A playground intervention for students with ... - Wiley Online Library

Psychology in the Schools, Vol. 44(8), 2007 Published online in Wiley InterScience (www.interscience.wiley.com).

© 2007 Wiley Periodicals, Inc. DOI: 10.1002/pits.20265

MODIFYING SOCIALLY WITHDRAWN BEHAVIOR: A PLAYGROUND INTERVENTION FOR STUDENTS WITH INTERNALIZING BEHAVIORS MICHELLE R. MARCHANT AND BROCK R. SOLANO

Brigham Young University ADAM K. FISHER AND PAUL CALDARELLA

BYU-PBS Initiative K. RICHARD YOUNG AND TYLER L. RENSHAW

Brigham Young University There is little research regarding interventions for children with internalizing behaviors in schools, both within classrooms and in nonclassroom environments. In response to this need, a nonclassroom treatment package, consisting of (a) social skills instruction, (b) mediated self-management, and (c) a reinforcement system, was implemented to modify the socially withdrawn behavior of 3 elementary students. The effects of this treatment package were evaluated on the school playground—during recess—by recording both the number of communicative acts and the total time spent engaged in appropriate peer play for each target student. All target students showed marked improvement in their playground, social interaction. Future research should be conducted with similar populations, using variations of the described methods in other school settings. © 2007 Wiley Periodicals, Inc.

Social competence, the ability to interact successfully with peers and significant adults, is a critical aspect of a student’s development because it is associated with teacher acceptance, academic achievement, peer acceptance, and positive peer relationships (Walker, Ramsey, & Gresham, 2004). Consequently, educators face the challenge of increasing the social competence of students with both externalizing and internalizing behavior problems in order to increase the likelihood of positive school experiences and therefore positive school outcomes. Though researchers have indicated the importance of social competence, efforts to foster positive social relations in students with behavioral problems have often been unsuccessful and discouraging (Gresham, Sugai, & Horner, 2001). Educators and researchers therefore need to continue to confront the challenge of investigating empirically validated interventions for increasing social competency in students who lack social skills, particularly those who display internalizing behaviors. In educational and psychological literature, quiet, “invisible” students who display anxious, depressed, withdrawn, and somatic symptoms are typically classified as internalizers (Achenbach & Rescorla, 2001; Gresham & Kern, 2004; Merrell, Blade, Lund, & Kempf, 2003). Internalizing disorders have a negative influence on children’s academic performance, physical health, future psychological adjustment, and employment opportunities (Flook, Repetti, & Ullman, 2005; Merrell, 1994, 2003; Merrell & Walker, 2004). However, because this category of emotional behavioral disorders (EBD) is characterized as “disturbing” to the individual exhibiting the behavior rather than “disturbing” to others or the environment (Kauffman, 2001), teachers frequently view students with internalizing behavior as merely shy, failing to recognize the ramifications of this behavior on student outcomes both in and out of school (Reynolds, 1992). Due to their covert nature, internalizing behaviors present unique challenges in referral, assessment, and intervention practices in schools. Specifically, because schools typically use “reactive” methods (e.g., office disciplinary referrals) for identifying students in need of behavioral services (Nelson, Benner, Reid, Epstein, & Currin, 2002; Walker, Cheney, Stage, & Blum, 2005),

Correspondence to: Michelle Marchant, Department of Counseling Psychology and Special Education, 340-B MCKB, Brigham Young University, Provo, UT 84062. E-mail: [email protected]

