Running head: STRUCTURED PLAY GROUPS

Structured Play Groups and Young Children with Autism: A Review of Research Jody M. Pirtle

Author Note Jody M. Pirtle, Department of Disability and Psychoeducational Studies, University of Arizona. The author would like to thank Dr. June Maker, Dr. Stephanie MacFarland, Linda Reeves, Sonya Spolsky, and Jung Sook Kim for their personal assistance in critiquing this manuscript. Correspondence concerning this manuscript should be addressed to Jody M. Pirtle, Department of Disability and Pscyhoeducational Studies, University of Arizona, Tucson, AZ. Email: jbartz@email.arizona.edu

STRUCTURED PLAY GROUPS Abstract In this systematic review of research, the author analyzed studies of structured play groups and their influences on the development of social play and communication skills in young children

with autism. The purpose of this review was to build upon a review of the research conducted by McConnell that included published literature through May 2000. In general, researchers who used structured play groups demonstrated increases in the social play and communication skills of young children with ASD; however, limitations regarding the reliance on adult facilitators and the generalizability of the results to settings outside the intervention are noted. Suggestions for future research focused on the use of play groups to develop and foster communication skills in young children are included. Keywords: autism, structured play groups, play groups, play intervention, young children

STRUCTURED PLAY GROUPS Structured Play Groups and Young Children with Autism: A Review of the Research

Playing has been important to young childrens development. It has set the stage for later social competence (Stone & La Greca, 1986), and through play, children have experienced cognitive, social, linguistic, motor, and emotional growth (Furman & Robbins, 1985; Rubin, Fein & Vandenberg, 1983). When they play, children can explore various societal roles and rules, giving them the opportunity to work through anxieties and social conflict while developing selfesteem and social competence. Play provides children with and without disabilities the opportunity to interact positively with each other. However, sometimes educators do not consider the importance of play skills when making programming decisions for young students diagnosed with autism spectrum disorders (ASD). Young children with ASD demonstrate delays, deficits, or atypical characteristics in the frequency, type, and quality of social interaction and communication with other individuals (McConnell, 2002). These unique and complex problems are significant challenges for practitioners and families (Yang, Wolfberg, Wu & Hwu, 2003). Researchers have devoted substantial efforts to describing the developmental course of social interactions and communication skills among children with ASD and have focused similar efforts to the design of interventions to promote or facilitate development of these competencies. Young children with ASD are vulnerable to being excluded from their peers; simple co-location of children with autism and more competent peers without direct intervention is not sufficient to produce increases in social interaction (Myles, Simpson, Ormsbee, & Erickson, 1993). Typical children engage in play that is meaningful, imaginative, and socially interactive. In contrast, young children with autism tend to engage in repetitive, isolated play that does not stimulate their social skill development. Children with ASD can also lack the ability to play

STRUCTURED PLAY GROUPS spontaneously and imaginatively, may restrict their play to limited, often repetitive and nonfunctional themes or activities, and are less likely to imitate the social behavior of others (American Psychological Association, 2000). Additionally, typical peers may choose not to interact with children with disabilities (Guralnick, Connon, Hammond, Gottman, & Kinnish, 1995) or may need direct training to engage them in reciprocal play (Myles, Simpson, Ormsbee, & Erikson, 1993). Children with autism possess additional characteristics that impede their development of social play. First, poor communication skills limit their reciprocity in play (Guralnick, 1990). A hallmark characteristic of children with autism is lack of or delay in appropriate language development. Second, children with autism often have difficulty interpreting and predicting the thoughts, feelings, and behaviors of other children. These impediments, called theory of mind

challenges (Baron-Cohen, 1995), inhibit the development of friendships (Tager-Flusberg, 1999). Third, because individuals with ASD may have restricted interests, they may be resistant to exploring new play themes with other children. Fourth, children with autism are less likely to initiate play with others, and when an invitation is extended, often it is not delivered properly to typical peers. The lack of social play and communication skills among young children with autism supports the need to provide direct intervention to young children with autism as well as training to their peers. Structured Interventions Structured interventions are used to teach a variety of skills to young children with autism. Play groups are one type of structured intervention. Integrated play groups (IPG) and peer-mediated play groups are sub-categories of structured play groups (Figure 1). All structured play groups include the following components: (a) use of typical peers as models or directors of

