EXAMINING THE SOCIAL VALIDITY OF A DYNAMIC ASSESSMENT OF SOCIAL

SKILLS: CAREGIVERS’ PERSPECTIVES ON A MEASURE OF SOCIAL SKILLS FOR

CHILDREN WITH AUTISM SPECTRUM DISORDERS

By

COLLEEN M. BUTCHER

A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL

OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA

2016




ProQuest Number: 10679091




All rights reserved

INFORMATION TO ALL USERS
The quality of this reproduction is dependent upon the quality of the copy submitted.

In the unlikely event that the author did not send a complete manuscript
and there are missing pages, these will be noted. Also, if material had to be removed,
a note will indicate the deletion.






ProQuest 10679091

Published by ProQuest LLC (2017 ). Copyright of the Dissertation is held by the Author.


All rights reserved.
This work is protected against unauthorized copying under Title 17, United States Code
Microform Edition © ProQuest LLC.


ProQuest LLC.
789 East Eisenhower Parkway
P.O. Box 1346
Ann Arbor, MI 48106 - 1346
© 2016 Colleen M. Butcher
To Mom, Dad, Curran, Katie and Andrew
 ACKNOWLEDGMENTS

First, I would like to thank my parents for encouraging and supporting me

throughout my life. I am forever grateful to them for helping to shape my beliefs about

education and hard work, as well as the importance of finding ways to use one’s gifts to

help others. Their support has allowed me to pursue my dreams in a way that I never

would have been able to achieve on my own. Words cannot express my gratitude for all

of the hard work and sacrifices they have made to support me.

I am also grateful for my siblings. I am so lucky to have a best friend in my sister

Katie. Her constant encouragement has been invaluable. Her humor, wisdom, and

willingness to listen have helped me to maintain focus when times get hard. I am also

grateful for my brother-in-law, Andrew, whose quick wit and thoughtfulness has helped

to shape the way I think about my work. Finally, I would like to thank my brother,

Curran. He is an excellent model of pursuing one’s passions, even when the road may

be challenging, and his conviction about the importance of research and knowledge is

inspiring.

I would also like to express gratitude to my supportive doctoral committee and

mentors. In particular, I am grateful for my chairperson, Dr. Tina Smith-Bonahue. I truly

appreciate her ability to reassure and support me, while also challenging me to continue

to grow and learn. I would also like to thank Dr. Krestin Radonovich for her mentorship

and guidance over the past several years. I am so inspired by her commitment to

serving children and families, as well as the autism community. I appreciate her

dedication to training future practitioners to think critically about both assessment and

intervention, as well as to identify research opportunities that can contribute to the field.

I am also grateful for Dr. Elayne Colon and Dr. Hazel Jones for their help in

4
conceptualizing and conducting my research. I have learned so much from their

expertise in relevant issues for our field and methodologies for developing and

improving the quality of my study.

5
 TABLE OF CONTENTS

page

ACKNOWLEDGMENTS .................................................................................................. 4

LIST OF TABLES ............................................................................................................ 9

LIST OF FIGURES ........................................................................................................ 10

LIST OF ABBREVIATIONS ........................................................................................... 11

ABSTRACT ................................................................................................................... 12

CHAPTER

1 INTRODUCTION AND RATIONALE FOR THE STUDY ......................................... 14

Characteristics of ASDs .......................................................................................... 14

The Importance of Early Detection and Assessment .............................................. 18

2 REVIEW OF THE LITERATURE ............................................................................ 22

Conceptualization of Social Skills and Impairments Experienced by Individuals

with ASD .............................................................................................................. 22
Theories on the Cause of Social Skill Impairment in Individuals with ASD ............. 24
Assessing Social Functioning in Individuals with ASD ............................................ 26
Norm-Referenced Social Skill Rating Scales Frequently Used with Individuals
with ASD .............................................................................................................. 29
Social Responsiveness Scale, 2nd Edition (SRS-2). ......................................... 30
Social Skills Improvement System (SSIS). ....................................................... 32
Vineland Adaptive Behavior Scales, 2nd Edition (Vineland-II). .......................... 34
Autism Symptomology Measures used as Social Skills Assessments with
Individuals with ASD ............................................................................................ 37
Criterion-referenced Methods of Evaluating Social Skills of Individuals with ASD .. 41
Limitations and Future Directions for Research ...................................................... 46

3 METHODS .............................................................................................................. 49

Purpose of the Study and Research Questions ...................................................... 49

Methodology of the Current Study .......................................................................... 51
Participants ............................................................................................................. 53
Identification and Recruitment. ......................................................................... 53
Selective Sampling ........................................................................................... 56
Data Collection ....................................................................................................... 57
Semi-Structured Interview ................................................................................ 58
Field Notes ....................................................................................................... 60
Data Analysis .......................................................................................................... 60

6
 Trustworthiness, Validity, and Objectivity................................................................ 61
Trustworthiness ................................................................................................ 61
Validity .............................................................................................................. 62
Researcher Reflexivity...................................................................................... 62

4 RESULTS ............................................................................................................... 64

The Theory ............................................................................................................. 64

Model ...................................................................................................................... 65
Part I: Participant Experiences and Beliefs ............................................................. 69
Interaction and Relationships with the Child. .................................................... 70
Interactions with peers. .............................................................................. 70
Relationships with teacher. ........................................................................ 71
Family. ....................................................................................................... 73
Idealizing Childhood ......................................................................................... 74
Comparing the child to expectations of typical children ............................. 74
Academics. ................................................................................................ 76
Bullying. ..................................................................................................... 77
Future. ....................................................................................................... 78
Necessary social behaviors ....................................................................... 78
Part II: Intra-individual Child Characteristics ........................................................... 80
Non-ASD Traits. ............................................................................................... 80
Restricted Interests, Repetitive Behaviors, and Rigidity. .................................. 81
Variability of Behavior. ...................................................................................... 82
Social Communication Challenges. .................................................................. 83
Part III: Evaluation .................................................................................................. 84
Part IV: Reaction to Results .................................................................................... 86

5 DISCUSSION ......................................................................................................... 89

Discussion and Implications.................................................................................... 89

Caregiver Perspectives and the Validity of the Assessment ................................... 92
Accuracy of the Dynamic Assessment ............................................................. 94
Relevant Social Behaviors Identified by Participants........................................ 96
Social behaviors identified by teachers. ..................................................... 98
Social behaviors identified by parents. ..................................................... 100
Measuring Social Communication with the Dynamic Assessment ................. 102
Social Validity of Observation and Questionnaires ......................................... 104
Implications and Directions for Future Research .................................................. 106
Limitations............................................................................................................. 115

APPENDIX

A INTERVIEW GUIDES ........................................................................................... 119

B SOCIAL COMMUNICATION ASSESSMENT ....................................................... 121

7
LIST OF REFERENCES ............................................................................................. 130

BIOGRAPHICAL SKETCH .......................................................................................... 142

8
 LIST OF TABLES

Table page

3-1 Child and parent participants .............................................................................. 56

4-1 List of themes which emerged from interview data ............................................. 66

9
 LIST OF FIGURES

Figure page

4-1 The grounded theory .......................................................................................... 65

10
 LIST OF ABBREVIATIONS

ADI-R Autism Diagnostic Interview-Revised

ADOS Autism Diagnostic Observation Schedule

ADOS-2 Autism Diagnostic Observation Schedule, 2nd Edition

ASD Autism Spectrum Disorder

DSM Diagnostic and Statistical Manual of Mental Disorders

PDD-NOS Pervasive Developmental Disorder, Not Otherwise Specified

SCQ Social Communication Questionnaire

SRS Social Responsiveness Scale

SRS-2 Social Responsiveness Scale, 2nd Edition

SSIS Social Skills Improvement System Rating Scales

SSRS Social Skills Rating System

Vineland-II Vineland Adaptive Behavior Scales, Second Edition

11
 Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

EXAMINING THE SOCIAL VALIDITY OF A DYNAMIC ASSESSMENT OF SOCIAL

SKILLS: CAREGIVERS’ PERSPECTIVES ON A MEASURE OF SOCIAL SKILLS FOR
CHILDREN WITH AUTISM SPECTRUM DISORDERS

By

Colleen M. Butcher

August 2016

Chair: Tina Smith-Bonahue

Major: School Psychology

This qualitative research study sought to understand the caregiver perspectives

about a social communication assessment, the Dynamic Assessment, as well as their

beliefs about relevant behaviors for social functioning. More specifically, the study

examined the process of the an evaluation of social communication, including

interviews, questionnaires, observation, and direct assessment, the caregivers’

perspectives regarding the process and the results of the evaluation, and specific

behaviors that they feel are important for successful social communication.

Qualitative methodology was used to gain a deep, meaningful understanding of

caregivers’ experiences and perceptions about the evaluation, the results, their beliefs

about social communication. To obtain this rich information, data was collected by

conducting pre- and post-assessment interviews with the parents and teachers of four

boys who were referred for assessment due to concerns about social communication.

Data analysis included coding, creating categories that emerged from the codes,

determining patterns, and identifying themes that represented their experience and

perceptions.

12
 Data analysis produced a model that indicates that caregivers’ beliefs about

childhood and experiences with the particular child influenced the evaluation, as well as

their reactions to the results of the assessment. The evaluation was also influenced by

the child’s intra-individual characteristics, which both guided the assessment referral

and determined the results of the evaluation. The evaluation influenced the participants’

reactions to the results. In turn, the caregiver reactions to the results are believed to

further affect the caregiver’s perspective on the child.

Participants expressed satisfaction with the use of the Dynamic Assessment and

school observations as a way to evaluate social communication functioning. They

reported that the results of the Dynamic Assessment provided accurate and detailed

information about their child. Participants also described which behaviors they view as

being important for successful social functioning, such as the ability to initiate and

maintain conversations, reading nonverbal communication, and having social

awareness.

