social intervention needs. The classroom teachers, the child care provider, the parents, and I collaboratively developed and implemented specific intervention strategies over the course of the school year (in the preschool, child care, and home settings). The intervention hierarchy that we developed included a wide array of strategies, some of which were identified at the onset, and others that were developed as the situation warranted.

The plan was based on the hierarchy of Brown et al. (2001). At the base of the hierarchy are less intrusive classroomwide interventions that are intended to influence children's attitudes. The next level involves the use of naturalistic interventions, including the incidental teaching of social behavior. The final level incorporates social integration activities and the explicit teaching of social skills--individualized interventions that are taught to address specific areas of need, such as script training, modeling, coaching, directive teacher approaches, and peer-mediated approaches with children (Furman & Walden, 1990; Goldstein & Cisar, 1992; Goldstein & Gallagher, 1992; Grubbs & Niemeyer, 1999; Guralnick, 1990; McEvoy, Odom, & McConnell, 1992). Brown et al. (2001) suggested that a social intervention plan should begin with the least intrusive strategies. Then, through careful, ongoing monitoring of the child's social interactions (through direct observation), more intensive interventions are incorporated as needed.

Some classroomwide interventions were as follows:

* Inservice training was conducted before the beginning of the school year with teachers, specialists, and the child care provider. The topics included the nature of the child's visual impairment, the possible effects of the visual impairment on the child's development, the teaching and learning of braille, and orientation and mobility techniques.

* A class discussion about the purpose of braille took place during circle time. Each child was shown samples of braille, and was given a card that had his or her name printed in braille. (Similar discussions took place in the child care setting.)

Examples of naturalistic interventions included:

* A classroom teacher noticed the annoyance of two of the participant's classmates when the participant attempted to make physical contact with them (holding on to their clothing) while they were in line to go out to the playground. The teacher explained why the participant might engage in physical contact and ways to request that she not do so (along with alternative approaches that the participant might use to travel safely in line or to request assistance).

* The child care provider noticed that other children would try to engage the participant in conversation without calling her by name. The child care provider intervened, encouraging the other children to identify themselves to the participant when they attempted to initiate contact and prompting the participant to respond appropriately in these social interactions.

* The classroom teachers and the child care provider supplied the family with names of children who would be socially responsive, out-of-school playmates. The participant's parents routinely arranged for play dates with these children.

The following is an example of social integration activities:

* Deliberate, daily in-school interactions were arranged between more socially responsive children and less socially responsive children. The children were purposefully assigned to small groups for specific activities. The teachers controlled the activities for a short time and then withdrew. As the year progressed, the teachers' participation time decreased.

The explicit teaching of social skills included the following:

* The classroom teachers played role-playing games with the participant, promoting opportunities for her to develop and practice strategies to gain and sustain access to children who were already engaged in play. Within the activity, the participant identified ways in which she might gain the attention of classmates with whom she wished to play, such as by approaching them with their favorite toy and asking them to join her in play. The classroom teachers encouraged the participant to practice this exchange with them before applying it with her peers. (It should be noted that the participant successfully attempted and used this skill at the next possible opportunity, which may have reflected her desire to connect with previously unattainable peers. She was observed using this approach the same day in the child care setting as well.)

Results

PREINTERVENTION

Structured play observations

As was mentioned earlier, at the beginning of the school year (before any social skills interventions were implemented), the participant's play behaviors and peer interactions were observed over a 2-week period (during free play) in the preschool classroom (60 minutes) and the child care setting (40 minutes) for a total of 100 minutes (observations were recorded in 10-minute intervals). As is illustrated in Figure 1 (and reported in Celeste, 2006), in both the classroom and child care settings, the participant spent 50% of the total time she was observed in solitary play (engaged in exploratory activities), 25% of the time in parallel play (engaged in constructive activities), and 25% of the time in group play (engaged in functional motor or dramatic play activities). She rarely responded to peers' attempts to gain her attention or engage her; instead, she played independently, aware of and in proximity to other children but without interacting with them.