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students with internalizing behavior problems are both identified and referred less for these needed services than their counterparts with externalizing behavior problems (Gresham, Quinn, & Restori, 1999; Kauffman, 2001; Lane, Gresham, & O-Shaughnessy, 2002). Thus, most research regarding internalizing behavior problems has focused on assessment and classification rather than intervention practices (Merrell, 2001). In an extensive review of empirical studies regarding treatment of internalizing behavior problems, from 1985 to 2001, only 27 well-controlled studies were identified (Compton, Burns, Egger, & Robertson, 2002). Furthermore, only six prevention or early intervention studies were located, to date, concerning children with internalizing behavior (Kendziora, 2004). Both reviews suggest that research, in general, with children and adolescents with internalizing behaviors is scarce. Though treatment research for internalizing behaviors is limited, the methods employed for treatment have been similar. For example, in the aforementioned studies (Compton et al., 2002; Kendziora, 2004), the majority of children were treated for depression and anxiety—two primary categories of internalizing behavior problems (Achenbach & Rescorla, 2001; Gresham & Kern, 2004; Merrell, 2001)—via cognitive-behavioral therapy (CBT). This CBT was typically group based and administered via therapists at outpatient clinics. Despite the limited number of interventions reported, research affirms that if children and adolescents with internalizing tendencies are accurately identified and properly treated, the outcomes are favorable (Compton et al., 2002; Kendziora, 2004; Merrell & Walters, 1998). However, generalization of treatment outcomes into natural settings is a concern (Ollendick & King, 1994; Skinner, Neddenriep, Robinson, Ervin, & Jones, 2002), and thus developing effective intervention approaches for natural environments warrants investigation. Because it offers repeated opportunities for socialization, school is a natural environment important for a child and adolescent’s social and emotional development. Recognizing that social competence is highly associated with successful schooling experiences and outcomes, intervening with internalizing behavior problems in school settings is essential. However, because students with externalizing behavior problems are more readily identified and referred, school personnel typically target these students for intervention while overlooking students with internalizing behaviors (Gresham, Lane, Macmillan, & Bocian, 1999; Walker et al., 2004). Nonetheless, because students with internalizing behavioral tendencies also have limited social competence, they too are in need of treatment (Gresham, 2002; Merrell, 2001). According to Merrell (2001), internalizing disorders are divided into four categories: depression, anxiety, social withdrawal, and somatic or physical problems. Within the DSM system, however, social withdrawal is more commonly considered a cluster, rather than a separate disorder (Merrell & Walters, 1996). Despite definitional and categorical discrepancies, students who exhibit socially withdrawn behavior—characterized by a general fear of novel and social situations (Achenbach & Rescorla, 2001; Merrell & Walters, 1996)—are in particular need of social skills instruction. However, research focusing on social withdrawal has rarely been conducted in school-based settings, being conducted largely in residential treatment facilities (Skinner et al., 2002). Though self-management—as an intervention component—has not been thoroughly investigated with students with behavioral challenges, researchers have indicated it is an effective treatment component in supporting, modifying, and maintaining positive social behavior within schools (Cole & Bambara, 1992; Peterson, Young, Salzberg, West, & Hill, 2006; Todd, Horner, & Sugai, 1999; Webber, Scheuermann, McCall, & Coleman, 1993). For example, Christensen, Young, and Marchant (2004) found that a self-management, combined with peer feedback and positive reinforcement, was effective in developing socially appropriate classroom behavior (e.g., getting the teacher’s attention, interacting with peers, complying to instructions) among students with both externalizing Psychology in the Schools

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and internalizing behavior problems. All participants showed a 34% increase in their behavior from baseline to intervention, and this improvement remained over time as the treatment was withdrawn. Furthermore, the authors recommended the investigation of peer-mediated selfmanagement strategies in school settings, particularly with students who exhibit internalizing behavioral tendencies, such as social withdrawal (Christensen et al.). Considering that little research has been conducted with students with internalizing behaviors, including social withdrawal, there are limited interventions that have been investigated with this population. Treatments for students with internalizing behavior have been administered via (a) peer tutoring, (b) opportunities to play with socially skilled children, and (c) positive peer reporting (Christensen et al., 2004; Fantuzzo, Manz, Atkins, & Meters, 2005; Skinner et al., 2002), the latter of which has been used most frequently. In fact, positive peer reporting has received favorable reviews and recommendations as a key component for treating socially withdrawn behavior (Rosenberg, Wilson, Maheady, & Sindelar, 1992; Skinner et al., 2002). Positive peer reporting (PPR) involves (a) teaching students to notice positive peer behavior, (b) teaching students to report positive peer behavior, and (c) administering reinforcement to the students for reporting these behaviors (Skinner et al., 2002). This method is primarily implemented with students who are socially withdrawn. PPR has been shown to be successful, as reported in an extensive literature review (Skinner et al.), when used to enhance social interactions in residential and classroom settings. Two limitations of this technique, however, are noted: social interactions have not remained once the treatment is removed and there is a lack generalization of these interactions to more natural, less structured settings (Skinner et al.). In an effort to respond to these limitations, Moroz and Jones (2002) conducted a study using PPR to improve the social behavior of three socially withdrawn elementary school students. Each student’s teacher first implemented PPR in the classroom, which consisted of a classmate consistently praising the socially withdrawn student for engaging in appropriate social interaction. The researchers then implemented PPR on the playground during lunch recess. The findings of the study supported the use of peers as effective motivators of pro-social behavior for the target students, with a 66% mean increase in social interaction across all participants. Furthermore, ratings of treatment acceptability were high, teachers reported continuous and accurate implementation, and anecdotal reports from teachers suggested that all students, including the peer participants, viewed the procedure positively. The outcomes suggest the need for further research involving more direct involvement between the socially withdrawn students and the supporting peers. Specifically, they recommended that the supporting peers participate in unstructured recess activities with the socially withdrawn students and provide continuous effective feedback about their social behavior in order to obtain greater increases in social interaction (Moroz & Jones). Their recommendation warrants investigation considering that research associated with changing social behavior on the playground has predominantly targeted students with externalizing behavior problems (Leff, Power, Costigan, & Manz, 2003; Lewis, Powers, & Newcomer, 2002; Walker, Hops, & Greenwood, 1981). In summary, the majority of research with internalizing behavior problems has been conducted with students who are identified with anxiety and depression. Strategies used to treat students with internalizing behavior have included cognitive-behavioral strategies, social skills instruction, self-management, and peer mediation. Moreover, limited research has been conducted with students who are socially withdrawn in natural settings. In an effort to extend the aforementioned research, the purpose of this study was to investigate the implementation of a treatment package, combining three evidence-based strategies—social skills instruction, peer mediation, and self-management paired with positive reinforcement—with students rarely targeted for empirical Psychology in the Schools