13
 CHAPTER 1
INTRODUCTION AND RATIONALE FOR THE STUDY

In recent years, the prevalence of Autism Spectrum Disorder (ASD) has

increased substantially. Based on 2014 estimates, 1 in 68 children in the United States

have an ASD, and for boys, that number rises to 1 in 42. Additionally, individuals with

ASD are found among all ethnic and socioeconomic groups (Centers for Disease

Control & Prevention, 2014). The increase in prevalence has been attributed to several

causes, including the rise in awareness of professionals, understanding that ASD can

coexist with other disorders, and perhaps most importantly, the changes in diagnostic

criteria that allow for the inclusion of children with milder symptoms (Isaksen, Diseth,

Schjølberg, & Skjeldal, 2013). This rise in prevalence is particularly important because

the cost of lifespan services for people with ASDs is substantially higher than the cost of

serving individuals with other disabilities (Howard, Sparkman, Cohen, Green, &

Stanislaw, 2005). Average medical expenses for an individual with an ASD is 4.1 to 6.2

times greater than expenses for a typically functioning individual (Centers for Disease

Control & Prevention, 2012). The per-year cost of education for a child with an ASD is

nearly 3 times the cost of education for a typically developing child (Autism Society,

n.d.). This significant increase in prevalence of ASDs has implications that affect society

both locally and nationally. Therefore, practitioners working with this population have an

obligation to continue in the pursuit of finding the most effective assessment and

intervention methods.

Characteristics of ASDs

Prior to 2013, ASDs were diagnosed based on criteria established by the

American Psychiatric Association’s Diagnostic and Statistical Manual of Mental

14
Disorders, 4th Edition, Text Revision (DSM-IV-TR) (2000), and were considered to be

forms of Pervasive Developmental Disorder. This category of diagnoses included

Autistic Disorder, Asperger’s Syndrome, Rett’s Disorder, Childhood Disintegrative

Disorder, and Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS).

To be diagnosed with one of these disorders, an individual had to show impairment in

the areas of social skills, communication, and/or restricted, repetitive, or stereotyped

interests or behaviors. The constellation of required symptoms varied based on the

diagnosis (American Psychiatric Association, 2000). However, beginning in 2013, with

the release of the new Diagnostic and Statistical Manual of Mental Disorders, 5th edition

(DSM-5) (American Psychiatric Association, 2013b), Autistic Disorder, Asperger’s

Syndrome, and Pervasive Developmental Disorder, Not Otherwise Specified have all

been classified as Autism Spectrum Disorder. With the changes in the categorization

came changes in the descriptions of defining symptoms. One major difference is the

collapsing of deficits in social skills and communication abilities required for a diagnosis,

into one category of social communication impairment (American Psychiatric

Association, 2013b).

Under DSM-5 criteria, to receive a diagnosis of an ASD, individuals must

demonstrate impairments in two domains: social communication, and restricted,

repetitive patterns of behavior, interests, or activities. Regarding social communication,

individuals with ASDs can experience deficits in social-emotional reciprocity, nonverbal

communication behaviors, and developing, maintaining, and understanding

relationships. The second domain of restricted, repetitive patterns of behaviors,

interests, or activities can include repetitive speech or motor movements, ritualized

15
patterns of behaviors, restricted and fixated interests, and hyper-/hyporeactivity to

sensory stimuli (American Psychiatric Association, 2013b). Additionally, to meet criteria

for an ASD, the symptoms have to be present in early childhood, although the full extent

of the impact on functioning may not be evident until demands exceed a child’s

capacities. The impairments experienced must cause clinically significant impairments

in functioning, and must not be better explained by another medical or psychiatric

diagnosis (American Psychiatric Association, 2013b).

Experts accept that pervasive developmental disorders including the previously

diagnosed Autistic Disorder, Asperger’s Syndrome, and PDD-NOS, as well as the

currently diagnosed ASD encapsulates a wide range of symptoms and profiles of

abilities. The trend over the past decades has been to expand the understanding of the

manifestation of autism symptomology (Seltzer, Krauss, Shattuck, Orsmond, Swe, &

Lord, 2003). Although the new ASD criteria set forth in the DSM-5 has been widely

debated, the proponents of this new criteria argue that the wording of the current

symptom descriptions can capture more of the nuances of behaviors (Kanne, 2013)

ranging from someone who may have average or above average intelligence and

language capabilities, with some struggle to maintain personal relationships as well as

restricted, repetitive interests, such as individuals who may have previously received a

diagnosis of Asperger’s Syndrome or PDD-NOS under DSM-IV-TR criteria, to someone

who is completely nonommunicative who engages almost entirely of repetitive

behaviors, like individuals who likely would have met criteria for Autistic Disorder

(American Psychiatric Association, 2013a). Additionally, the stated intent of the updated

criteria is to more reliably identify all individuals who would have received the diagnosis

16
under the previous criteria (Autism Speaks, 2013). Others have argued that some

children who may have previously had access to services under a PDD-NOS disorder

may no longer meet criteria, despite experiencing clinically significant challenges in

social communication or restricted interests (Autism Research Institute, 2013).

Given the wide variation in impairment and abilities of individuals with ASDs, the

impact of this disorder can range from minimal to severe. Accordingly, the necessary

interventions can range substantially among individuals on the spectrum. However,

many experts agree that early intervention is a key strategy to help increase the

likelihood of successful, independent functioning for individuals with ASDs. Early

diagnosis and intervention can reduce the cost of lifelong care by up to two-thirds

(Autism Society). Providing instruction and treatment for thirty hours per week or more

for children before the age of five is recommended to improve outcomes across

domains, with more significant improvements obtained with intervention prior to age

three (Luiselli, Cannon, Ellis, & Sisson, 2000). One of the most common methods of

implementing intervention is to use behavioral therapy, which has been supported in

research literature for decades as one of the most effective interventions for children

with ASDs (Howard et al., 2005). Behavior therapy can be used to target a wide range

of problems, including: “destructive behavior, tantrums, aggressive and disruptive

behaviors, stereotypies/self-stimulation, toilet training, eye contact, imitation, verbal

behavior and language skills, peer and social interactions…[and] classroom behavior”

(Matson & Smith, 2008, p. 62).

Although all children with ASDs may benefit from early intervention, several

variables have been correlated with more successful long-term outcomes. Early

17
language and nonverbal communication skills are significant predictors of a child’s

future adaptive behavior in the domains of communication and socialization (Szatmari,

Bryson, Boyle, Streiner, & Duku, 2003), and thus children who develop these skills at a

younger age are more likely to have higher adaptive functioning in these domains.

Accordingly, the severity of autism-related symptoms is also a predictor of

responsiveness to intervention, and thus positive developmental trajectories (Matson &

Smith, 2008). Intelligence Quotient (IQ) also relates to outcomes for children with ASD,

as children with higher IQs and functional, spontaneous language by the age of six have

more successful outcomes (Szatmari et al., 2003), suggesting that higher IQ might be a

factor that can mitigate the impact of ASD on daily functioning.

The Importance of Early Detection and Assessment

Based on this accepted premise that early intervention helps to increase the

likelihood that individuals with ASD can function independently with minimal supports,

the impetus falls on researchers and practitioners to find increasingly reliable ways to

diagnose ASDs among younger children. Dawson, Toth, Abbott, Osterling, Munson,

Estes, & Liaw (2004) note that if social attention impairments are identified early in life,

and changes can be made to the way that the child attends to the social environment

children with ASDs may move toward more typical development. The National

Research Council (2001) stated that “the diagnosis of autism can be made reliably by

professionals experienced in the diagnostic assessment of young children with autism

spectrum disorders” (p. 212). The diagnostic criteria involve complex constructs, which

present unique challenges in assessment. In particular, social communication can be a

very contextually bound construct, and a high degree of clinical expertise in what

constitutes typical versus atypical social behaviors is necessary to conduct effective

18
evaluations. Additionally, practitioners need to be able to evaluate ASD symptoms from

a developmental perspective, because the symptoms that a preschool child exhibits

may look significantly different from the symptoms exhibited by a teenager who also has

an ASD (Ozonoff, Goodlin-Jones, & Solomon, 2005).

In current practice, typical ASD assessments for children involve some

combination of gathering information about the child’s social skills from parents or

teachers, exploration of developmental history, assessment of adaptive functioning,

evaluation of communication ability, observation of social behaviors and potentially

repetitive behaviors or restricted interests. To measure social functioning, an evaluator

may choose to gather information by interviewing parents, teachers, or children,

conducting direct observations in social settings, or asking parents, teachers, or the

child to fill out standardized social skills rating scales. Communication ability is often

measured by standardized language testing, and may also include measures of

pragmatic language abilities. When feasible, a practitioner can administer the Autism

Diagnostic Observation Schedule (ADOS), currently in its second edition, or the Autism

Diagnostic Interview-Revised (ADI-R), both of which are generally considered to be the

“gold standard” of autism assessment. Practitioners who conduct ASD evaluations

include psychologists, speech-language pathologists, pediatricians, or psychiatrists.

However, other practitioners, including physical therapists, occupational therapists, and

teachers can provide valuable information that helps in both diagnostic decision-making

and intervention-planning (Zenko & Hite, 2014).

A crucial tenet of psychological assessment is to triangulate data from a

multitude of sources, which often can include formalized testing, interviews, and

19
behavioral observations. The decision of which combination of assessment tools to use

is complex, and should be made after consideration of multiple factors, including the

child’s level of verbal communication, attention and speed of processing, tolerance of

new transitions, and ability to respond to verbal instructions and social expectations

(National Research Council, 2001). The purpose of the assessment is another important

consideration when deciding upon an assessment plan. Evaluations may be conducted

for the purpose of qualification for educational services, medical diagnosis and third

party payment for intervention services, intervention planning, progress monitoring, or

reevaluation (Zenko & Hite, 2014).

Obtaining information through a variety of methods and informants is particularly

important in assessing children for ASDs because symptoms of ASD may not be

evident during a short interaction with the child in only one context (Ozonoff et al.,

2005). For example, a child may not demonstrate obviously impaired social skills and

language ability when interacting with an adult evaluator who places limited social

demand on the child. Additionally, certain repetitive behaviors or interests may not be

expressed during brief assessment periods. Therefore, practitioners seeking to make

diagnostic decisions about ASDs need to obtain information from individuals who have

daily experience with the child. Discussing the child’s behavior during the assessment

with a parent or teacher can also help the diagnostician determine whether the

displayed behaviors are typical of daily functioning, and can help interpret some

idiosyncratic behaviors or communication (Zenko & Hite, 2014).

Beyond some of the practical considerations, the nuances of diagnosing ASDs

can be complicated by determining the degree of impairment and ruling out differential

20
diagnoses. Although social skill impairments are inherent in ASDs, many people who do

not meet the criteria for ASD will experience difficulty with social communication. For

example, experts have observed that individuals who have family members with ASD

often exhibit milder deficits in social communication or sensory sensitivities. These

individuals are sometimes described as having a broad autistic phenotype (Whitehouse,

Barry, & Bishop, 2007). Differential diagnoses for ASDs can also be complicated by

overlap between ASD and other conditions. Certain other psychiatric and/or medical

conditions are known to impact social skills, such as Williams Syndrome, in which

individuals may demonstrate impairment in joint attention skills (Laing et al., 2002).

