Autism Treatment Center of America®

The Son-Rise Program - Supportive Research

A Child-Centered Approach Makes Social Interaction Motivating

Facilitators and parents employing the SRP make social interaction their primary focus when working one-on-one with a child with Autism, recognizing that social avoidance is the crux of the autistic challenge. There are two ways in which a child-centered approach makes social interaction motivating.

a) Follow the Child: Start with the Child’s Motivation

The SRP works with objects and activities for which the child is internally motivated. This play-based approach starts with the child’s area of motivation (e.g. jumping on a trampoline). The adult joins in with this area of play until the child spontaneously socially orients to the adult (e.g. makes eye contact, physical contact or a vocalization attempt). This spontaneous expression of social interest from the child is then responded to by the adult in a manner designed to be motivating to the child (based on the individual child’s interests and previous response patterns), for example, jumping on the trampoline while pretending to be a monkey. Any subsequent responses by the adult to the child’s expressions of interest are similarly fine-tuned to be motivating to the child. Thus ensues a cycle of reciprocal social exchange within the area of the child’s motivation. The SRP proposes that this approach raises the salience level of social interaction by tying the child’s internal motivations to social interaction.

Autistic children can become very focused on their particular areas of motivation, often to the point of being termed “obsessional” or “perseverative”. Many traditional approaches have tried to steer children away from their areas of motivation in an attempt to broaden the child’s range of interest. The SRP instead recognizes these interests as doorways into that child’s world, a means of forming a connection to become the foundation for more spontaneous and flexible social exchange. Support for this perspective comes from Koegel, Dyer and Bell (1987) who found a negative correlation between social avoidance and child-preferred activities in autistic children. That is, when prompted to engage in activities the children had already demonstrated an interest in, children were much less socially avoidant than when prompted to engage in activities chosen by the adult.

Baker, Koegel and Koegel (1998) further underlined the effectiveness of the child-centered approach with autistic children in a group setting. They took the obsessional interests of a group of children with Autism (e.g. US geography) and made them into common games that could be played by the autistic child and his/ her peer group (e.g. tag game on a giant map of the US). From very low levels of social interaction in the baseline condition, the percentage of social interactions increased dramatically during the intervention period and continued to be high at a 2 month follow-up. These increases in social play interactions continued even in the absence of the adult who had done the initial prompting. Furthermore, the autistic children began to engage more in other non-obsession themed games after the intervention. Baker et al (1989) conclude that “the obsessional themes of children with Autism, which are typically viewed as problematic, can be transformed successfully into common games to increase positive social play interactions” (p.306-307).

The parents of the autistic children involved in this study reported either no increase, or a decrease, in the child’s engagement in the target obsessional theme at home, after the initiation of the obsessional themed games. This finding is consistent with Charlop et al (1990) who used obsessional themes as reinforcers for children to complete other tasks and found no increase in the children’s use of these particular obsessional themes. The SRP similarly maintains that using a child’s obsessional theme or topics of perseveration as a platform for social interaction does not encourage further perseveration but instead helps transform perseverative, rigid play or conversation into socially appropriate, flexible, reciprocal interaction, because it makes social interaction more motivating than previously. Again, direct empirical observation is required to assess these observations.

b) Give Control: Be Responsive and Sensitive to the Child

The second crucial factor in facilitating the emergence of a genuine and spontaneous interest in the social world is giving control or employing a responsive style of interaction (Beckwith and Cohen, 1992). The SRP is child-centered. This means a) the topic of play is derived from the child’s individual interests, and b) the child actively chooses when to begin and end that interaction. This is critical and the juncture at which traditional approaches to special education tend to differ. Trivette (2003) defined this responsive style of interaction as involving two important components. First, the adult responds only to the child’s production of a behavior. This means that the adult responds only after the child makes a physical gesture (e.g. waves, smiles, touches), a vocal sound (e.g. a coo, a word) or an action (e.g. throws a ball, picks up toy). Second, the adult’s response to this action is sensitive, that is, appropriate in its level of intensity. A sensitive response is one in which the intensity level matches the child’s developmental level and mood. For example, if the child is crying, the adult may offer a soothing song; if the child is excited and laughing, the adult might offer a swing in the air (Trivette, 2003).

In a meta-analysis of 13 studies looking at the effects of this style of interaction, Trivette (2003) concluded “that a responsive caregiver style of interaction positively influences the cognitive development of children with, or at risk for, developmental disabilities” and also “has a positive influence on the social-emotional development of these children” (Trivette, 2003, p.5). All 13 studies meeting inclusion criteria for this meta-analysis (1,336 children in total) showed the same result––that adult responsiveness substantially helped these children’s cognitive and social-emotional development.