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research—those with socially withdrawn behavior. The intent of this package was to increase students’ positive social communication as well as their appropriate peer play in a natural environment, the school playground. Method Participants Target students. The 3 target students attended a suburban, K– 6 elementary school with an enrollment of 450 students, located in central Utah. Fifty percent of the school’s students qualified for free or reduced-price lunch and 20% of the school’s students were identified as having limited English proficiency. All target students were of lower- to middle-class socioeconomic status and all were identified as being at risk for internalizing behavior problems, specifically, socially withdrawn playground behavior. Because none were identified as having an educational disability, target students’ intelligence scores were assumed to be in the average range. Parental consent was granted for each student’s participation. Catherine, a 7-year-old, Caucasian, first-grade student, had moved three times during the previous year—currently attending her fourth school within 2 years. Her mother worried that the frequent moves had caused Catherine to avoid making friends. Catherine spent 4 to 5 hr each day watching television and never played with her older sister. During school recess she would swing by herself, rarely interacting with other students. Michael, an 11-year-old, Caucasian, fifth-grade student, frequently visited the principal’s office during lunch recess, complaining of a severe stomachache. During morning and afternoon recesses, he often climbed up a tree and hid because he felt he had no friends. Scott, an 11-year-old, Caucasian, fifth-grade student, admitted he procrastinated completing in-class assignments so that he would have to finish them during recess, in the library. When Scott was required to go to recess, he often hid in the bushes the entire time. Selection procedure. For the past 4 years, the target school has participated in a positive behavior support (PBS) initiative, designed to proactively provide services for the emotional and social needs of all students in the school. As part of the PBS initiative, all students in the school were initially screened using the Systematic Screening for Behavior Disorders (SSBD), a multigate, mass screening tool that identifies students (grades 1– 6) at risk for externalizing and internalizing behavior disorders (Walker & Severson, 1992). During stage one of the SSBD, all general education teachers listed and then ranked the students in their classes who exhibited internalizing or externalizing behavior problems. From this stage, 35 students in the school were identified as possibly at risk for internalizing behavior disorders. For the purpose of identifying appropriate target students for this study, a school service team consisting of the principal, assistant principal, behavioral specialist, and school psychologist selected 20 of these 35 students to advance to stage two of the SSBD. In this stage, the teachers of the 20 selected students completed a checklist assessing the students’ adaptive (e.g., follows established classroom rules) and maladaptive (e.g., pouts or sulks, ignores directions) behaviors on a 5-point Likert-type scale (Walker & Severson, 1992). From the results of these checklists, the school service team identified 9 possible target students via modified SSBD criteria (i.e., critical events ⱖ 4, adaptive behavior ⱕ 41, 14 ⬍ maladaptive behavior ⬍ 19; H. M. Walker, personal communication, June 18, 2002). After an informal observation on the playground, to determine that the identified students demonstrated socially withdrawn behavior, the school service team then selected 6 of the 9 target students to participate in the study. Thereafter, the type and severity of the participants’ internalizing behaviors were assessed using the Internalizing Symptoms Scale for Children (ISSC; Psychology in the Schools

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Merrell & Walters, 1998) or the Preschool and Kindergarten Behavior Scales, Second Edition (PKBS-2; Merrell, 2002), both deemed useful for evaluating the emotional and social needs of children, conducting research, and implementing school-based interventions (Merrell, 1999). Additionally, an interview was conducted with each participant’s teacher to obtain specifics about the participant’s behavior. Of the 6 target students, 3 withdrew before the study was completed. Thus, the data for only 3 target students are included herein. The remainder of the 20 students originally identified as possibly at risk for internalizing behavior disorders all received other appropriate services for their social and emotional problems. Peer mediators. For each target student, a peer partner was selected to mediate social skills instruction and playground interaction. Peer mediators were selected by the target students’ teachers, with final approval given by the school principal, via the following criteria: (a) has good school attendance, (b) engages in positive interactions with peers, (c) avoids negative interactions, (d) follows directions, and (e) is someone the target student feels comfortable with and trusts (Kauffman, Mostert, Trent, & Hallahan, 2002). Parental consent was obtained for all peer mediators as well. Adult mediators. Three female university students, ages 20–24, assisted in mediating the final treatment condition: an undergraduate majoring in psychology, an undergraduate majoring in special education, and a graduate student in school psychology. Setting This study took place at an urban elementary school in central Utah. All baseline and intervention sessions were conducted on the school playground. Training sessions for target students, peer partners, and self-management supervisors were conducted on the playground and in the classroom. Materials Materials for the study included individual rating cards, point sheets, point summary sheets and a MotivAider威—a device that clips on the student’s pants pocket and vibrates at fixed time intervals. This device has been successfully used with elementary-age students with behavioral challenges (Flaute, Peterson, Van Norman, Riffle, & Eakins, 2005). Small portable cassette players, ear plugs, clipboards, and audiotapes were used by observers. Measures A screening instrument was used in the selection of target students at risk of internalizing behavior disorder. Self-report and teacher rating measures served to further specify the nature and severity of target students’ behavioral needs to be aligned with the intervention. Following is a description of instruments, assessment findings identifying the 3 target students, and operation definition and measures of the target behavior (dependent variable) and intervention (independent/ experimental variables). Screening instrument. The SSBD is a screening tool that uses a multiple-gate system to identify students (grades 1– 6) at risk for externalizing and internalizing behavior disorders. Test– retest reliability for stage one of the SSBD is reported to be good (.72 ⱕ rs ⱕ .79) and the internal consistency of the stage two subscales is estimated to be high ( ␣ ⬎ .80; Walker & Severson, 1992). Additionally, interrater agreement on the internalizing and externalizing dimensions of stage one is also good (.82 ⱕ rs ⱕ .94; Walker & Severson). Furthermore, the use of SSBD has Psychology in the Schools