Individuals with other disorders might also demonstrate restricted or repetitive interests

or behaviors. For example, an individual with an anxiety disorder or obsessive-

compulsive disorder may repetitively ask questions related to their anxiety (Ozonoff et

al., 2005). The repetitive interests or behaviors found in individuals with ASDs might

also be present in individuals who have an intellectual disability (ID). However, ID can

be differentiated from ASD by a careful examination of an individual’s language and

social skills (Matson, 2007). An individual with reactive attachment disorder can present

with inappropriate social interaction, delays in language development and

communication skills, and self-stimulating behaviors, making it particularly challenging

to differentiate from an ASD (Mukaddes, Kaynak, Kinali, Besikci, & Issever, 2004). A

trained practitioner has to use clinical expertise to determine whether an individual’s

presentation best fits a diagnosis of an ASD, another condition, or simply represents a

form of functioning found among typically developing individuals.

21
 CHAPTER 2
REVIEW OF THE LITERATURE

The following literature review explores topics relative to understanding social

communication challenges and assessment strategies in individuals with ASD. Various

theoretical conceptualizations and models of social communication functioning and

impairment are examined. Current methods of evaluating social functioning that are

described in the literature are also discussed. These include the use of norm-referenced

assessments and questionnaires, diagnostic instruments, and criterion-referenced

strategies.

Conceptualization of Social Skills and Impairments Experienced by Individuals

with ASD

Various authors and researchers conceptualize social communication in different,

yet overlapping ways. Mundy, Sigman, Ungerer, and Sherman (1986) describe three

categories or functions of nonverbal social communication behavior, including: (a) social

interaction, which involves the use of behaviors to elicit or maintain interaction in which

the partner focuses on the child; (b) indicating joint attention, which involves the

coordination of attention to share awareness of an object or event; and (c) requesting,

which involves the use of behaviors to coordinate attention to obtain a person’s aid in

accessing an object or event. Dykstra, Boyd, Watson, Crais, and Baranek (2012) argue

that social communication served functions of social interaction, behavior regulation,

and joint attention, and that these behaviors developed in the first year of life for

typically developing infants.

Kaczmarek (2002) conceptualizes communication competence as possessing

social appropriateness and communicative appropriateness, which intersect to establish

social-communication effectiveness. In this model, social and communicative

22
appropriateness are evaluated by others in regards to acceptability and successful

outcomes of behaviors. However, social-communication effectiveness can be measured

by the child’s own perceived level of functioning, as well as the degree to which the

child is socially accepted (Kaczmarek, 2002). In another framework, Sheridan,

Hungelmann, and Maughan (1999) differentiate between social skills and social

competence. In this model, social skills are defined as discrete and learned behaviors

exhibited to perform a task, while social competence is based on the evaluative

judgments of others as recipients of social overtures (Sheridan et al., 1999). Prizant,

Wetherby, Rubin, Laurent, and Rydell (2006) describe social communication

competence as “communicating and playing with others in everyday activities and

sharing joy and pleasure in social relationships” (p. 3). Experts have also identified

behaviors associated with successful social communication. Rao, Beidel, and Murray

(2008) describe social skills as specific behaviors that result in positive social

interactions. The authors include examples of smiling, making eye contact, asking and

responding to questions, and giving and acknowledging compliments (Rao et al., 2008).

Similar to the differences in conceptualizations of social communication, authors

also argue that the deficits experienced by individuals with ASD can vary. In describing

impairments in early social communication, Mundy and Crowson (1997) state that

children with ASD experience a syndrome specific pattern of strengths and

weaknesses, with the highest level of difficulty experienced in developing nonverbal

joint attention skills, moderate difficulty in developing turn-taking skills, and the least

amount of difficulty in developing nonverbal requesting abilities. Common areas of

deficit noted in the research include difficulties with orienting to social stimuli, effective

23
use of eye contact, initiating interaction, and responding to others’ distress (Rao et al.,

2008, Weiss & Harris, 2001).

In an alternative conceptualization of social communication challenges

experienced by individuals with ASD, White, Keonig, and Scahill (2007) note

impairments in the areas of social pragmatics (such as turn-taking in conversation and

taking the listener’s perspective), poor speech prosody, a tendency to dwell on certain

topics, difficulty understanding and expressing emotions, and difficulty interpreting non-

literal language. Zenko and Hite (2014), describe impairment in symbol use in language,

including semantics, syntax, and morphology usage. Authors also reference

impairments in interpreting verbal/nonverbal cues (Rao et al., 2008), understanding

facial expressions, using appropriate greetings, establishing joint attention, appreciating

conventional humor, and engaging in spontaneous and pretend play (Weiss & Harris,

2001).

Theories on the Cause of Social Skill Impairment in Individuals with ASD

Various theories have emerged regarding the cause of the social communication

impairments experienced by individuals with ASD. The social motivation theory (or

hypothesis) posits that this core deficit in social communication ability is the result of

interruption of the processes involved in social interest. Based on this theory, social

motivation has evolved to help humans be suited to work well as members of a group,

and an ASD is considered an extreme case of diminished social motivation (Chevallier,

Kohls, Toiani, Brodkin, & Schultz, 2012). According to this theory, children with ASD find

social activities less rewarding than neurotypical peers because, in children with ASD,

the reward centers in the brain are less activated for social stimuli (Stavropoulos &

Carver, 2013).

24
 Another particularly common theory centers on the construct of “theory of mind.”

Theory of mind is a basic understanding that one’s own perspective is different than

others. Essentially, it is the awareness of others’ thoughts, emotions, motives,

intentions, personality, and belief systems, which may differ from one’s one. Some

experts hold that theory of mind is a critical element of social communication ability.

Baron-Cohen, Leslie, and Frith (1985) describe theory of mind as, “a mechanism which

underlies a crucial aspect of social skills, namely being able to conceive of mental

states…knowing that other people want, feel, or believe in things” (p. 38). Proponents of

this theory as it relates to ASD argue that individuals on the autism spectrum have a

deficit in their theory of mind, which impedes their ability to engage in perspective taking

and relating to others. However, language skills appear to mediate deficits in theory of

mind. Bennett, Szatmari, Bryson, Duku, Vaccarella, and Tuff (2013) argue that

language skills may facilitate important compensatory pathways that support theory of

mind.

One neurocognitive theory regarding ASD, the weak central coherence theory,

argues that relative failure to process information in context is a core deficit in ASD,

which can lead to challenges in social functioning. Proponents of the weak central

coherence theory claim that individuals with ASD process information in ways that are

fragmented and meaningless. Social functioning relies heavily on the integration of

information and the application of meaning to stimuli, and thus weakness in central

coherence can have significant implications for social communication abilities (Berger,

Aerts, van Spaendonck, Cools, & Teunisse, 2003). The extreme male brain is a second

neurocognitive theory that may account for the challenges people with ASD experience

25
in social functioning. Originally proposed by Hans Asperger in 1944, Baron-Cohen

(2002) argues that female brains are more suited to empathize, while males’ brains are

better able to systemize information. He thus proposes that individuals with ASD have

an “extreme” male brain, in which there is a strong tendency toward systemizing.

However, this superior ability to systemize, Baron-Cohen argues, comes at the expense

of the ability to empathize, which is the most powerful way of understand and predicting

the social world (2002), leading to deficits in social functioning. Finally, the

underconnectivity theory is another neurocognitive perspective that combines

components of both weak central coherence and the extreme male brain theories,

because both central coherence and empathizing require the rapid and integrated

operations of neural systems. The premise of underconnectivity is that individuals with

ASD have less efficient neural connections between systems, which would impact their

ability to process and apply information, potentially leading to deficits in social

functioning (Baron-Cohen & Belmonte, 2005).

Assessing Social Functioning in Individuals with ASD

Although social communication impairments are inherent in the diagnosis of

individuals with ASD, substantial variation exists in the way that these skills are

measured. Social skills assessments often serve two functions: (1) to identify general

and specific areas of social difficulty, and (2) to evaluate treatment outcomes (Sheridan

et al., 1999). The lack of consistency among social skills assessments for individuals

suspected of having ASD is problematic, because this variability makes it difficult to

repeatedly and regularly evaluate the effectiveness of interventions designed to target

social skills (Cunningham, 2012), limiting the practitioner’s ability to draw conclusions

about evidence-based practices to improve social communication ability. Methods of

26
social skills assessment can include: (1) behavioral observations, (2) behavior rating

scales, (3) interviewing, (4) self-report instruments, (5) project-expressive techniques,

and (6) sociometric techniques (Merrell, 2001). However, in research on the

measurement of social skills in individuals suspected of having an ASD, both rating

scales and observational methods are frequently used to investigate social competency

(Matson & Wilkins, 2007).

Interviewing the examinees being evaluated can provide insight into their

perceived level of social functioning. However, it can also be very informative to have

people significantly close to the examinees provide an evaluation of how others

perceive the individual’s level of functioning. For example, sometimes individuals with

ASD claim to have successful social interactions with individuals who are known to be

indifferent toward, or even unkind to the individual with ASD. Bauminger and Kasari

(2000) found that when comparing reports of friendships provided by mothers of

children with ASD and the children themselves, the mothers revealed that the “friends”

identified by their child often did not reciprocate the interaction with the child with ASD,

and when the two children did spend time together, the activities often did not involve

direct reciprocal social interaction. These results suggest that gathering data from

multiple perspectives can help to clarify which, if any, social relationships identified by

the person with ASD are actually functional and supportive relationships. Additionally,

given the communication difficulties that are characteristic of ASD, an examinee may

struggle with finding the most informative language to adequately and comprehensively

describe his or her functioning. For example, if a child has significant language

impairment and is asked to describe social activities, he or she may not respond or

27
provide a limited response due to the language demand necessary to communicate his

or her ideas.

