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Background. Children with autism have severe and persistent impairments in social interaction and communication skills, affecting their participation in daily occupations at play, leisure and school and in personal care activities, thus requiring intervention. Intervention in the form of applied behavior analysis involves teaching skills in discrete steps. The unique capacities of the child require focus to foster new learning, and is done using the concept of closed circles of reciprocal communication, called Circles of Communication (CoC). Floor Time Play (FTP) is an intervention technique representing this approach, and involves moving the child through six developmental milestones (self-regulation, attachment in relationships, two way communication, problem solving, representational capabilities and representational differentiation) by encouraging the child to undertake reciprocal interactions (Dionne & Martini, 2011).
Purpose. The purpose of this study was to determine the effectiveness of FTP intervention with a child with autism (Dionne & Martini, 2011).
Method. The study involved a single subject. The participant was a boy aged 3 years 6 months diagnosed with autism at the age of 2 years 5 months. The child had delayed language and play skills, and was largely non-verbal.
During the intervention phase, the mother kept a daily journal to obtain a description of the FTP intervention at home. The child was seen four times a week for 45 minutes at a clinic. Each session had an observation phase and an intervention phase. Only observation was carried out for the first two weeks. For the subsequent 7 weeks, intervention was part of the process. Each intervention phase was of three times the length of the baseline phase to reduce variability.
All interventions were recorded in video, and analyzed. Two statistical approaches were applied: the celebration line approach and the two standard deviation band method.
Findings. The findings of the observation phase confirmed that the participant exhibited mild to moderate autism. Visual analysis of the intervention phase showed intra subject variability, making the discernment of a trend difficult visually. Statistical analysis showed that all the data points in the intervention phase fell above the extended celeration line. A majority of the sessions were above the two standard deviation band, indicating a significant difference between the number of CoC between phases A and B. The mother’s journal showed a distinct progress in the child (Dionne & Martini, 2011).
Discussion. Data variability made it difficult to use visual analysis to determine trends in CoC. The variability was attributed to the increased problem solving demands on the child by the therapist, augmenting the efforts of the mother. Statistical analysis confirmed the significant difference between the numbers of CoC in Phase B vis a vis Phase A. The study provided preliminary evidence for using FTP with a child with autism. Being a single subject study, it does not lend to generalization, which would require further research with a broader sample of children. The study’s strength is its detailed explanation of data variability and comprehensive statistical analysis. The mother’s journal complemented the study with interesting insights (Dionne & Martini, 2011).
Conclusion. In view of the significant increase of CoC in the intervention phase and the corresponding positive inputs from the mother’s journal, continued studies of the FTP approach are recommended.
Analysis of Study against Criteria for a Quality Single Subject Research Study
Description of Participants and Settings
Description of Participant in Sufficient Detail. The gender, age, disability and diagnosis of the participant are recorded in sufficient detail for further studies to be able to select similar participants.
Description of Process for Selecting Participant. The participant was recruited through an advertisement with the Autism Society. Due approval was obtained from the research ethics board of the local university. These steps are replicable.
Description of Physical Setting. The physical setting of the experiment is described as clinic and home. The authors have referred to achievements of CoC in these settings, and have referred to videotapes of the recordings. However, a distinct description of the physical settings is absent.
Description with Operational Precision. The authors selected CoC as the dependent variable. CoC could be described precisely, thus meeting the criteria of Horner et al.
Measurement of Dependent Variable with a Procedure that Generates a Quantifiable Index. CoC could be observed, and measured. The number of CoC per session was taken as an index.
Valid Measurement of Dependent Variable with Replicable Precision. CoC were directly observable, and could therefore be said to be able to be measured with precision.
Repeated Measurement of Dependent Variables over Time. CoC were collected throughout the study, and hence the parameter of repeatability was met.
Collection of Data on Reliability and Interobserver Agreement of the Dependent Variable. Interobserver agreement of the CoC was achieved by recording all sessions on video. The set framework for FTP guided the reliability of the CoC. An inter-rater reliability (kappa=0.81) was achieved.