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repeatedly been shown to be effective in identifying at-risk elementary students in regular classrooms (Kelley, 1998; Walker et al., 1990; Zlomke & Spies, 1998). A complete review of the SSBD can be found in Zlomke and Spies (1998). Assessment instruments. The ISSC is the only self-report instrument that assesses the broad band of internalizing symptomatology as well as the positive and negative affect of elementary students, grades 3– 6 (Merrell, 1999; Merrell & Walters, 1998). The score levels for the ISSC’s domains are normal, at risk, and high risk. The ISSC’s internal consistency is reported to be high (.85 ⱕ ␣ ⱕ .91), and the test–retest reliability has been shown to be consistently good (.70 ⱕ rs ⱕ .90; Merrell & Walters). ISSC’s convergent validity is also high; for example, correlations between the ISSC total score and the Youth Self-Report (Achenbach, 1991) internalizing broadband score, the Children’s Depression Inventory (Kovacs, 1992) total score, and the Revised Children’s Anxiety Manifest Scale (Reynolds & Richmond, 1985) have all been shown to be high (r ⫽ .86, .75, and .78, respectively). Furthermore, ISSC scores have also been used as indicators for discriminating between students with seriously emotionally disturbed (SED) behavior and students within the normal behavior range (Merrell, 1999). The PKBS-2 is a 76-item behavior rating scale designed to measure the social skills and problem behaviors of students in the third grade and below (Merrell, 2002). Specifically, the PKBS-2 is a teacher report of a student’s social cooperation, social interaction, independence, social withdrawal, anxiety, somatic complaints, and depressive symptomatology. Possible score levels for the PKBS-2 include levels high functioning, average functioning, moderate deficit, and significant deficit. The internal consistency of the PKBS-2 is reported to be high (.8 ⱕ ␣ ⱕ .99), and the test–retest reliability is reported to be good (.58 ⱕ rs ⱕ .86). The PKBS-2 also has high convergent validity. For example, the correlation between the total social skills score of the PKBS-2 and the preschool version of the Social Skills Rating System (Gresham & Elliot, 1990) is reported to be r ⫽ .76. A complete review of the PKBS-2 can be found in Spies and Plake (2005). Results from the PKBS-2 and ISSC are reported below. Catherine’s teacher completed the PKBS-2 to provide information on Catherine’s behavioral needs. Catherine scored in the moderate deficit range on both the social cooperation and social interaction subscales and in the average range on the internalizing subscale. The ISSC was administered individually to the 2 fifth-grade target students. Michael scored in the high risk range for internalizing symptoms and in the at-risk range for general emotional distress; Scott scored in the at-risk range for both internalizing behaviors and general emotional distress. Results from the teacher interviews and the ISSC and PKBS-2 checklists indicated that the students’ internalizing behaviors occurred primarily on the playground. (See Table 1 for the results of the checklists.)

Table 1 Participants’ Profiles PKBS subscales Name Catherine Michael Scott

ISSC subscales

Grade

Age

SC

SI

I

1st 5th 5th

7 11 11

MD

MD * *

A

I

GED

PA

HR AR

* AR AR

N N

*Not applicable due to student’s age. SC: Social Cooperation; SI: Social Interaction; I: Internalizing; GED: General Emotional Distress; PA: Positive Affect. MD: moderate deficit; A: average; HR: high risk; AR: at risk; N: normal. Psychology in the Schools