STRUCTURED PLAY GROUPS play [opposed to the adult directing the play] and (b) use of play intervention in natural settings to promote childrens generalization of social and communication skills (Goldstein, Kaczmarek, Pennington, & Schafer, 1992). Integrated play groups (IPGs). Interventionists using IPGs, a more structured form of play groups, foster childrens social interactions by arranging the physical environment purposefully and guiding participation within the environments. Within their design, Wolfberg and Schuler (1993) included the following eight key features in their IPG model: 1. Natural Integrated SettingsIPGs are implemented in natural social settings

characterized by a higher proportion of children who are socially competent than children who require extensive social support. 2. Well-Designed Play SpacesWhen designing play space, researchers and practitioners take into consideration spatial density and size, arrangement, organization of materials, and general accessibility. 3. Selection of Play MaterialsGender and culturally diverse toys that encourage interaction are selected. 4. Establishing a Consistent Schedule and RoutineA highly predictable environment is created by establishing a consistent schedule and carrying out ongoing opening and closing routines. 5. Forming Balanced Play GroupsPlay groups are limited in the number of familiar peers and/or siblings to afford the child with autism optimal opportunities to develop social skills. 6. Focus on Child CompetenceSelf-selected play is a key element; spontaneous initiations by children are viewed as indices of a childs development.

STRUCTURED PLAY GROUPS 7. Guided ParticipationThe adults role is to guide rather than direct the children to participate in increasingly sophisticated play activities. 8. Full Immersion in PlayChildren are fully immersed in the total group play experience through a system of mutual support. Peer-mediated play groups. A less-defined form of structured play groups than IPGs, peer-mediated play groups, have been recommended to address social skills acquisition; typical peers are viewed as instructional resources or change agents and are provided training by the adults in how to model, prompt, and reinforce academic and/or social responses from students with autism (Carr & Darcy, 1990; Gaylord-Ross, and Haring, 1987; Haring, 1992; Haring & Breen, 1992). Within these play groups, various teaching strategies are used to train peers to facilitate and promote appropriate communicative and social behaviors in children with autism. DiSalvo and Oswald (2002) organized play groups into three approaches according to expectancies to promote interaction: (a) manipulation of the situation or contingencies, (b) peer instruction in social interaction strategies, and (c) instruction of in initiation strategies for the

target child. In the first approach, learning and modeling opportunities were created so that peers can encourage the students with autism to interact. During the second approach, typically developing peers were taught specific strategies to enhance social interactions with students with autism. Finally, in the third approach, students with autism were taught initiation skills. McConnell (2002) reviewed results from aggregated research on the characteristics of social interactions and interventions used to improve social skill outcomes among young children with autism. McConnell based his review on published literature through May 2000 and included structured play groups, but did not focus on the development or promotion of communication skills in young children with autism. The purpose of this paper was to review the available

STRUCTURED PLAY GROUPS research (since May 2000) on the use of play groups, more specifically, IPG and peer-mediated, as strategies to promote competence or improve social play and communication performance of young children with autism. The following question guided the review and synthesis of the

research: What influence do structured play groups, both IPG and peer-mediated, have on the on the social and communication skill outcomes of young children with autism? Method Selection Criteria This paper was based on a review of the empirical research on the effects of structured play groups on the social play and communication skill development of young children with autism. To be included in this review of research, the study had to meet the following criteria (a) all participants were between three and eleven years old; (b) target participants were diagnosed with ASD; (c) intervention was limited to use of structured, integrated, or peer-mediated play group strategies; and (d) the research was published after May 2000 in a peer-reviewed journal. Selection of the Research First, electronic bibliographic searches of Psych-lnfo (PSYCHINFO), and the Education Resources Information Center (ERIC) from May 2000 through March 2010 were conducted for published resources using the following keywords: autism, structured play groups, play groups, play intervention, young children, and preschool. These searches resulted in 340 articles. By reviewing the articles abstracts, the author further narrowed the research to interventions focused solely on structured, integrated, or peer-mediated play interventions for young children with autism between the ages of 3 and 11. A total of 14 articles met the criteria for this review. Table 1 displays the participants, purposes, and results for the articles considered for this review. Additional information from meta-analytic reviews, literature reviews, on-line resources,