Description with Replicable Precision. FTP interventions were chosen as the independent variable. Sufficient references are given by the authors to enable replication.
Symmetric Manipulation and Under Control of the Experimenter. FTPs were under the control of the experimenters, who subjected the participant to FTP in the second phase of the experiment.
Overt Measurement of the Fidelity of Implementation. The implementation of FTPs was clearly shown over the period of the experiment. Teaching methods included the demonstration of adult-child interaction pattern, involving the child in a play scenario, and guiding the parents with verbal suggestions. The sessions involving the FTPs were clearly described, ensuring fidelity of implementation.
Existence of a Baseline. The observation phase of the experiment determined the baseline for the experiment.
Description of Baseline Conditions with Repeatable Precision. The authors have adequately described the baseline conditions, mentioning that semi structured activities and free play situations took place in this phase.
Experimental Control/ Internal Validity
Provision of at least Three Demonstrations of Experimental Effect at Three Different Points of Time. Visual analysis, statistical analysis and a mother’s journal were employed to record the experimental effect. Multiple points of time were recorded, both in Phase A and B of the experiment.
Control over Common Threats to Internal Validity. The authors removed aberrations from their findings, by discarding a spurious increase in CoC in Session 6. This helped to eliminate rival hypothesis that the participant improved in the observation phase itself, while in actuality, FTP was imparted in Session 6.
Whether Results Document a Pattern that Demonstrates Experimental Control. The results show a distinct improvement over the extended celeration line and above the two standard deviation band. Thus, experimental control is established.
The study lacks external validity, as it is not replicated across participants. Further experiments would be required to establish external validity.
Social Importance of Dependent Variable. It is important for children to close circles of communication and respond to environmental stimuli. Hence, CoCs were socially important, and aptly chosen as dependent variable.
Magnitude of Change in Dependent Variable is Socially Important. It is important for autistic children to respond to stimuli. The degree of change due to FTP intervention made it socially desirable and important to conduct the experiment.
Implementation of Dependent Variable is Practical and Cost Effective. The experiment involved day-to-day props, thus being practical and cost effective.
Implementation of Independent Variable over Extended Periods of Time in Typical Physical and Social Contexts. The contexts of the experiment were obtained from daily life, involving daily activities of play and rituals. The experiment was conducted over an extended time, thus meeting the standard set by Horner et al.
Criteria for Experimental Control
Horner et al. lay down a number of criteria to establish experimental control. The importance of the criteria proposed by Horner et al. are analyzed below.
Minimum of Five Single-Subject Studies. Horner et al. propose that five single subject studies meeting minimally acceptable methodological criteria and published in peer reviewed journals be taken before accepting experimental control. Five single subject studies, if reaching the same conclusions, would obviate the possibility of error. Publication in peer-reviewed journals would ensure that the studies follow the accepted rigors of social science research.
Conduct of Studies by Three Different Researchers across Three Geographical Locations. If three different researchers conduct the studies, they would cancel one another’s errors in implementation in terms of experimental design. Different geographical locations would ensure that sociocultural contexts are generalized.
Five or More Studies Including a Total of at least 20 Participants. Multiple studies involving as many as 20 participants would ensure generalization of results. Results of any study could be nullified if not corroborated by other studies.
Ethical and Sociocultural Issues
In addition to the criteria established by Horner et al. for experimental control, the ethical consideration of informed consent of participants should be factored in. If participants were observed without consent, it would constitute a breach of trust.
In addition, sociocultural sensitivities of the backgrounds of the participants should be taken into account to ensure that experimental designs do not include activities that are inimical to the region and culture of the participant. These aspects would ensure that the experiments are sensitive to the sociocultural contexts. Once published, such studies would have a greater chance of being acceptable to the target population.
Dionne, M., & Martini, R. (2011). Floor time play with a child with autism: A single-subject study. Canadian Journal of Occupational Therapy 78/3: 196-203.
Horner, R.H., Carr, E.G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of single-subject research to identify evidence-based practice in special education. Council for Exceptional Children 71/2: 165-179.
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