Case Study: Amanda’s Journey to Recovery (A Clinician’s Report) Blog #2

Peer Power, this has been the theme of the last few weeks. I have seen amazing strides with the consumer over the past few weeks mainly in four areas, shared attention, which is maintaining eye contact and looking at items when instructor points or tells her to look; following gestured cues and modeled cues, which is responding to prompts involving hand gestures or an instructor showing the child what to do by doing it themselves; looking at facial changes to be successful in vocal contagion, which is imitating the instructors vocalizations; and a large reduction in tantrum behavior presently defined as falling to the floor and crying.

I had the privilege of bringing a four year old typical peer in to work with this consumer for ½ and whole day sessions for a total of 4 sessions. Peer sessions are sessions in which a typical peer is used to model or show the consumer correct responses and play skills, provide rewards to the consumer and also to simply model typical behavior. According to a study by Egal, Richman and Koegal, when a child with autism observes a typical peer modeling correct responses their correct responding will increase dramatically (Egal et al, 1981). The peer was initially paired as a reward with the consumer in the same fashion as the instructor.  Pairing is using rewards to “pair” yourself or in this case a peer as a fun person—“the giver of goods”. The pairing sessions were as follows: I had the peer give the consumer highly reinforcing items, gain the consumer’s attention, make funny noises and simply play with the consumer in all of their highly preferred activities. The first day with the peer, the consumer did not acknowledge him unless he followed her and persistently offered reinforcing items, basically he had to continue to present items for the consumer to accept it. By the fourth day she was approaching him, accepting rewards (highly preferred items), making eye contact with him when he stated her name and following his modeled responses rather than mine (the instructors). The consumer followed many  modeled many play actions by the peer including moving animals around a pretend zoo, making yo gabba characters dance and playing with stuffed animals as babies.

With the peer as a model, the consumer was able to master several targets that she had been struggling with including quiet hands, some vocal contagion targets, and significant progress was made in intra-verbal songs. At the end of last week, the peer hugged the instructor. The consumer observed the peer doing this, laughed and ran over hugging her mom. This was the first time the consumer had ever exhibited this behavior on her own. She made eye contact with her mom while hugging her and then proceeded to hug her two more times in the same fashion 2 more times that session. This behavior has continued without the peer’s presence and over the weekend the consumer began kissing her mom and dad as well.

It has been an exciting few weeks filled with huge strides for this consumer. It has been a pleasure watching her become more interactive with not only the adults in her life, but now also a typical peer. I am excited to see where the next month takes us, and how many more strides she will make!