STRUCTURED PLAY GROUPS theoretical and opinion-based articles, books, and book reviews provided background information about autism and structured play groups. Results The variability of participants within special education research can make identifying evidence-based practices difficult and complex (Odom, Brantlinger, Gersten, Horner, & Harris, 2005). With the exception of one pilot exploratory study, all researchers reviewed used singlesubject methodology. Although some variability exists in the quality and appropriateness of specific experimental designs, single subject investigations can, and most typically do, maintain the highest standards of internal validity (McConnell, 2002). Table 2 outlines quality indicators that help determine if a specific single-subject study is a credible example of research and if a specific practice or procedure has been validated as evidence-based (Horner, Carr, Halle, McGee, Odom, & Wolert, 2005). The author listed all research reviewed in this paper and whether or not individual quality indicators were addressed within the article. Of the 14 studies reviewed, three of the researchers (21%) met all the quality indicators. Of the remaining 11 studies, the percentage of met components ranged from 64% to 94%. Social Play Skills Researchers within ten of the fourteen studies (71%) focused solely on social play outcomes in young children with autism and one researcher (7%) focused on social play and communication skill outcomes. All researchers provided a detailed description of both the interventions and the dependent variables; however, no more than three studies used the same intervention and no more than two researchers measured the same social play dependent variables. All researchers performed their structured play interventions within a school setting with the exception of Zercher et al. (2001), who implemented the intervention in a church

STRUCTURED PLAY GROUPS Sunday school. All researchers concluded that social play skills increased during intervention periods. IPG interventions and outcomes. The most common intervention implemented across the studies was IPG strategies, with three of the fourteen researchers (21%) using variations of this intervention to measure social play skill outcomes (Lantz, Nelson, & Loftin, 2004; Yang,

Wolfberg, Wu, & Hwu, 2003; Zercher, Hunt, Schuler & Webster, 2001) This is not surprising as Wolfberg and Schuler (1993) and Schuler and Wolfberg (2000) are credited with the IPG methodology designed to promote play and social development for children with autism within adult-facilitated groups. Within similar IPG interventions, dependent variables were diverse. Lantz, Nelson, and Loftin (2004) measured (a) Isolate Play (solitary play), (b) Orientation-Onlooker (showing an awareness of peers, but not entering play), (c) Parallel-Proximity (playing independently beside rather than with peers), (d) Common Focus, (e) and Common Goal behaviors for the target participants. Yang, Wolfberg, Wu, and Hwu (2003) operationally defined the dependent variable as the effects of participation in the IPGs on the cognitive/symbolic and social dimensions of play for two children with autism. Definitions for the cognitive/symbolic dimension of play included the following elements (a) Not engaged, (b) Manipulation (exploring toys, but not using in conventional ways), (c) Functional (conventional use of toys), and (d) Symbolic-pretend (imaginary play). Zercher, Hunt, Schuler, and Webster (2001) used a multiple baseline design across subjects to assess the effects of participation in an integrated play group on the joint attention, symbolic play, and language behavior of the two brothers with autism. Peer-mediated interventions and outcomes. Two of the studies were based on the use of visual strategies (Ganz & Flores, 2007; Nelson et al., 2007) and two were based on the use of