Subsequent research has continued to support this finding (Mahoney and Perales, 2003; Mahoney and Perales, 2005) and found that responsive interactive style also has positive outcomes on language development (MacDonald, 1989; Manolson et al, 1995). In a long-term study, Siller and Sigman (2002) found that the more mothers of children with Autism engaged in responsive interaction with their children, the higher the levels of communication functioning their children attained at 1, 10 and 12 years of age. Mahoney, Boyce, Fewell and Wheeden (1998) reported that in a large scale, multi-site early intervention research project (Infant Health and Development Program, 1990), maternal responsiveness accounted for six times more of the variance in the developmental functioning of low birth-weight children than did the children’s participation in an intensive (25 hour per week) high-quality school program. Investigating responsive teaching is especially important in the light of findings that mothers of developmentally delayed children tend to be more directive (not responsive) when interacting with their children (Spiker, et al., 2002).

Lewis and Goldberg (1969) suggest that this responsive style of interaction has such a positive effect on children’s development because it facilitates the child’s feelings of control and self-efficacy. This contributes to the child’s sense of competence and so increases the likelihood of the child engaging in subsequent interactions and learning situations. Mahoney and Perales (2003) propose that a responsive style of interaction enhances social behaviors that may be the same as the pivotal response behaviors seen to enhance the efficacy of discrete trial training interventions (Koegel, Koegel, Shosan and McNerny, 1999). Pivotal behaviors “are the processes children employ to learn and practice new behaviors during spontaneous interactions. Following this line of reasoning, it seems possible that as parents engage in higher levels of responsive interaction with their children, they are actually encouraging children to learn and use pivotal developmental behaviors, which are the processes enabling them to acquire untrained socioemotional competencies” (Mahoney and Percales, 2003, p. 84). This would explain why studies using interventions focusing on these pivotal developmental behaviors show children learning skills that they then generalize to other learning situations (Koegel, Koegel and Carter, 1998; Kaiser, Carter, Koegel, 2003).

The SRP employs, exclusively, a responsive style of interaction that they call “giving control”. Under the SRP, each time a child makes spontaneous social contact, the adult responds in a “sensitive” manner as described above; additionally, when a child disengages from social contact, the adult responds by respectfully withdrawing and waiting for a social cue from the child before pursuing any further interactions. Each time this happens, the child learns that s/he has control over her/his social environment. Considerable research shows that children develop to the degree that they have control over their behavior and their effects on the environment (MacDonald, 2004). A child inhabiting the fragmented, unpredictable, chaotic perceptual world described above, who is also extremely challenged by communicating his/her wants, and whose autonomic system appears to be out of control, does not have a sense of being in control of the world or even of his/her body in the way a typically developing child does (Bluestone, 2004). Thus, the importance of providing a social environment maximizing the child’s sense of control can be seen.

That children with Autism do not have a sense of control in the world could explain why they seek out patterns––meaning, predictability and order in a chaotic world. Baron-Cohen (2004) found the content of rituals and topics of perseveration (of higher-functioning children and adults with Autism and Aspergers Syndrome) is not random, but tends to cluster in the domain of systems (including technical, natural and abstract systems). These systems are underlain with rules and regularities more easily grasped by the autistic mind (Baron-Cohen, 2004). The social world is not an organized system regulated by fixed rules but rather a fluid, ever-changing bombardment of sensory input. If the autistic child is to feel comfortable in the social world, then the social world must be made as controllable as possible to encourage the autistic child to participate. This is exactly what is done by the SRP. So when a child in an SRP playroom disengages from the social interaction, the facilitator respects this and allows the child to disengage, does not keep pursuing the interaction as recommended in other relationship-based approaches (Greenspan & Wieder, 1998) and waits for the child to re-engage before continuing to build social interaction. When consistently immersed in a social environment of this nature, SRP proposes the child learns that he has control over the previously uncontrollable social world. This puts the child in the driver’s seat and shows him that he can indeed effectively elicit a response from another when he chooses; this sense of control forms a foundation for reciprocal interaction (Dawson and Galpert, 1990). Koegel, Koegel and McNerney (2001) review data suggesting that “when children with Autism are motivated to initiate complex social interactions, it may reverse a cycle of impairment, resulting in exceptionally favorable intervention outcomes” (p.19).

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