Another important way to gather information about the social functioning of an

individual with ASD is to have informed caregivers, or the individual with a suspected

ASD diagnosis him-/herself, fill out a rating scale about social behaviors. These scales

offer a significant advantage in that they provide normative data about typical skills

being demonstrated by individuals at a particular grade level. A major criticism about the

use of rating scales developed to be completed in evaluation of children suspected of

having an ASD is the limited inclusion of individuals with ASD in the normative sample

(Matson, 2007). Additionally, social skills rating scales can identify deficits, but they do

not help with a differential diagnosis of an ASD (Matson & Wilkins, 2007). Another

concern relates to the possibility that the rating scales may be influenced by limited

knowledge of the rater, who may not be privy to the intricacies of social interaction

among children (Locke, Kasari, & Wood, 2013).

Finally, practitioners can engage in direct observations of behavior to assess

social functioning. In some instances, this includes the use of contrived scenarios, such

as role-playing (Matson & Wilkins, 2007). Direct observations can also incorporate the

use of a formal observational assessment system. These systems may identify relevant

social skills such as the frequency of social initiations, or the responses to bids for social

interactions (Conroy, Boyd, Asmus, & Madera, 2007). The benefit of direct observations

is that it provides the examiner with specific examples of social functioning. However,

this method may include only a limited duration of time in which to assess social skills,

and the settings in which these skills are being assessed may provide limited social

28
validity, especially in cases where the social interactions are being conducted in a

clinical setting, reinforcing the importance of collecting information from people close to

the child being assessed (Ozonoff et al., 2005). Additionally, Merrell (2001) identifies

threats to the validity of this type of assessment including: (a) poorly defined

observational domains, (b) unreliability of observers, (c) lack of social comparison data

of typically performing children, (d) observer reactivity, (e) situational specificity of the

behavior, (f) inappropriate recording techniques, and (g) biased expectations of the

observer.

A promising option for the assessment of social skills is the Dynamic Assessment

(Winner, 2007), a semi-structured assessment, and involves various tests that target

skills including conversation, affect recognition, and perspective taking. This

assessment provides opportunities in which the diagnostician can relate to a student

without facilitating the student’s social success. The stated goal of the Dynamic

Assessment “is to get real-world, functional information that can become the foundation

of the student’s social thinking treatment program” (Winner, 2007).

Norm-Referenced Social Skill Rating Scales Frequently Used with Individuals with
ASD

Most practitioners espouse a multi-method, multi-modal approach to evaluating

the social skills of individuals suspected of having an ASD. Due to the significant

variation in social functioning, particularly among children with ASD, it is difficult to

accurately measure social skills using only one method, rater, or setting (Locke, et al.,

2013). Particularly among very young children, parents often miss early warning signs

about impairment in development of social skills, such as a delay in responding to and

29
initiating joint attention, or orienting to social stimuli (Johnson, Myers, & the Council on

Children with Disabilities, 2007).

A commonly used method of measuring social skills is to ask the individual being

evaluated and/or people close to the examinee to complete a rating scale that has been

developed to give norm-referenced scores. The benefit of using this method is that

these rating scales can provide insight into how the people around the examinee

perceive his/her social functioning on a daily basis, as well as offer a score to compare

against what would be typically expected of a child that age. Some of the frequently

used rating scales to evaluate social functioning of individuals suspected of having an

ASD include the Social Responsiveness Scale, 2nd Edition (SRS-2) (Constantino &

Gruber, 2012), the Social Skills Improvement System (SSIS) (Gresham & Elliott, 2008),

and Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) (Sparrow,

Cicchetti, & Balla, 2005).

Social Responsiveness Scale, 2nd Edition (SRS-2)

Developed by Constantino and Gruber (2012), the Social Responsiveness Scale,

2nd Edition (SRS-2) is designed to measure autistic impairment in social awareness,

social information processing, social responses, social motivation, and social

communication. The scale is also used to measure preoccupations and mannerisms

characteristics of autism (Constantino & Gruber, 2012). The items on the scale are

crafted to involve the rating of the behavior itself, without placing any judgment on the

behavior, and include measures of frequency, but not intensity. For children aged 2 ½ to

18 years, the forms are designed to be completed by an adult who has had at least one

month’s experience observing the child’s behavior in a common venue (such as work,

school, or the home). For adults, aged 19 and up, there are self-report rating scales, as

30
well as rating scales for others who know the individual being assessed. The authors of

the SRS-2 recommend obtaining rating scales from multiple informants whenever

possible (Constantino & Gruber, 2012).

To generate items for the SRS-2, the authors relied on clinical experience

working with individuals with pervasive developmental disorders, edited these items for

face validity, clarity, and appropriateness, then had the items reviewed by parents of

children with ASD, as well as experts from various fields (including special education,

school psychology, clinical child psychology, neuropsychology, pediatrics, child

neurology, and child psychiatry) (Constantino & Gruber, 2012). The standardization

sample included reports on 1,014 school-aged children, 247 pre-school-aged children,

and 702 adults, with the ethnic diversity of the sample similar to ethnicity data based on

U.S. Census. The authors also reported on 9 studies using this measure with ASD

populations (Constantino & Gruber, 2012).

The SRS-2 measures multiple domains of social communication. The social

awareness domain includes items related to recognizing facial expressions of others,

personal hygiene, response to joint attention, and awareness of and adherence to social

norms. Social cognition is measured by items related to understanding pragmatics of

language, sensory sensitivities, understanding cause and effect relationships, and

recognizing the “whole pictures”. The social communication domain involves items

related to the ability to communicate feelings, engage in turn-taking interactions, use of

eye contact, ability to imitate others and play appropriately, offering comfort, relating to

peers or adults, facial expressions, vocal prosody, and rigidity of thinking. Finally, the

social motivation domain includes items related to confidence, preferences of being

31
alone or with others, willingness to initiate social interactions, and willingness to

separate from others (Constantino & Gruber, 2012).

Given that the SRS-2 was released very recently, limited research on the utility of

this measure is reported in the literature. However, substantial literature regarding the

use of the first edition of the Social Responsiveness Scale (SRS) can be found. Some

authors noted the decision to include the SRS was because this is a social skills

measure that is shown to be sensitive to change, and thus is useful as a pre-/post-

intervention measure (White, Ollendick, Scahill, Oswald, and Albano, 2009; Laugeson,

Frankel, Gantman, Dillon, & Mogil, 2012). White and Roberson-Nay (2009) reported that

they utilized this measure because it provides a dimensional measure of ASD, in which

higher scores reflect a higher degree of social disability. There are also authors who

report concerns about the limitations of the SRS, notably that it scores on this measure

may be confounded when a child has significant problem behaviors (Hus, Bishop,

Gotham, Huerta, & Lord, 2013).

Social Skills Improvement System (SSIS)

Developed by Gresham and Elliott (2008), the Social Skills Improvement System

Rating Scales (SSIS), includes parent-, teacher- and self-report forms to be used in

evaluating children ranging from age 3 to 18 years old. The parent and teacher forms

include measures of both the frequency and the importance of the behavior. Domains

measured on the SSIS include social skills, problem behaviors, and academic

competence. The authors used a social behavioral framework in constructing this

assessment, and involved revising information from the previous version of this

assessment, the Social Skills Rating System to provide greater coverage of important

behaviors on the existing subscales, as well as develop mew items to improve

32
alignment across forms (Gresham & Elliott, 2008). New items were designed to be

representative of activities or skills describe in content guidelines, relevant across a

broad age range, pertinent and readily understood by raters, and easily translatable into

intervention plan objectives (Gresham & Elliott, 2008, p. 45). To develop the problem

behavior scales, the authors referred to the Diagnostic and Statistical Manual of Mental

Disorders, 4th Edition, Text Revision (DSM-IV-TR), looking at the categories of

behaviors described in the diagnosis of attention-deficit/hyperactivity disorder and

pervasive developmental disorders (Gresham, Elliott, Vance, & Cook, 2011).

The SSIS was standardized on a sample including 4,700 children, ages 3 to 18

years old, who were matched on U.S. census data regarding race/ethnicity,

socioeconomic status, and geographic region (Crosby, 2011). The authors also included

results based on assessment of individuals in special populations, including autism

spectrum disorder, attention-deficit/hyperactivity disorder, developmental delay,

emotional/behavioral disturbance, gifted/talented, intellectual disability, specific learning

disability, and speech/language impairment (Gresham & Elliott, 2008).

As a rating scale designed to measure social communication skills, the SSIS

involves items that pertain to a range of behaviors across domains. These domains

include: communication, including turn-taking, eye contact, vocal prosody, gestures, and

politeness; cooperation, including helping, sharing, and complying with rules/directions;

assertion, including initiating behaviors (e.g. asking for information, and introducing

oneself) and responding to actions of others; responsibility, including showing regard for

property/work and communicating with adults; empathy, including showing concern and

respect for others’ feelings and viewpoints; engagement, including joining activities and

33
inviting others to join, initiating conversations, and making friends; and, finally, self-

control, including responding appropriately in conflict and non-conflict situations

(Gresham & Elliott, 2008).

Authors utilizing the SSIS note some of its advantages and limitations. Gillis,

Callahan, and Romanczyk (2011) note that this measure was designed to screen for

social skills difficulties and assist in determining intervention goals, but that it was not

specifically designed to be used with individuals with ASD. Crosby (2011) notes that the

authors of the SSIS provide a model of Social Behavioral Strengths and Weaknesses,

through which an examiner can begin to identify behavioral skill deficits as opposed to

performance deficits across environments, which can allow for targeted intervention

plans.

Vineland Adaptive Behavior Scales, 2nd Edition (Vineland-II)

The Vineland Adaptive Behavior Scales, 2nd Edition (Vineland-II) was developed

by Sparrow, Cicchetti, and Balla (2005). It can be used to evaluate individuals from birth

through 91, includes forms for interviews or rating scale administration, and can be

completed by parents or teachers. The measure reportedly evaluates the domains of

communication, daily living, and socialization. Additionally, for individuals below the age

of 7, there is a domain measuring motor skills. The Vineland-II is a measure of adaptive

behaviors, which involve “the performance of daily activities required for personal and

social sufficiency” (Sparrow et al., 2005, p. 6). To develop this scale, the authors based

items on research, a literature review, and extensive clinical experience. The items then

were reviewed by clinicians for relevance and bias, and sent to a large sample for item

tryout (Sparrow et al., 2005). For the purposes of standardization, the authors collected

data on 3,695 individuals ranging in age from birth to 90 years, and matched with U.S.

34
Census data in race/ethnicity, socioeconomic status, and geographic region. The

standardization sample also included clinical samples of groups of individuals with

attention-deficit/hyperactivity disorder, autism (verbal and nonverbal),

emotional/behavior disorders, deaf/hard of hearing, specific learning disabilities, visual

impairment, and mental retardation (Sparrow et al., 2005).