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social stories (Delano & Snell, 2006; Quirmbach et al., 2009). Interactive LEGO play therapy was chosen by Legoff and Sherman (2006) and Owens, Granader, Humphrey, and Baron-Cohen (2008) as the intervention to increase social skills. Kroeger et al. (2007) were the only researchers who employed video modeling as the instrument used to teach play and social skills. Thomas and Smith (2004), who followed Beyer and Gammeltofts (2000) and Sherratts (1999) direction, used the play intervention, Tabletop Identiplay, to teach play skills to children with ASD during their exploratory study. The remaining researchers used researcher-made interventions to measure social play skill development. Social play was defined in diverse ways. Delano and Snell (2006) defined the dependent measures as (a) appropriate social engagement with a peer, (b) inappropriate social engagement with a peer, and (c) the absence of engagement with a peer. Nelson, McDonnell, Johnston, Crompton, and Nelson (2007) identified dependent measures as the percentage of opportunities that a child used (a) the Keys to Play or (b) another strategy such as words, sign language, or parallel manipulation of objects to enter a play group. Quirmbach, Lincoln, Feinberg-Gizzo, Ingersoll, and Andrews (2008) operationally defined the play skills that comprised each participants total social skills score: (a) greeting behaviors, (b) requesting to play a game, (c) inviting another person to play, and (d) accepting anothers choice of game. Thomas and Smith (2004) assessed childrens play behaviors such as playing with toys, and demonstrating functional play during free time before and after their two-week pilot intervention. Kroeger et al. (2007) defined prosocial behaviors as initiating behaviors, responding behaviors, and interacting behaviors. Hobson et al. (2008) created two composite variables, mechanics of pretend play (based on attributions of symbolic meaning and flexibility) and playful pretend (based on self-

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awareness, investment, creativity, and fun) on an a priori theoretical basis. No other researchers included in this review created composite variables. Legoff and Sherman (2006) were the only researchers who measured overall social adaptation and reduction in socially inappropriate behaviors. Owens, Granader, Humphrey, and Baron-Cohen (2008) measured (a) the frequency of self-initiated social contact with peers, and (b) the duration of social interactions with peers. Kasari et al. (2006) examined the efficacy of targeted discrete trial training interventions of joint attention and symbolic play within their mixed-effect regression model. Communication Skills Three of the fourteen researchers (14%) focused solely on communication or language skill development in young children with autism (Ganz & Flores, 2007; Kasari et al., 2008; Owens et al., 2008). Further examination of the articles revealed that communication and language skills were not measured in isolation. Zercher et al. (2001) were the only researchers (7%) who targeted both social and language skill outcomes initially, however, all researchers revealed social skill interventions as the catalyst to develop language skills. IPG interventions and outcomes. None of the researchers who used IPGs focused on communication or language skills development within their studies. Peer-mediated interventions and outcomes. Legoff and Sherman (2006) collected data post hoc from clinical files of children who had participated in both individual and group sessions for at least 36 months, and for whom initial and follow-up assessment data were available. In contrast, Owens, Granader, Humphrey, and Baron-Cohen (2008) evaluated the differences between LEGO play therapy and the Social Use of Language Programme (SULP). Previous researchers have demonstrated that LEGO therapy was an effective means of facilitating complex social interactions in children with autism (Dewey et al. 1988, Legoff, 2004)

STRUCTURED PLAY GROUPS while no empirical evidence existed to demonstrate the effectiveness of the SULP for children with autism. Kasari et al. (2008) re-analyzed 2006 data and examined the effect of the joint attention and symbolic play interventions on the growth in expressive and receptive language.