[FIGURE 1 OMITTED]

Social interactions with peers

An examination of specific peer interactions showed that the participant did not lead or follow the lead of her peers in either the classroom or child care settings (see Figures 2 and 3). Although she did not actively "refuse" to follow the lead of her peers, she did not respond to their indirect attempts to include her. She did not use peers as a resource (as a means of obtaining information or help) and frequently failed to respond to their attempts to use her as a resource. Similarly, she did not seek agreement from her peers and frequently failed to respond to their efforts to seek agreement from her. Although she sought the attention of her peers in both settings, she frequently failed to respond to their attention-seeking behaviors (see Celeste, 2006, for a complete report of the results of the participant's preintervention evaluation).

POSTINTERVENTION

Immediately following the initial observations, the intervention plan was implemented (mid-September) and continued throughout the school year. Before the end of the school year (early June), postintervention observations were conducted to identify any change in the participant's play behaviors or social interactions.

Structured play observations

In the classroom (see Figure 1), the participant spent none of the time she was observed in solitary play and 50% of the time in parallel play, engaged in constructive activities (such as building with blocks) and dramatic activities (like housekeeping). In the child care setting, she spent half as much time in solitary play (25%), engaged in exploratory activities, as during the preintervention observation and three times as much time (75%) in group play, engaged in exploratory activities (for example, visually examining puzzle pieces or small manipulatives) and dramatic activities.

Social interactions with peers

An examination of specific peer interactions revealed that unlike during the preintervention observations, the participant demonstrated a wide range of social interactive behaviors in both the classroom and child care settings (see Figures 2 and 3). The combined results for both settings indicated that she more routinely joined her peers in specific activities (7 preintervention versus 15 postintervention), led peer activities (0 preintervention versus 19 postintervention), used peers as resources (0 preintervention versus 9 postintervention), responded to peers' attempts to use her as a resource (4 preintervention 8 postintervention), and encountered far fewer instances of failed attempts by peers to gain her agreement (21 preintervention versus 14 postintervention).

LIMITATIONS

There are several limitations to the study. Given the nature of the single-case design, the ability to generalize the results may be limited. In addition, all data collection and coding were conducted by a single individual, who also served as the participant's teacher of students with visual impairments and orientation and mobility instructor, thereby not providing for interrater reliability.

Discussion and implications

After the social intervention plan was implemented, the participant demonstrated an increased range of play behaviors (she spent less time in solitary play in both the preschool and child care settings and a greater amount of time in group play) and an increased frequency of social interactions. However, this program should not be viewed as curative. Although the participant more frequently demonstrated skills that were necessary to join in activities with peers and to sustain social interactions, she continued to miss opportunities for social interaction. In the postintervention observations, she failed to respond to the attention-seeking behavior of her peers 15 times within the 60-minute observation time in the preschool classroom and 6 times within the 40-minute observation time in the child care setting. Although out-of-school play dates appeared to create in-class' opportunities for interacting with peers, these interactions were limited to children with whom she had frequent out-of-school play dates.

[FIGURE 2 OMITTED]

It was also apparent that (in agreement with the literature), the minimum social requirements expected by peers increased as the school year progressed. Peers were no longer engaged with only minimal verbal interactions. The participant had to be provided with more complex verbal schema to be able to initiate and maintain social interactions. As the school year progressed, her peers demonstrated less tolerance for off-topic conversations or imaginary language. It seems that the more familiar a child becomes with peers in a classroom or child care setting, the more challenging it is to maintain social interactions, which implies that social skills intervention must be long term to be effective. To be most effective, interventions must take into account the dynamic nature of social skills and the realization that demands constantly increase with the children's development.

[FIGURE 3 OMITTED]

In addition, social skill interventions need to be collaborative (that is, to include family members, teachers, and specialists) and conducted over the long term. Most social intervention programs tend to be short term (generally one school year in length) and are not designed to address specific needs. This approach does not hold the same prospect for long-term success. Multiple interventions that are implemented concurrently and sequentially are needed. Two years should not be considered unreasonable to effect lasting change in social competence. Although the results of this case study support the efficacy of social intervention strategies in the short term, further long-term evaluation is necessary to determine the lasting effects.

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Marie Celeste, Ed.D., assistant professor, Loyola College in Maryland, Education Department, 109 Beatty Hall, 4501 North Charles Street, Baltimore, MD 21210; e-mail: <[e-mail]>.

Celeste, Marie

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