The use of the socialization domain of the Vineland-II is frequently found in

research on social skills of individuals with ASD. The authors claim that this domain

measures interpersonal relationships, play and leisure time, and coping skills (Sparrow

et al., 2005). Within the domain of interpersonal relationships, items target skills such

as: use of eye contact, facial expressions, social smile, showing affection, imitating

others, showing interest in others, using appropriate vocal responses, providing help to

others, recognizing emotion in others, using social conventions (greetings, small talk,

etc.), understanding friendship, and cooperation. The domain of play and leisure time

includes items related to: interacting or playing with others, sharing, make-believe play,

turn-taking, following rules, and following rules. Finally, the domain of coping skills

involves items that involve: transitioning between activities, following social conventions

(e.g. chewing with one’s mouth closed, saying “please”, saying “good bye”, etc.),

apologizing, vocal prosody, accepting help, controlling emotions of anger or hurt, and

evaluating risks of behavior (Sparrow et al., 2005).

Similar to the SRS-2, many researchers have utilized the Vineland as opposed to

the more recently published Vineland-II. Szatmari, Bryson, Boyle, Streiner, and Duku

(2003) noted that the Vineland not only has excellent reliability and validity, but that it

also is sensitive to the severity of impairment found in individuals with ASD. Perry,

35
Flanagan, Geier, and Freeman (2009) conducted the Vineland with a large sample of

individuals with ASD and determined that although a profile of functioning is not

immediately evident in standard scores, but that when age equivalents are examined,

socialization and communication are frequently identified areas of weakness.

Researchers have examined correlations between the SRS and the Vineland

Socialization and Communications domains, as well as the between the ADOS and the

Vineland. Moderate correlations have been found between these instruments and the

Vineland (Bӧlte, Poustka, & Constantino, 2008)

Although the SRS-2, SSIS, and Vineland-II are some of the most commonly used

methods, there are still a wide range of other measures being utilized in measuring

social skills of children with ASD. These measures vary based on multiple factors,

including the age of the child being assessed, the setting in which the assessment takes

place, and the geographic location of the assessors. The Infant Toddler Social and

Emotional Assessment (ITSEA) is a parent-report measure of social-emotional and

behavioral competencies and problems for very young children (Green, Ben-Sasson,

Soto, & Carter, 2012). A measure called the Manchester Inventory for Playground

Observations (MIPO), is a rating scale designed to be completed after observing a child

in a playground setting (Gibson, Hussain, Holsgrove, Adams, & Green, 2011). Certain

measures are found more frequently in research conducted in Europe, such as the

Development and Well-Being Assessment (DAWBA) and the Children’s Communication

Checklist, 2nd edition (CCC-2). The DAWBA includes an interview, questionnaire, and

rating techniques, and is designed to generate ICD-10 or DMS-IV psychiatric diagnoses

for children ages 5 to 17 (Dworzynski, Happé, Bolton, & Ronald, 2009). The CCC-2 is a

36
rating scale that was developed to measure language and communication, but was not

specifically designed for use with individuals with ASD (Charman, Baird, Simonoff,

Loucas, Chandler, Meldrum, & Pickles, 2007), despite its common usage with this

population. In addition to formal, published measures, a number of researchers have

developed their own questionnaires. Examples include the Behavioral Assessment of

Social Interactions in Young Children (BASYC) (Gillis et al., 2007) or the Matson

Evaluation of Social Skills with Youngsters, 2nd edition (MESSY-II) (Matson, Kozlowski,

Neal, Worley, & Fodstad, 2010).

Autism Symptomology Measures used as Social Skills Assessments with

Individuals with ASD

In some of the literature, authors have opted to use assessments designed to

measure autism symptomology in lieu of a traditional social skills measurement.

Frequently used measures in the research include the Social Communication

Questionnaire (SCQ), the Autism Diagnostic Interview-Revised (ADI-R), and the Autism

Diagnostic Observation Schedule (ADOS). However, there are a variety of other

measures that have been developed for screening or diagnostic purposes that are used

for social skill assessment, including the Childhood Autism Rating Scales (CARS), the

Modified Checklist of Autism for Toddlers (M-CHAT), and the Baby and Infant Screen

for Children with aUtism Traits (BISCUIT).

The Social Communication Questionnaire (SCQ) is a brief instrument designed

to evaluate communication skills and social functioning in children who may have ASD.

It includes 40-items and is to be completed by a parent. There are two forms, the

Lifetime and the Current version. The Lifetime version is designed to measure the

child’s functioning throughout the life span, with a particular emphasis on behaviors

37
observed between ages 4 and 5. The Current version is designed to measure the child’s

present level of functioning, and can be utilized for progress-monitoring purposes. This

measure was designed to parallel the content of a more comprehensive evaluation of

autism symptomology, the ADI-R. The SCQ is considered a screening measure, with a

cutoff score of 15. It is not intended to diagnose an ASD, but rather to identify children

for whom further evaluation is warranted (“Social Communication Questionnaire

(SCQ)”).

Researchers have identified strengths and weaknesses of the use of the SCQ to

measure social communication and the presence of autism symptomology. Although the

authors of the SCQ report a cutoff score of 15, other researchers have suggested that

for higher functioning individuals, a lower threshold might be acceptable (White &

Roberson-Nay, 2009). Other authors have used this measure in research because it

has good discriminative validity between ASD and other diagnoses, although it may not

identify individuals with high-functioning individuals (Philofsky, Fidler, & Hepburn, 2007).

After reviewing the research, Schanding, Nowell, and Goin-Kochel (2012) conclude that

the optimal cutoff score for the SCQ might vary by age and other characteristics, such

as symptom severity. This variability would likely have implications for sensitivity and

specificity of the instrument (Schanding, Nowell, & Goin-Kochel, 2012).

The Autism Diagnostic Interview-Revised (ADI-R), is a more comprehensive

measure of social functioning and autism symptomology. This measures involves an

interview with a parent or caretaker that provides a thorough assessment of individuals

suspected of having an ASD. The interview includes 93 items, across the domains of

language/communication, reciprocal social interactions, and restricted, repetitive, and

38
stereotyped behaviors and interests. The ADI-R is designed to be useful for diagnosing

ASD, planning treatment, and distinguishing ASD from other disorders. It takes 1 ½ - 2

½ hours to administer and score, and can only be administered by individuals who have

been trained in this instrument (“Autism Diagnostic Interview, Revised (ADI-R)”).

Researchers who use the ADI-R note various benefits of this instrument. Le

Couteur, Haden, Hammal, and McConachie (2008) reported one advantage, in that the

ADI-R allows a practitioner to obtain developmental history for a lifetime differential

diagnosis of a pervasive developmental disorder, while also gaining information about

the individual’s present level of functioning. However, Pinto-Martin, Levy, Feldman,

Lorenz, Paneth, and Whitaker (2011) note that, despite its wide usage, the validity of

the ADI-R may be compromised when used to assess individuals with severe

disabilities. Additionally, the stability of diagnosis of young children made by use of the

ADI-R was less than the stability of diagnosis made by clinical presentation; however,

the stability of diagnosis based on the ADI-R increased with the age of the examinee at

the time of the assessment (Soke, Philofsky, Diguiseppi, Lezotte, Rogers, & Hepburn,

2011).

Considered by many to be the “gold standard” in assessing autism

symptomology (Locke et al., 2013), the Autism Diagnostic Observation Schedule

(ADOS) is also frequently used in research to evaluate a child’s social functioning and

to determine eligibility of participation when the diagnosis of an ASD is required. The

ADOS is designed to allow a practitioner to accurately assess and diagnose ASD

across ages, developmental levels, and language skills, and can be administered to

individuals ranging from toddlers to adulthood. The format of the ADOS is a

39
standardized behavior observation system and coding, and can be administered in 30-

45 minutes. However, the examiner has to have had training on this specific instrument

in order to administer it (“Autism Diagnostic Observation Schedule (ADOS)”).

Benefits of the ADOS include the fact that this instrument is designed to elicit

signs of autism in social interaction, communication, play, and repetitive behaviors

(Philofsky et al., 2007). Expanding on this, White & Roberson-Nay (2009) note that the

ADOS involves presenting individuals with activities and questions that specifically pull

for social and communicative behaviors that are often difficult for individuals with ASD.

Also, the ADOS provides opportunities for the examiner to observe an individual’s ability

to demonstrate creativity and imagination in structured and unstructured play, which can

be challenging for individuals with ASD (Assouline, Nicpon, & Doobay, 2009). However,

one major concern with the use of the ADOS in research is that authors often make the

mistake of using an individual’s raw score as a reflection of the severity of symptoms,

which is erroneous because the assessment is designed as a diagnostic instrument,

and not a progress monitoring tool (Gotham, Pickles, & Lord, 2009). Of note, in the

ADOS-2, the authors developed a 10-point comparison scale to provide a measure of

the severity of symptoms (Gotham, Pickles, & Lord, 2012).

As previously noted, other measures of autism symptomology are sometimes

used in the evaluation of social skills of individuals suspected of having an ASD. The

Baby and Infant Screen for Children with aUtism Traits (BISCUIT) is an informant-based

measure to be used when evaluating children from the ages of 17 to 37 months, and

includes assessments of autism symptomology, comorbid psychopathology, and

challenging behaviors (Rojahn, Matson, Mahan, Fodstad, Knight, Sevin, & Sharp,

40
2009). Also for use with young children, the Modified Checklist of Autism for Toddlers

(M-CHAT) is a brief, parent-report measure commonly used to screen for social deficits

that are often linked to the presence of an ASD (Eaves, Wingert, & Ho, 2006). The

Childhood Autism Rating Scale (CARS) is a widely used behavioral observation

measure designed to assist in the diagnosis of ASD by measuring autism

symptomology (Perry, Flanagan, Geier, & Freeman, 2009).

Criterion-referenced Methods of Evaluating Social Skills of Individuals with ASD

In addition to the rating scales and diagnostic measures often used to evaluate

social skills in children with ASD, some researchers have developed their own methods

that involve measures of directly observable behaviors or observations of performance

on measures believed to represent an underlying skill. Criterion-referenced measures

often involve evaluations of joint attention, theory of mind, initiations and responses,

play, social cognition, or some combination of these behaviors and constructs. Criterion-

referenced measures can range from including semi-structured administration, to

observation in naturalistic settings, further adding to the difficulties in comparing

measures.