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Kasari et al. (2008) measured language growth (word usage) and Ganz and Flores (2007) operationally defined the dependent variables (a) scripted phrases (word-for-word from scripts), (b) context-related comments (when script phrase was used), (c) unscripted phrases (unintelligible words, phrases or sentences), (d) response to peers and adults (when participant answered a peers or adults question within allotted time), and (e) intervals with any speech (any of above mentioned variables). Owens et al. (2008) demonstrated reduced autism-specific social difficulties and increased communication standard scores for LEGO Therapy participants. Additionally, they noted a reduction of maladaptive behaviors following both interventions. Conclusion The purpose of this review of research was to examine what influence structured play groups, both IPG and peer-mediated, have on the on the social and communication skill outcomes of young children with autism. Structured play groups are effective in promoting positive social play and communication skills outcomes in young children with autism; however, due to developmental variations among children (especially those diagnosed with autism), consistently defining social play skills can be challenging. Additionally, the reliance upon adult facilitators and the lack of generalizability are limitations to structured play groups that must be recognized. IPGs and Social Play Skills Researchers who used IPGs to address social play skill deficits in young children with autism all demonstrated that the IPGs were effective in increasing the desired social play skills.

STRUCTURED PLAY GROUPS Social play skill outcomes were all individualized based on each students needs; which is

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appropriate in the field of special education, but IPGs are the most structured play intervention which allows potentially for the flexibility in desired social skill outcomes. However, the differentiation found among the dependent variables within the research selected for this review makes it difficult to generalize results. IPGs and Communication Skills None of the researchers who used IPGs identified increased communication skills as targeted outcomes. Initially, IPGs were designed to foster childrens social interactions (Wolfberg & Schuler, 1993), not to increase communication skills, although the researcher noted the natural connection between social skills and communication skills in the studies reviewed. Discussion regarding the use of IPGs to address communication skill deficits in young children with autism is warranted. Peer-Mediated Play Groups and Social Play Skills All researchers who used peer-mediated play groups to increase social play skills of young children with autism demonstrated increases in the desired skills; however, the results must be interpreted with caution as all interventions and desired outcomes were described and defined differently. The lack of structure or consistent definition of the components of peermediated play groups makes generalizing the results challenging. Peer-Mediated Play Groups and Communication Skills Only three of the fourteen researchers focused specifically on communication or language skill development within their studies. This is surprising considering communication skill deficits are a core component of the autism diagnosis. Given the inherent communication

STRUCTURED PLAY GROUPS challenges for children with autism, a need for further research using play interventions to achieve targeted communication skill outcomes is magnified. Implications for Practice In concordance with McConnell (2002), with the exception of IPG strategies, few examples of empirical evaluations of intact, well-described and disseminable interventions or

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curricula were evident during this review. Peer mediated play groups are generally designed by the interventionist and vary greatly in design and implementation. However, although a variety of strategies were used, it is clear play interventions will increase social play and language skills in young children with autism. Within this review, the author discovered language skill development was reliant upon the implementation of a structured play group and practicioners who intend to use structured play groups solely for the purpose of language development may discover an increase in childrens social play skills as well. Recommendations for Future Research An additional gap in the literature is the lack of generalizability from the play group setting to the childs natural learning environment; only one researcher providing data to demonstrate generalizability of the skills (Quirmbach, 2009). Additional research, possibly longitudinal studies, targeting the generalization of social play and language skills postintervention are warranted. Additional qualitative information obtained would help to add to the richness of social play and communication skill outcomes for young children with autism. Research on social play skill outcomes and language skill development for young children with autism has advanced substantially in the past 20 years. This research has provided critical guidance for the world of practice and has added tremendously to our basic and applied understanding of conditions affecting the social and language development of young children

STRUCTURED PLAY GROUPS with autism. Several research lines already established should continue and other lines of research should be developed to further expand and deepen our understanding and capacity to best serve young children with autism.

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STRUCTURED PLAY GROUPS Yang, T., Wolfberg, P. J., Wu, S., & Hwu, P. (2003). Supporting children on the autism spectrum in peer play at home and school: Piloting the integrated play groups model in taiwan. Autism: The International Journal of Research and Practice, 7(4), 437-53. doi:10.1177/1362361303007004009 Zercher, C., Hunt, P., Schuler, A., & Webster, J. (2001). Increasing joint attention, play and language through peer supported play. Autism, 5(4), 374-398. doi:10.1177/1362361301005004004

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STRUCTURED PLAY GROUPS Table 1. Summary of the Study Participants, Purposes, and Results Study Participants Purpose 1. Delano & Snell 3 elementary-aged Evaluate the effects of (2006) children with autism social stories on the duration of appropriate social engagement.