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Dependent variables. Teacher interviews, ISSC, and PKBS-2 checklist results all indicated that positive social interaction was the largest behavioral deficit for each target student. For this study, positive social interaction is operationalized as effective communication and appropriate peer play. Specifically, effective communication was defined as the target student appropriately engaging a peer by looking at him or her and initiating verbal communication (e.g., “Hello,” “You want to play catch?” “What are you doing? “Can I play?”). The target student’s effective, communicative verbalizations were recorded by an observer. A new communication episode was only recorded after a 3-s or more silence between the target student and peer. Physical gestures such as waving and giving a thumbs up, high five, or handshake were also recorded by observers as effective communication. Ineffective verbal or physical communication, such as using vulgar language, making critical comments, complaining, ignoring others, making rude gestures, hitting, slapping, and kicking were not recorded. Appropriate peer-play was defined as the target student appropriately following the school’s five playground rules while engaging in an activity with a peer: (a) follow the rules of the game, (b) use equipment in a safe way, (c) let everyone play, (d) keep your hands and feet to yourself, and (e) use kind words. Appropriate peer play was recorded by observers only when target students were engaging in an activity with a peer that was within a 5-ft. radius of the target student. Examples of playing appropriately included running, jumping, playing on playground equipment, and playing with sports equipment with another student. If target students moved further than 5 ft. away from a peer while playing or were not following any one of the playground rules (e.g. hiding, wandering around the playground alone, hanging out by adults, name calling), the behavior was not recorded as appropriate play. Data Collection Procedures Target students were observed daily, on the playground, after lunch, for approximately 20 min during a 35-min recess period. Two observers positioned themselves at opposite ends of the playground to collect data. Data were reported on preprinted observation forms using continuous 10-s intervals, and data were summarized in two separate response columns: frequency of communicative acts per 10-s interval and percentage of intervals during which students played appropriately the whole interval (entire 10 s). Small, portable cassette players with earphones were attached to the clipboards containing audio tapes that signaled the end of each 10-s interval. The end of the 10-s interval was signaled by a voice on the audiotape stating the number of the interval followed by the word “record.” At times it was difficult for the observers to hear all the words said by the student, but during these situations visual observations allowed the observers to detect the nature of interaction. Observers and observer training. Four adults, two male and two female, were trained to conduct observations. All were 20 to 25 years of age and were undergraduates at a local university. After memorizing the definitions of the dependent variable at 100% accuracy, they participated in trial observations on the playground. It was necessary for them to become 90% consonant with the researcher at recording communicative acts and appropriate peer-play behaviors of nontargeted students before beginning to collect baseline data. Interobserver agreement was assessed by a second observer, who independently collected data during 52% of all of the students’ sessions across all phases of the study. Observers’ records were compared interval by interval. Agreement coefficients for data on effective communication and appropriate peer play were calculated by dividing the smaller number of responses by the larger number of responses for each interval and averaging these values across the session. Psychology in the Schools

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Interobserver agreement for appropriate play was calculated by dividing the number of intervals containing agreements by the total number of intervals and multiplying by 100%. An interval was considered an agreement if both observers scored either the presence or absence of behavior. The average interobserver agreement for all phases of the study was 92%, with a range of 82% to 98%. Independent Variable and Experimental Design A multiple baseline across participants was selected as the design for this study due to the small sample size and because the target behaviors are learned types of behavior (Bailey & Burch, 2002). The independent variable used with this design consisted of three components: (a) social skills training, (b) peer and adult mediation, and (c) a self-management system that included positive reinforcement. Baseline. Baseline data were collected during lunch recess under typical playground conditions. The playground environment at the school was similar to that of most elementary schools with the exception of a school-wide playground behavior program. Rules were posted, and supervisors oversaw organized playground games; however, a formal system for managing children’s behavior was not implemented. Baseline data revealed a low rate of communication and a low percentage of appropriate play for all target students. The specific rates and data are discussed in the results section. Training in social skills and self-management strategies. This phase of the study consisted of training the participating students in the use of social skills and self-management strategies. The researchers provided the instruction for 3 target students and their peer partners, both in the classroom and on the playground. Instruction was adopted from the Boys Town and Skillstreaming curricula, including “How to Start a Conversation,” “How to Play Appropriately,” “How to Invite Others to Play,” and “How to Ask to Play with Others” (Black, Downs, Brown, & Bastien, 1984; McGinnis & Goldstein, 1997). These social skills were selected according to input from the teacher interviews and ISSC/PKBS-2 results, which indicated a need for teaching all 3 students how to communicate and play more effectively on the playground. The target students and their peer partners were also trained to use a point card to self-manage and record their own effective communication and appropriate peer play, as well as their partner’s. During the first 2 days of training, instruction was delivered individually to each target student in the classroom. On the third day of instruction, the student’s peer partner was brought into the training session and the target student took part in teaching the peer partner the steps to each skill. A direct instruction strategy was used for the social skills and self-management instruction. In delivering the instruction, the researcher (a) explained the steps of each social skill and of the self-management routine, (b) modeled the skill/steps, (c) practiced the skill/steps with the student (and later with the peer partner), (d) praised both children on their performance, (e) corrected any deficit in the execution of the skill/steps, and (f ) discussed playground situations during which the students could implement a particular social skill. The mastery requirement for the recitation and use of skills/steps during training was 100%. After attaining this, both the student and peer partner practiced implementing the social skills and self-management strategy by role-playing various scenarios on the vacant playground. Reinforcement system. A reinforcement plan, using a point system, assisted the students with setting and meeting goals for both effective communication and appropriate peer play. Goals were set by reviewing the previous day’s performance and increasing the level of expectations. This was done at the beginning of each recess, when the students and peer partners received their point cards, in an effort to prompt the students’ in their progress toward more social interactions. Psychology in the Schools