One of the more structured methods of measuring social communication using

criterion-based evaluation is titled the Early Social Communication Scale (ESCS)

(Mundy et al., 2003). The authors provide the manual for the ESCS on the website for

this assessment. This measure can be conducted by a trained assessor, and takes

approximately 20 to 30 minutes to administer. It measures a variety of early social

communication skills, such as sharing, turn-taking, joint attention, and eye contact

(Cunningham, 2012). In this measure, initiations include coordinated looking, distal

pointing, proximal pointing, and showing, while responses include responding to

41
experimenter points and gazes (Kasari, Paparella, Freeman, & Jahromi, 2008). To be

considered an initiation of joint attention, the child must use eye gaze, pointing or

showing to share in the experience of the toy or object (Remington et al. 2007), rather

than using these strategies to obtain a desired object.

Joint attention is one of the constructs that researchers and practitioners

frequently try to measure when assessing social communication. Joint attention is

believed to be an important skill for the development of language and engaging in social

interactions (Zenko & Hite, 2014). There are multiple behaviors that relate to joint

attention, in both initiating and responding to bids to socially share something.

Researchers measuring joint attention have created a variety of different strategies for

measuring this ability. In a study on the efficacy of a program designed to increase

initiations of joint attention, Martins and Harris (2006) operationally defined initiations of

joint attention as pointing or providing a three-point gaze (in which the child would look

at an object, then look to a person, then look back to the object). In the same study, the

authors sought to determine children’s responses to another person’s bids for joint

attention using either attention-getting, turning one’s head toward an object, head

turning accompanied with pointing, or touching the item (Martins & Harris, 2006). In

another study measuring joint attention, Remington et al. (2007) the authors

operationalized initiations of joint attention as using eye contact, pointing or showing. In

the same study, responses to joint attention include the use of eye gaze directed toward

an object that to which someone is distally pointing.

In another study of joint attention, Hobson and Hobson (2007) measure multiple

dimensions of eye gaze, including reciprocity, depth, and contact. Raters first

42
determined whether gaze was directed toward a person, object, or away. Second, eye

gaze was evaluated based on quality and/or function, using a scheme that included

“orienting looks,” “sharing looks,” and “checking looks.” Within this framework, sharing

looks were considered to be reciprocal, deep, and personal, while checking looks were

described as nonreciprocal, superficial, and impersonal (Hobson & Hobson, 2007).

Other authors have used theory of mind in using criterion-referenced methods to

measure social skills. In research, this construct is often assessed indirectly, by

providing children with scenarios that require the ability to recognize the differences in

perspectives of multiple characters in a constructed scenario. For example, the “Sally

and Anne” test, utilized by van Buijsen, Hendriks, Ketelaars, and Verhoeven (2011),

among others, involves presenting participants with a scenario in which two children

observe an object being placed into one container, the first child leaves and the second

child moves the object, and when the first child returns, the participants are asked

where the first child thinks the object is now. The belief is that children who have

established a theory of mind will recognize that the first child is not privy to the same

information that the audience is, and will correctly answer that the first child will think the

object is still in the container. In contrast, children who have not developed a solid

theory of mind will assume that the first child knows what the audience knows, and

incorrectly answer that the first child will think the object is where the second child put it

(Feng. Lo, Tsai, & Cartledge, 2008).

Theory of mind is considered to be a multi-faceted construct, and accordingly,

some authors have utilized a variety of scenarios to assess different components of this

ability. Peterson, Wellman, and Slaughter (2012) attempted to measure theory of mind

43
be assessing six domains: (a) knowledge of diverse desires, (b) knowledge of diverse

beliefs, (c) knowledge access (e.g., understanding that not seeing something leads to

not knowing something), (d) knowledge of false beliefs, (e) knowledge of hidden

emotion, and (f) understanding of sarcastic irony. In another study, van Buijsen et al.

(2011) measured theory of mind by assessing the ability to read mentalistic significance

of the eyes (e.g., identifying what a character desires), understanding that a person can

hold a false belief, and recognizing the impact of knowledge access.

Another more directly observable criterion-referenced measure of social skills

involves assessing a person’s social initiations and responses. Different authors

conceptualize initiations and responses in various ways, but often these definitions

include a time frame in which to decide if a communicative act is an initiation or a

response. For example, some authors describe initiations as social behavior that occur

more than three seconds after a previous social behavior, and responses as social

behaviors emitted within three seconds after another’s social behavior (Oke &

Schreibman, 1990; Strain, Kerr, & Raglan, 1979). Authors also often include measures

of whether an initiation or response is positive or negative in topography (Oke &

Schreibman, 1990) or the mechanism of the initiation or response (e.g., motor-gestural,

or vocal-verbal) (Strain, Kerr, & Raglan, 1979). Some researchers measure both

frequency and latency of initiations and responses (Jahr, Eikeseth, Eldevik, & Aase,

2007). Knott, Lewis, and Williams (2007) went into greater detail in coding initiations

and responses by identifying specific types of prosocial (e.g., giving/sharing,

cooperating, helping, requesting, etc.) and agonistic (e.g. physical aggression, object

struggle, command, threats, etc.) initiations and responses.

44
 Play is another criterion used to evaluate social skills. Typically developing

children progress through stages of increasingly symbolic and social types of play,

including sensorimotor play, organizing play, functional play, and symbolic-pretend play

(Zenko & Hite, 2014). In some research with children with ASD, authors will specifically

include particular types of social behavior, such as parallel play, cooperative play, or

verbal interaction (Jahr et al., 2007). Richman, Reese, and Daniels (1999) measured

interactive play between children and their mothers as a form of social communication

ability. In contrast, Hobson, Lee, and Hobson (2009) evaluated symbolic play as a

measure of social communication ability by observing a child’s attribution of symbolic

meaning and flexible use of objects, self-awareness, and investment in symbolic

meaning, creativity, and fun. In an early study of play behavior and social skills in

children with ASD, Romanczyk, Diament, Goren, Trunell, and Harris (1975) measured

play behaviors including isolate play, social play, and offering and taking toys.

Authors have also used criterion-referenced measures of social cognition to

assess social skills. Embregts and van Nieuwenjuijzen (2009) included the Social

Problem Solving Test (SPT), a measure of social information processing, as a measure

of social functioning. The SPT includes video vignettes that showed a child experiencing

a problem, and then a second child entered, at which point the actors would enact three

possible solutions: a pro-social/assertive response, an antisocial/aggressive response,

or an antisocial/passive response. The participants in the study were then questioned

about what cues the participants picked up in the scene, how the participants

interpreted the information, and how the participants would respond in that situation

(Embregts & van Nieuwenhuijzen, 2009). Coleman, Hare, Farrell, and Van Manen

45
(2008) developed the Social Cognitive Skills Test (SCST), which includes seven stories

with eight corresponding questions for each story. The SCST examines the evolution of

role taking in children ages 4 to 12 years, including egocentric role taking, subjective

role taking, self-reflective role taking, and mutual role taking (Coleman et al., 2008).

Other authors have used varying combinations of behaviors or constructs when

measuring social communication ability. Drew, Baird, Taylor, Milne, and Charman

(2007) included assessment of communicative acts in their research, which involved

observation of vocalization, eye contact, joint attention bids, gestures, and acts.

Reamer, Brady, and Hawkins (1998) measured child social behavior, which is described

as verbal or motor behavior directed from one child to a sibling. Hobson and Hobson

(2007) used eye gaze, including orienting looks, sharing looks, and checking looks, as a

measure of social communication. Bauminger, Solomon, Aviezer, Heung, Brown, and

Rogers (2008) measured friendship, which they break into two components: positive

social interactions and friendship manifestation. The former involves goal-directed

behavior, sharing behavior, prosocial behaviors, conversation, nonverbal interaction,

affect, and play. The latter, includes decision-making, conversational flow, and social

conversation (Bauminger et al., 2008).

Limitations and Future Directions for Research

A review of the research literature suggests a lack of consensus among authors

and practitioners regarding the most appropriate method to assess social

communication skills for children with ASD. In particular, rating scales, autism

diagnostic instruments, and criterion-referenced assessments are all used in various

studies. Although it is important to include multiple methods of assessment when

determining diagnosis or intervention planning, the lack of consistency in measurement

46
across studies makes it difficult to compare the effectiveness of interventions being

researched. Additionally, the essential limitations of each of the stated methods can

impact the ability to develop a profile to suggest areas of strengths and weaknesses

around which interventions should be designed to assist students with ASD. Although

rating scales often report strong psychometric properties, they are bound by the

limitations of the knowledge of the reporter, as well as the potential narrow scope of the

content in the included items. Autism diagnostic instruments may address specific social

deficits that are known to be associated with an ASD, they may not provide a full profile

of a child’s social functioning upon which interventions can be designed. Criterion-

referenced methods offer direct observations of abilities, by trained professionals.

However, the methods used vary substantially and may not be based on solid research

or theory.

Despite the challenges of existing methods of social skills assessment, it is

crucial to understand an individual’s profile of social functioning in order to find effective

targets for intervention planning and progress monitoring. Significant research has been

done on the psychometric properties of existing standardized assessments of social

skills. However limited research on the social validity of these measures could be found.

That is—in many cases, the people who best know the individual being assessed are

not being asked whether or not the results accurately describe the person’s social

functioning. In one notable exception, Gresham and Elliott (1988) researched the social

validity of the SSRS by examining the social importance of behaviors being measured

on this rating scale. To evaluate social importance, the authors provided teachers with

questionnaires asking them to rank on a 3 point-scale the importance of a list of

47
behaviors. Results of this study indicated that the teachers ranked academic behaviors

as being more important than peer interaction skills (Gresham & Elliott, 1988). Social

validity is particularly important in considering the assessment of social skills, as social

competency is inherently evaluated by others (Gresham, 1983).

48
 CHAPTER 3
METHODS

Purpose of the Study and Research Questions

A review of the current research indicates there is no consensus on the best

practice to evaluate a child’s social communication functioning. One potential

assessment that has been developed is the Dynamic Assessment, a semi-standardized

measure of social communication ability that has been developed to aid in evaluation

and intervention planning for children with social skill deficits associated with ASD. This

involves establishing interactions between the child and the examiner that are designed

to elicit certain social behaviors, and observing how the child responds to these

scenarios. Tasks on the Dynamic Assessment involve following and interpreting eye

gaze, determining the gestalt of a series of pictures that tell a story about a social

interaction, conversation, and interpreting facial expressions to determine the thoughts

or feelings of people in pictures of social scenarios.