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Results All three participants showed an increase in the duration of time they spent engaged socially with both a training as well as novel peer in intervention setting. All three participants context-related language increased through use of visual strategies during play group sessions. The children with autism demonstrated lack of playful pretend that typifies the socialdevelopmental underpinning of typical creative play. Children in joint attention initiated more shows and greater improvement in responding to joint attention and children in play groups showed greater diversity of play. (continued)

2. Ganz & Flores (2007)

3 children with autism (all between 3 and 6 years of age) and 3 typically developing peers 16 (boys) with autism and 16 children (11 boys, 5 girls) with learning difficulties or developmental delays, but without autism

Investigate the impact of using visual strategies during play group sessions on the communication skill development. Determine if the play of children with autism manifests a lack of the socialdevelopmental hallmarks that typify creative symbolic functioning. Examine the efficacy of targeted interventions of joint attention and symbolic play.

3. Hobson, Lee, & Hobson (2009)

4. Kasari, Freeman, & Paparella (2006)

58 children with autism aged 3 and 4 years (46 boys, 12 girls)

Running head: STRUCTURED PLAY GROUPS

24

Table 1. Summary of the Study Participants, Purposes, and Results continued Study Participants Purpose Results 5. Kasari, Paparella, 56 children from Examine (a) whether Children who & Freeman (2008) original study (follow or not positive received targeted joint up) changes in joint intervention showed attention would result greater language in positive changes in growth over the 12 language development months than children in children with ASD in control group. at 12 months postintervention and (b) predictors of language growth. 6. Kroeger, Schultz, & Newsom (2006) 25 children (aged 4 to 6 years old) with ASD Investigate the effectiveness of group-delivered social skills interventions for young children with ASD Both groups improved in prosocial behaviors; however, children in direct teaching groups made greater gains than children in play activity groups. IPG intervention was effective in improving play behaviors of one participant and behaviors generalized to students typical classroom setting. (continued)

7. Lantz, Nelson, & Loftin (2004)

2 novice players (with ASD) and 3 expert players

Implement an IPG program in a rural, Midwestern elementary school

Running head: STRUCTURED PLAY GROUPS

25

Table 1. Summary of the Study Participants, Purposes, and Results continued Study Participants Purpose Results 8. Legoff & Sherman 60 children (49 males, Present LEGO LEGO therapy (2006) 11 females, mean age therapy outcome data participants showed 9:3) in the LEGO reflecting changes in a greater improvement group; 57 children (47 broader range of in broad range of males, 10 females, social skills and social skills and a mean age 10:1) in the autistic behaviors reduction in autisticcontrol group; all over a 3-year period type social behaviors participants diagnosed compared with over a 3-year period with ASD, Aspergers outcomes for compared with or PDD-NOS comparable levels of matched controls. social skills interventions that did not include LEGO materials. 9. Nelson, McDonnell, Johnston, Crompton, & Nelson (2007) 4 children with ASD (between 45 months and 51 months old) Examine effects of a visual intervention strategy (Keys to Play) on the play initiation skills of four young children with ASD in inclusive preschool classes Evaluate the effectiveness of LEGO therapy in comparison to Social Use of Language Program (SULP) on the social skills of participants. Intervention package was successful in teaching pre-school aged children with autism to initiate entry into play groups.