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Specifically, communication was expected to increase by 10 acts of communication over the previous day’s total. Appropriate play was expected to increase by one additional 5-min interval over the previous day. For example, if a student talked 25 times and played for one 5-min session on Monday, then Tuesday’s goals would to communicate 35 times and participate in appropriate play with a peer throughout two 5-min sessions. Each target student and his or her peer partner had the possibility of earning 16 points every day, 8 of which were possible for communication. If the student was within two acts from the day’s communication goal, the pair would earn 8 points. The student and peer partner could earn the remaining 8 points for appropriate play at or approaching the day’s goal. An additional point, referred to as an “honest point,” was given to the pair if the target student’s self-rating on his or her point card matched within three points of the peer rating. Daily reinforcers were awarded for points earned, including special privileges that provided additional opportunities for social interaction (e.g., 5 min of extra recess with a peer), as well as tangible or edible reinforcers (e.g., candy bars, soda, bouncy balls). Each week new goals and schedules of reinforcement were established with the pairs. With peer. Daily implementation of the treatment consisted of each target student and peer partner going on the playground together and attempting to use the social skills. The peer partner encouraged the target student to use the social skills with other students, either by inviting others to play or by joining a group of students who were already playing together. The target students and peer partners used the MotivAider, which signaled the 5-min intervals. This prompted the student to take a break from what he was doing and to rate himself and his peer and mark the ratings on their point card; researchers called this time period a “rate break.” The students were instructed to circle yes if they had played appropriately with another person during the 5 min or no if they had not, considering the “appropriate play” definition they had been taught. The 5-min time interval was selected to allow the pairs to rate each other four times during the lunch recess session. At the end of recess the target students and their peer partners totaled their own tally marks. With adult. After 3 weeks the peer partners were removed from the study because they were not connecting with the target students. Involvement in the study was also negatively affecting the peer partners’ social interactions with their friends—their friends no longer played with them. So, adult mediators replaced the peer partners. During this phase the students were expected to evaluate only their own social interaction and chart their own progress using the same interval recording system as they had during the “with peer” condition. The alteration for this phase was that the adult mediators observed and recorded the target students’ playground behavior on the point cards. At the end of lunch recess each student’s tally marks was counted and matched with the rating of the adult mediator, by the adult mediator. The distinction between the “with peer” and “with adult” conditions was that the student did not have a peer to monitor or with whom to compare ratings. The adult mediators also calculated the number of points the target students earned for the day. As in the “with peer” phase, each student had the possibility of earning 16 points with an additional “honest point” for each identical match. The student graphed his or her totals for communication and appropriate play on a 3 ⫻ 5 index card after school and reviewed a new chart before going out to lunch each day. The same reinforcement system was implemented throughout this phase. Social Validity To ensure that the treatment package goals, procedures, and effects were widely accepted, a social validity questionnaire was administered to teachers, peer partners, and target students. The questionnaires requested information about perceptions of pre- and post-intervention behavior, Psychology in the Schools

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perceptions of the methods, and advantages/disadvantages of the methods. Outcomes are discussed in the Results section. Treatment Fidelity Treatment fidelity data were collected for the training of the students and peer partners in the use of the social skills, the self-management system, and the reward system by way of a checklist. The checklists had this format: The training steps were listed, each with a box to check if the step had been completed accurately. Treatment fidelity maintained at 100% accuracy. Results The results of the study, including data for each participant, are presented in Figure 1, and individual results are discussed in detail below. The goal of the treatment package was to increase both the rate of peer communication and percentage of appropriate play for all target students. Note that the training condition data merely offer a visual display of the change that occurred in the behaviors during the training time. Systematic implementation of the independent variable was not in effect during the training condition. Catherine Baseline. During baseline, Catherine exhibited 0 to 0.9 communicative acts per minute, with a mean rate of 0.44. The percentage of intervals in which Catherine played appropriately with her peers ranged from 0% to 11%, with a mean of 2%. Training. Catherine’s peer-communication rates during training were 0 and 1.75 communicative acts per minute, with a mean of 0.88. The percentages of intervals in which she played appropriately with peers were 0% and 10.77%, with an average of 5.3%. With peer. From the last baseline data point to the first peer-mediated intervention data point, Catherine had an increase of 0.59 communicative acts per minute and a 24% increase in her percentage of appropriate peer play. When matching with her peer partner, Catherine’s communicative acts per minute ranged from 0.2 to 1.8, with a mean of 1.02. Catherine’s percentage of appropriate play intervals with peers ranged from 0% to 28%, with a mean of 24%. With adult. From the last data point of the peer-mediated intervention to the first data point of the adult-mediated intervention, Catherine had an increase of 4.17 communicative acts per minute and a 23% increase in her percentage of appropriate peer play. After the peer partner was removed and adult mediation was implemented, Catherine’s communicative acts ranged from 1.2 to 5.9 per minute, with a mean rate of 3.5; her percentage of appropriate peer play ranged from 20% to 100%, with a mean of 80%. Michael Baseline. Michael exhibited 0 to 0.20 communicative acts per minute during baseline, with a mean of 0.05. The percentage of intervals in which he played appropriately with peers ranged from 0% to 2%, with a mean of 0.14%. Training. During the training phase, Michael exhibited 0.25 and 0.30 communicative acts per minute, with an average of 0.28. Furthermore, his percentage of appropriate peer play rose to 100%. With peer. From the last baseline point to the first peer-mediated intervention data point, Michael’s peer communication increased by 0.23 communicative acts per minute and his percentage of appropriate peer play increased by 78%. When matched with a peer partner, his communicative Psychology in the Schools

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Figure 1.