As one potential option for social communication ability of children with ASD, it is

crucial to evaluate the usefulness and appropriateness of this measure as a component

of an assessment battery. Because social skills are largely evaluated by a person’s

ability to successfully interact with people around them, it is important to consider

others’ impressions of a child’s social skills when interpreting a potential impairment.

For this reason, it is important that any social skills measure provide an accurate and

comprehensive perspective of a child’s functioning based on the opinions of people

close to the child, such as parents and teachers. The purpose of this research, then is

to determine whether caregivers view the results of the Dynamic Assessment as being

socially valid as an accurate representation of a child’s true functioning in everyday life.

49
 Social validity is particularly important when evaluating measures of social

competency because the perceptions of the people who regularly interact with the

individual being assessed can provide insight into the importance and necessity of

various skills or abilities. When describing the considerations most important in

evaluating social skills assessment, Cunningham (2012) notes the particular importance

of social validity, as well as measures of symptom severity, adaptive functioning, and

the availability of appropriate norms. Gresham (1983) notes that social competency is

inherently evaluative because it represents one person’s judgment of another person’s

performance, thus it is important to gather perspectives from people who observe this

performance regularly. Hughes (1990) argues that to conduct socially valid research on

social competency, the researcher should first determine which social skills are

identified by teachers and peers as being important.

The current study proposes to explore parents’ and teachers’ perspectives of the

accuracy and completeness of the results of the Dynamic Assessment for children who

are suspected of having social communication impairments and/or ASD. The guiding

research questions for this study are:

 Does the profile obtained through the results of the Dynamic Assessment
accurately reflect informants’ perspectives of the child’s social functioning?

 What behaviors do teachers report as being important for successful social

interactions that are not captured on the Dynamic Assessment?

 What behaviors do parents report as being important for successful social

interactions that are not captured on the Dynamic Assessment?

 What social functioning characteristics are accurately described based on the

results of the Dynamic Assessment?

 To what extent do other measures, including a direct observation of social

communication and the administration of the SRS-2 questionnaire, capture the
informants’ perspectives of the child’s social functioning?

50
 Methodology of the Current Study

For measures of social communication that report reliability and validity, previous

research has generally been conducted using quantitative methods and statistical

analyses as their main form of data collection. Although establishing properties such as

interrater reliability, test-retest reliability, internal consistency, and convergent validity is

important to strengthen a psychological evaluation tool, measures of social skills can

also be informed by considering opinions of individuals who interact with a person and

observe that person in a variety of social contexts. Qualitative research methods can be

used to provide a deeper understanding of parents’ and teachers’ perspectives of the

accuracy of the Dynamic Assessment in describing a child’s strengths and weaknesses

in the domain of social communication. Additionally, qualitative research allows parents

and teachers to express what behaviors or constructs they feel are most important in

successful social functioning. Qualitative research has the potential to reveal the

complexity of information in a way that quantitative research cannot. By its nature,

qualitative research allows a researcher to focus on cultural and contextual factors, and

to gain insight into psychological and social processes and practices (Leech &

Onwuegbuzie, 2007). Data collected through interviews focuses on people’s lived

experiences (Leech & Onwuegbuzie, 2007).

In investigating social validity, qualitative research methods provide in depth

information about complex constructs that may not be observable through quantitative

methodologies. Quantitative methods of assessing social validity are “frequently too

limiting to explicate the dynamics surrounding people’s perceptions” (Lyst, Gabriel,

O’Shaughnessy, Meyers, & Meyers, 2005, p. 199). Given that assessments are

frequently used to measure outcomes and plan intervention, social validity is particularly

51
important because stakeholders should find the procedures, goals, and outcomes of the

assessment to be both important and acceptable (Kramer, 2011). By attempting to

understand parents’ and teachers’ perceptions of the accuracy of the Dynamic

Assessment, as well as what behaviors are relevant to successful social functioning,

results more directly reflect the child’s typical performance in day-to-day settings, as

well as expectations of a child’s social interactions. Therefore, qualitative methods

would result in more abundant and rich data to address the research questions

proposed in this study.

One method frequently used in qualitative research is grounded theory, which is

an approach that involves the use of a systematic set of procedures to develop an

inductively derived theory about a phenomenon (Strauss & Corbin, 1990). Grounded

theory includes flexible strategies that allow the researcher to: (a) study social and

psychological processes, (b) collect direct data, (c) manage data analysis, and (d)

develop and test a theoretical framework (Charmaz & Belgrave, 2003). The purpose of

this method is to develop a theory that is centered in reality through a recurrent and

simultaneous process of data collection and analysis (Strauss & Corbin, 1990). Moving

back and forth between the data and analysis allows the data collection process to

become more focused over time. In using grounded theory, the goal is to begin with an

area of inquiry and allow what is theoretically relevant to emerge, in the absence of an a

priori conceptual framework or hypothesis (Wimpenny & Gass, 2000). When using

grounded theory, the researcher collects data, and engages in an initial round of coding.

Throughout this initial coding and subsequent analysis, the researcher uses the

constant comparative method, which involves applying codes to data, and continuing to

52
compare incoming data with previous incidents coded the same way. Through this

constant comparison, the researcher is able to generate theoretical properties of the

category (Roulston, 2010). Throughout the analysis process, the researcher also utilizes

memo writing to reflect on the research process, decision-making, and the development

of interpretations (Roulston, 2010). Once new incidents in the data no longer add

aspects to the emergent theory, theoretical saturation has been achieved, and the

analyst can begin to write up the theory using coded data and memos (Glaser &

Strauss, 1967, p. 113). In grounded theory, it is the representativeness of the concepts,

not of persons, that is critical (Corbin & Strauss, 1990). In this study, the final theory

results in increased understanding of parents’ and teachers’ perceptions of the accuracy

of the information resulting from the administration of the Dynamic Assessment, as well

as knowledge of behaviors that parents and teachers find important for a child’s

successful social functioning.

Participants

Identification and Recruitment

Parents and teachers of children who were referred for an evaluation due to

concerns about the child’s social communication were asked to participate in this study.

Parents are defined as the primary caregiver of the child with ASD, and teachers are

defined as the classroom teacher with whom the child spends the most time each week.

Specifically, the child had to have been referred to the clinic based on the possible

presence of symptoms of ASD and specific concerns about the child’s

social/communication functioning. Parents and teachers of children aged 6 to 11 were

recruited for this study, as children within this age range are eligible to participate in the

Dynamic Assessment. To be included in the study, the parent or teacher must have

53
observed the child engage in social interactions with adults or peers for at least one

month, because it was necessary for the participant to have witnessed the child with

ASD interacting with peers in multiple contexts over a sustained period of time.

Parents were recruited through the university psychology clinic. Parents who

were referred for an intake or pre-authorization interview who have children who display

characteristics of ASD, with specific concerns about social communication, were asked

about their willingness to allow a comprehensive social skills evaluation to be

administered to their children, as well as their willingness to participate in a pre- and

post-assessment interview to discuss the child’s social skills and the results of the

assessment. Parents were informed that their willingness or refusal to participate in this

study will not affect the possibility of the clinical assessment which they are seeking.

Additionally, the parents were asked about their willingness to allow the child’s teacher

to participate in similar pre- and post-assessment interviews.

Once parents were identified and contacted, they were asked to agree to

participate in all aspects of the research procedure, including completing a

questionnaire (the Social Responsiveness Scale, 2nd Edition) and completing two semi-

structured interviews. For parents who gave consent, teachers were also be

approached to request participation in two interviews to discuss the child’s social

functioning, behaviors believed to be important to social functioning, and the results of

the social skills assessment. In cases where teachers agree to participate, they were

also asked to agree to complete the questionnaire, as well as a semi-structured

interview.

54
 Once parents and teachers had consented to the pre- and post-assessment

interviews, the children were administered a social skills assessment that includes three

components: the Dynamic Assessment, an observation of social-communication with

peers in a school setting, and the completion of the SRS-2 questionnaire by both

parents and teachers. The Dynamic Assessment is a semi-structured assessment that

takes approximately 30 minutes to administer. It involves a short interview with the child,

as well as tasks that require the child to interpret the examiner’s eye gaze to various

items around a room, to sequence a series of pictures and describe the narrative of the

story, and describe a scene from a picture that involves a social scenario (e.g., a man

has ordered food in a restaurant but does not have the money to pay, and the clerk is

staring at him). The observation of social-communication with peers lasted

approximately 10 minutes, and was be conducted in a time identified by the classroom

teacher as an opportunity for the child to socially engage with peers (e.g., lunch or

recess). The observation included partial interval time sampling to identify what type of

social behavior, if any, the child is engaged during 10-second intervals. The observation

system is based on a social skills observation manual designed for the purpose of

observing children with ASD socially interact during the course of pre- and post-

intervention measurement for a research study conducted at the same university. A

protocol for the Dynamic Assessment, the social/communication observation coding,

and the SRS-2 questionnaire are included in Appendix B.

A total of four triads (parent-child-teacher) participated in this study. Table 3-1

includes a summary of child and parent participants. All parents were married. Of the

child participants, one had previously been diagnosed with ASD by a neurologist. A

55
second child had previously been diagnosed with ADHD. As a result of the

neuropsychological evaluation sought out through the university psychology clinic, all

four children were diagnosed with ASD. Four female teachers also participated in the

study. All participants were Caucasian/Non-Hispanic.

Table 3-1. Child and parent participants

Child’s Child’s Previous Participating Parent(s) occupations
name age diagnoses parent(s)
Calvin 8 ADHD Father Homemaker
William 7 None Mother Administrative
Assistant
David 11 ASD Mother Homemaker
Eric 8 None Mother and Father Real Estate Agent;
Insurance Company
Branch Manager

Selective Sampling
In grounded theory, the development of the research changes the sampling

approach. Specifically, when using selective sampling, the research uses the

information provided by early participants to help guide the selection of future

participants. To obtain an accurate and thorough depiction of parents’ and teachers’

perspectives about the information gained from the Dynamic Assessment, as well as

opinions about behaviors that facilitation successful social functioning, selective

sampling was used. Selective sampling is based on practical necessity, based on time,

location, events, and people. The power in selective sampling lies in the selection of

information-rich cases, such as those from which the researcher can learn a great deal

about issues of particular importance to the study. The primary difference between

selective and purposeful sampling is that in selective sampling, the researcher is able to

determine, after data collection has begun, whether certain categories emerge that

would prove to be more informative to the research question, which can influence future

56
selection of participants (Coyne, 1997). The process of data collection must evolve over

time, based on concurrent analysis as data collection takes place. For the purposes of

this study, information-rich participants included individuals who were able to provide

discussions of the child’s social functioning based on observation of the child in peer

settings, and participants’ analysis and reflection regarding the child’s social functioning.