10. Owens, Granader, Humphrey, & BaronCohen (2008)

Children between 6 and 11 years old with IQ >70 and were able to speak in phrases

Autism-specific social difficulties were reduced following LEGO therapy with no change after SULP therapy. There was a reduction of maladaptive behaviors following both interventions. Participants in LEGO therapy group showed small yet statistically significant increase in duration of social interactions while SULP group did not. (continued)

Running head: STRUCTURED PLAY GROUPS Table 1. Summary of the Study Participants, Purposes, and Results continued Study Participants Purpose Results 11. Quirmbach, Lincoln, FeinbergGizzo, Ingersoll & Andrews (2009) 45 children (between 7 to 11 years) with ASD Attempt to (a) demonstrate that a single social story intervention effectively improves specific play skills for large cohort of children with ASD, (b) compare different formats of a social story to determine which component most effective, (c) assess whether or not children with ASD can generalize and maintain skills gained from social story intervention, and (d) determine which prerequisite skills are needed for child with ASD to benefit from social story intervention

26

Researchers demonstrated that (a) a large cohort of children with ASD significantly increased valuable game play skills, (b) both standard and directive social stories were equally effective in eliciting improvements in game play skills, and (c) participants in both directive and standard groups continued to demonstrate appropriate game play skills across trials and maintained their skills 1 week postintervention, and (d) social stories are an effective intervention for children with autism ages 7-14 who have Verbal Comprehension Index (VCI) scores from the WISC-IV above 68. (continued)

STRUCTURED PLAY GROUPS

27

Table 1. Summary of the Study Participants, Purposes, and Results continued Study Participants Purpose Results 12. Thomas & Smith 3 children with ASD Examine effectiveness Following (2004) (between 3 years, 4 of the routine and intervention, all months and 4 years, 1 systematic use of play children increased the month old) intervention meeting amount of time spent the needs of children playing with script with ASD within a toys, using script pilot, exporatory sequence as a basis study for their play, and using functional play in their free-play time. 13. Yang, Wolfberg, Wu & Hwu (2003) 2 children with ASD (one female, aged 7:11 and one male aged 6:5), and 6 typically developing peers and/or siblings 2 novice twin boys with ASD (aged 6:3) and 3 non-disabled sisters aged 5:5, 9:6 and 11:9. Study the effects of participation in and IPG on the symbolic and social play of participants. Determine if IPG strategies could be adapted for younger children in a nonschool community setting. Each participant made notable gains in both social and symbolic play while participating in IPG. Elements of IPG strategies can be used effectively in community settings as well as school settings.

14. Zercher, Hunt, Schuler & Webster (2001)

Running head: STRUCTURED PLAY GROUPS

28

Table 2 Summary of Quality Indicators for Single-Subject Research (Horner, et al., 2005, Lane, 2009) Study Quality Indicator 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Participants and Setting Participant description Y Y Y Y Y Y Y Y Y Y Y Y Y Y Participant selection N Y N Y Y N N Y Y Y Y N N Y Setting description N Y Y N N N Y Y Y Y N Y Y Y Dependent Variables Operational description Measured over time Valid and precise Interobserver agreement

Y Y Y Y

Y Y Y Y

Y N N Y

Y Y Y Y

Y Y Y Y

Y Y Y N

Y Y Y Y

Y Y Y Y

Y Y Y Y

Y Y Y Y

Y Y Y Y

Y Y Y Y

Y Y Y Y

Y Y Y Y

Independent Variable Operational description Y Systematically manipulated Y Fidelity of implementation Y Baseline Established pattern Description Y Y

Y Y Y N N

Y Y Y N Y

Y Y Y Y Y

Y Y Y Y Y

Y Y Y N Y

Y Y Y Y Y

Y Y Y Y Y

Y Y Y Y Y

Y Y Y N Y

Y Y Y Y Y

Y Y N N Y

Y Y Y Y Y

Y Y Y Y Y

Experimental Control Three demonstrations of effect Y Internal Validity Y External Validity Social Validity Y Y

N Y Y Y

N Y Y Y

Y Y Y Y

Y Y Y Y

N N N Y

Y Y Y Y

Y Y Y Y

Y Y Y Y

N Y Y Y

Y Y Y Y

N N Y Y

Y Y Y Y

Y Y Y Y

STRUCTURED PLAY GROUPS

29

Structured Interventions Play Groups Peer-mediated play groups

Figure 1. Hierarchy of Structured Interventions

Integrated Play Groups