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Rate of communication and percent interval of appropriate play.

acts ranged from 0.2 to 0.37 per minute, with a mean of 0.28, and his percentages of appropriate peer play ranged from 23% to 100%, with a mean of 78%. With adult. From the last data point of the peer-mediated condition to the first data point of the adult-mediated intervention, Michael exhibited 0.22 to 1.27 communicative acts per minute, Psychology in the Schools

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with a mean rate of 0.72, and his percentage of appropriate peer play ranged from 26% to 100%, with a mean of 81%. When adult mediation was implemented, Michael’s communicative acts then increased by 0.44 acts per minute and his percentage of appropriate peer play increased by 3%. Scott Baseline. During baseline, Scott exhibited 0 to 1.7 communicative acts per minute, with a mean of 0.47. Scott’s percentage of intervals in which he appropriately played with peers ranged from 0% to 16%, with a mean of 3%. Training. Scott exhibited 1.6 to 2 communicative acts per minute during training, with a mean of 1.8. His percentage of appropriate peer play ranged from 60% to 86.6%, with an average of 68.9%. With peer. Scott had an increase, from the last baseline data point to the first peer-mediated intervention data point, of 2.45 communicative acts per minute as well as an 83% increase for time spent in appropriate peer play. With the peer-mediated intervention, Scott’s communicative acts ranged from 1.60 to 5 per minute, with a mean of 2.9. His percentage of appropriate peer play ranged from 60% to 100%, with a mean of 86%. With adult. From the last data point of the peer-mediated intervention to the first data point of the adult-mediated intervention, Scott’s communicative acts increased by 1.05 per minute, and his time spent playing appropriately with peers increased by 11%. With adult-mediated intervention, Scott’s communicative acts ranged from 2.17 to 5.70 per minute, with a mean of 3.96, and his percentage of appropriate peer play ranged from 88% to 100%, with a mean of 96%. Scott thus averaged 4 communicative acts per minute and 19 minutes of appropriate peer play per recess. Social Validity The treatment package was perceived by teachers, peers, and target students as effective in increasing the target students’ positive social interaction on the playground. The least favored component of the treatment package was the peer-mediated intervention, because it kept the peer partners from being able to play with their friends in the way they were accustomed. The most popular components of the treatment package were social skills instruction and the reward system. Furthermore, one teacher reported that the training was intrusive because four students (two target and two peer partners) were taken from activities in her classroom. Discussion Internalizing behavior problems, particularly social isolation, are being widely recognized as serious problems in need of effective intervention strategies (Merrell, 2001; Walker et al., 2004). Without positive peer interactions, some children fail to develop the social skills needed for positive interpersonal relationships and successful behavioral development (Gresham, 2002). The purpose of this study was to explore the effectiveness of a treatment package consisting of (a) social skills instruction, (b) peer mediation, and (c) a self-management system paired with a reinforcement system on the social interaction behavior (i.e., communicative acts and appropriate peer play) of elementary students identified with socially withdrawn behavior. An adult mediation phase was added to the original phases of the study, thus altering the initial purpose. This study’s findings suggest that this treatment package contributed to the increase of positive social interactions of the participants. Because the intervention was delivered via a “package” approach, it is difficult to determine which component(s) of the intervention affected the change and which were functionally unrelated. Psychology in the Schools

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Nonetheless, definite patterns are evident in the data. Both strengths and limitations associated with the components of the treatment package emerged. The first intervention, “with peer,” appeared to demonstrate a functional relationship between the treatment package and the dependent variable. When the baseline data were compared with the peer-mediated intervention data, a 17% average increase in communicative acts per minute and 43% increase in appropriate peer play was found across all participants. However, when the “with peer” condition data were compared with the “with adult” condition data, the outcomes were more favorable for the “with adult” condition. Compared to the “with peer” intervention data, data from the “with adult” intervention showed a 58% average increase in communicative acts per minute and an 85% increase in appropriate peer play. These outcomes indicate that the combination of social skills instruction, adult-mediated self-management, and a reinforcement system was more effective than the similar peer-mediated combination. However, the primary limitation of this study is the sequencing of the two experimental conditions. Multiple treatment interference must be considered when analyzing the outcomes (Tawney & Gast, 1984), as the combination of the two interventions (not the “with adult” intervention alone) may be accountable for the greater increases when the type of mediation was changed. Therefore, future research should investigate the impact of these treatments as separate components to determine their individual versus combined or sequential impact. These findings also suggest that the effectiveness of adult-mediated interventions with this population need systematic examination. The research of Moroz and Jones (2002) provides evidence that the use of peer mediation improves the positive classroom social interaction of students who are socially withdrawn. However, the limited effectiveness of peer mediation with students who demonstrate socially withdrawn behavior in this study challenges the effectiveness of peer mediation as the sole strategy when applied in a playground setting. We suggest the difference in effectiveness of the two mediated conditions may be accounted for by the relationship between the target students and their peer partners. Data from the social validity questionnaire indicate that, overall, the targeted students did not feel comfortable with their peer partners and that the peer partners did not enjoy spending time with the target students. Thus, we suggest that future research investigate both the selection process of peer partners as well as effective interventions, involving peer partners, for students with socially withdrawn behavior. Although peer mediation was not favored among participants, all peer partners and targeted students reacted positively to learning and using the four social skills. The data indicate that the target students found the social skills useful for promoting play with other students. This finding thus strengthens the body of research on the effectiveness of social skills instruction to promote positive social interaction from students with internalizing behavior problems (Gresham, 2002; Merrell, 2001). This study also expands self-management strategy research by using a self-management intervention in efforts to replace inappropriate behavior with socially appropriate actions. Future research using self-management in this type of package should be implemented in other settings such as the classroom and various material contexts, particularly with students who are identified with internalizing behavior problems, including social withdrawal. Students reported that they enjoyed “setting goals and earning prizes for making friends,” suggesting that additional research also be conducted with interventions that use a self-management program and reinforcement system but are not adult or peer mediated, perhaps monitored exclusively by the target student. Such efforts can potentially increase the acceptability and sustainability of implementing self-management in school-based settings where teacher time and support is often limited with individualized interventions. Psychology in the Schools

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Reports from the target students’ parents and teachers indicated that the playground intervention positively influenced the target students’ behavior in other settings, such as at home and in the classroom. For example, Catherine’s mother told researchers that “For the first time, Catherine wants to play with the neighborhood kids rather than sit and watch TV.” Although the only evidence to support generalization of the social skill is anecdotal, it appears that generalization across settings and time may have occurred. Another example of this generalization effect was found in poststudy observations that were conducted 4 months following the completion of the intervention across 3 days. These data were actually collected during the following school year and employed the same methods that were used in the initial study. Target students maintained, on average, a 45% increase in communicative acts per minute and 53% increase in their appropriate peer play when compared with their original baseline data. In the future, researchers should examine the generalization effect of the interventions using methods that demonstrate experimental control to determine their effect on the socially withdrawn target students’ behavior in other settings. One final generalization issue is raised within the selection and identification of the participants. Recognizing that the participants ranged from 1 first-grade student to 2 fifth-grade students suggests limitations of the results generalizing to any one specific population, particularly in respect to developmental abilities. Thus, additional research in this area should be conducted with students of similar age and developmental capacities. By extending the research in this manner, research conducted with students who demonstrate internalizing behavior problems will be strengthened in respect to external validity. In conclusion, although the outcomes of this study are encouraging, in that they provide direction for how best to intervene with this underidentified population, the findings are preliminary, with strengths and limitations outlined previously. The scope of this investigation should be expanded so methods that potentially reverse this serious behavior pattern continue to be examined. References Achenbach, T.M. (1991). Manual for the youth self-report and 1991 profile. Burlington, VT: University Associates in Psychiatry. Achenbach, T.M., & Rescorla, L.A. (2001). Manual for the ASEBA school-age forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth and Families. Bailey, J.S., & Burch, M.R. (2002). Research methods in applied behavior analysis. Thousand Oaks, CA: Sage. Black, D.D., Downs, J.C., Brown, L.J., & Bastien, J.P. (1984). S3 workshop manual: Social skills in the school. Boys Town, NE: Father Flanagan’s Boys Town. Christensen, L., Young, K.R., & Marchant, M. (2004). The effects of a peer-mediated positive behavior support program on socially appropriate classroom behavior. Education and Treatment of Children, 27, 199–234. Cole, C.L., & Bambara, L.M. (1992). Issues surrounding the use of self-management intervention in the schools. School Psychology Review, 21, 193–201. Compton, S.N., Burns, B.J., Egger, H.L., & Robertson, E. (2002). Review of the evidence base for treatment of childhood psychopathology: Internalizing disorders. Journal of Consulting & Clinical Psychology, 70, 1240–1266. Fantuzzo, J., Manz, P., Atkins, M., & Meters, R. (2005). Peer-mediated treatment of socially withdrawn maltreated preschool children: Cultivating natural community resources. Journal of Clinical Child and Adolescent Psychology, 34, 320–325. Flaute, A.J., Person, S.M., Van Norman, R.K., Riffle, T., & Eakins, A. (2005). Motivate me! 20 tips for using a Motivaider for improving your classroom. Teaching Exceptional Children Plus, 2(2) Article 3. Retrieved July 8, 2006, from http://escholarship.bc.edu/education/tecplus/vol2/iss2/art3. Flook, L., Repetti, R.L., & Ullman, J.B. (2005). Classroom social experiences as predictors of academic performance. Developmental Psychology, 41, 319–327. Gresham, F.K. (2002). Caveat emptor: Considerations before buying in to the “new” medical model. Behavioral Disorders, 27, 158–167. Gresham, F.M., & Elliot, S.N. (1990). Social skills rating system manual. Circle, MN: American Guidance Service. Psychology in the Schools

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