Data Collection

Interviews were the primary source of data collection for this study. The use of

semi-structured interviews is a widely used method of data collection. It was expected

that the use of semi-structured interviews would allow open conversation, by framing

questions in a way that was sufficiently general to cover a wide range of experiences

and was narrow enough to elicit and explore specific experiences of participants

(Charmaz & Belgrave, 2003). In particular, a problem-centered semi-structured

interview allows the use of more specific probing to answer questions about the problem

at hand. When using a problem-centered interview, an interview guide can be used to

support the narrative provided by the participant, but allows for redirection in an

interview if the conversation becomes unproductive. During a semi-structured interview,

it is important to include conversational entry or rapport building strategies at the

beginning of the interview, slowly leading to more specific prompts and questions (Flick,

2009). In a semi-structured interview, the interview begins at the same starting point,

because it assumes a common set of discussable topics (Roulston, 2010). After asking

broad questions, more specific probing occurred regarding the parent or teachers’

perspectives about the results of the Dynamic Assessment. More direct questions were

used to address what behaviors were included or omitted in the Dynamic Assessment

that are important for a child’s successful social functioning. Specific probing was used

57
to deepen the researcher’s understanding through summarizing, feedback, and

questions of comprehension to allow participants to better clarify answers. Interviews

were recorded and transcribed by the primary investigator so that the context of

responses can be taken into account when conducting analysis.

During a good interview, a researcher uses strategies that generate story-telling,

as well as strategies aimed at generating understanding. The former includes the use of

a pre-formulated introductory question, general exploration that allows for the drawing

out of additional details, and ad-hoc questions to be asked if an interviewee leaves out

topics relevant to the research question (Witzel, 2000). Strategies intended to generate

understanding include specific explorations by the interviewer based on previous

knowledge gained through prior research or information brought up earlier in the

interview, and clarifying questions for cases in which an interviewee gives evasive or

contradictory responses (Witzel, 2000). By using these interviewing skills, the dialogue

between the interviewer and the interviewees provided rich sources of data for

understanding parents’ and teachers’ perspectives on the results of the Dynamic

Assessment, as well as behaviors that they believe to be important for successful social

functioning.

Semi-Structured Interview

Semi-structured pre- and post-assessment interviews were conducted with five

parents and four teachers. Although there is no methodological rule in grounded theory

regarding a required number of participants, Pollio, Henley, and Thompson (1997)

recommend three to five interviews to provide adequate situational diversity for

identifying thematic patterns. Interviews were conducted individually with each

participant, except for Eric’s parents, who were interviewed together, and ranged from

58
approximately 30 to 75 minutes in duration. Interviews occurred before the assessment

was administered, to get an initial impression of the child’s social functioning from the

perspective of parents and teachers, as well as after the assessment was given, to

discuss the results of the assessment in relation to the child’s social functioning.

Interviews with teachers took place in the teachers’ classrooms. Most of the interviews

with parents took place at a medical building in an examining room made available by

the university’s psychology clinic, although one parent interview was conducted by

phone, due to transportation challenges. All interviews were audio recorded and

transcribed to ensure accuracy of the information provided and the context in which the

information was shared. The beginning of each interview involved establishing rapport

with the interviewee, and learning general information about the child. The first interview

involved questions designed to elicit the interviewee’s opinions about the child’s social

functioning, including what behaviors are most important for this child to be successful

in social interaction. During the second interview, the interviewer re-established rapport,

and then transitioned into discussing the results of the Dynamic Assessment, and then

the other measures included in the social functioning assessment, including the social

communication observation and SRS-2. Interview questions began with general

questions about what the parent or teacher hoped to learn through the process of this

evaluation and their opinion about the results. Questions became more specifically

targeted about specific behaviors that were or were not captured on the Dynamic

Assessment, and what behaviors the interviewees believe to be important for successful

social functioning for the child that was assessed (please see Appendix A). To ensure

content validity to the information obtained through interviews, the primary investigator

59
offered to email the transcriptions of the interviews to interviewees, so that interviewees

could confirm the accuracy of the content of the interviews (See Appendix A).

Field Notes

Field notes provide written records of observational data gathered during

fieldwork, and consist of descriptions of social interactions, and the context in which

they occurred (Montgomery & Bailey, 2007). Field notes should be rich in detail, offer

sufficient chronology, and include limited editorial content (Martin & Turner, 1986).

Immediately following each interview, the researcher wrote field notes, reflecting on the

dialogue that occurred between the research and participants. Information in field notes

was used to supplement interview transcripts to enhance the meaning and context of

the interview. Field notes were also recorded during the process of the assessment, to

provide additional qualitative information and context during the assessment. Field

notes can also provide additional information that will be helpful during data analysis

and the generation of theory.

Data Analysis

In grounded theory, there are three main stages of data analysis: open coding,

axial coding, and selective coding (Leech & Onwuegbuzie, 2007). Throughout these

stages, the researcher continually uses constant comparison to inform sampling and

theory development (Roulton, 2010). In open coding, data was broken down analytically

and compared with other data from the same set to look for similarities and differences.

Additionally, at this stage, pieces of data were coded—that is, pieces of data were given

conceptual labels that could be combined to form categories or subcategories (Corbin &

Strauss, 1990). During the second phase, axial coding, categories were related to

subcategories and relationships were tested against the data. At this stage all

60
hypothetical relationships were proposed deductively, and must be considered

provisional until verified with additional data. If theories did not hold up with incoming

data, they were discarded (Corbin & Strauss, 1990). Finally, during selective coding, all

categories were unified around a core category, and remaining categories were filled in

with descriptive detail. The core category may emerge from the already identified

categories, or it may emerge as a more abstract term that is needed to explain the

phenomenon. Diagramming was used to assist in the development and communication

of categories (Corbin & Strauss, 1990). As a final result of data collection and analysis,

the researcher developed a theory regarding parents’ and teachers’ perceptions about

relevant behaviors for social interaction, and how well the results of the Dynamic

Assessment represent the child’s social functioning.

Trustworthiness, Validity, and Objectivity

Trustworthiness

There were several steps involved to ensure procedural reliability in this study.

First, interviews were recorded and transcribed by the research, to ensure that

transcriptions are accurate. Additionally, field notes were analyzed to describe how the

researcher analyzed and categorized data, as well as how data was categorized. By

describing these methods, future researchers can replicate the study if desired.

Additionally, the use of semi-structured interviews and ongoing data analysis allowed for

continual assessment of reliability. The use of an interview guide allowed for

comparisons between data sets (Flick, 2009). Finally, constant comparative analysis

permitted consistent themes and categories to emerge from data, within individual

interviews as well as across participants.

61
Validity

Multiple strategies were employed to ensure the validity of this research. First,

descriptive validity, which involves ensuring accurate and complete recording of

interview data (Flick, 2009), was achieved through the use of tape recording and

transcription, thus ensuring that data was not condensed or misinterpreted. The use of

field notes also allowed the researcher to describe the setting and context of each

interview, as well as capturing observations that cannot be conveyed through the

recording or transcription. Additionally, the use of open-ended questions during semi-

structured interviews allowed for participants to elaborate on their own answers,

increasing the likelihood that participants would provide complete and accurate

perspectives regarding the research questions.

Researcher Reflexivity

Within the field of qualitative research, scholars have emphasized the importance

of evaluating one’s assumptions and values to examine their effect on the research

process (Burck, 2005). For the purposes of this study, the researcher will kept a

reflective journal of thoughts, feelings, opinions, and assumptions throughout the

duration of this study. However, regardless of attempts to remain objective, subjectivity

will be present and must be addressed.

As the primary researcher in the current study, it is important to expose my

experiences, biases, and assumptions. I am a middle-class, Caucasian woman,

currently enrolled in a doctoral program in Florida. As a young child, I felt passionate

about helping individuals with medical conditions or disabilities. In particular, having had

multiple family members with ASD diagnoses, I have been interested in learning more

about related disorders. After attending college, majoring in psychology, and obtaining a

62
master’s degree in social foundations of education, I chose to spend a year teaching

elementary school, to gather field experience prior to entering a doctoral program. My

first teaching assignment was in a self-contained classroom of children with ASD. My

experience with this population helped me to have a deeper understanding of the

variability of children within this diagnostic category, as well as provided me with

increased motivation to specialize in working with children with ASD. These decisions

influenced my decision to pursue a doctoral degree in school psychology, to gain

expertise in assessment, intervention planning, and consultation with other

professionals to best serve children with ASD, and their families. During my experiences

in the school psychology program, I have gained practicum experiences in school and

clinical settings, providing assessment, intervention, and consultation services to assist

children with ASD, as well as their families and teachers. In my third year of my doctoral

program, I was part of a research team to discover the best practices for the

assessment of social skills for children with ASD. During this research, I found that there

has been great variability in the methods and target behaviors or constructs in social

skills assessment. I became concerned about this lack of consistency, because it

appears to represent fragmented processes of assessing social functioning, which is at

the core of an ASD diagnosis and should be a core target of intervention. This

experience led me to develop an interest in the challenges affiliated with social skills

assessment, and influenced my desire to further research potential assessment

strategies, ultimately leading to the topic of the proposed study.

63
 CHAPTER 4
RESULTS

The Theory

Through their experiences and perceptions, teachers and parents shared their

reactions to the results of the social communication assessment, including the Dynamic

Assessment. Additionally, participants offered insight into their beliefs about social

communication behaviors, and the skills necessary for successful social interaction. The

current study asks the participants about their experiences with the child and the

evaluation process, as well as their thoughts about social behaviors and contexts.

Participants discussed the process of seeking and obtaining the evaluation, what they

hoped to learn from the results, their perception of the child’s current social functioning,

and their beliefs about social skills. Although it was not an intended focus of the study,

participants also frequently discussed their ideas about what is important for the child’s

behavior and functioning in other areas (e.g., academic functioning, the child’s problem

behaviors, and possible symptoms of other mental health challenges, like anxiety or

inattention). Comments related to these concepts offer some insight into their beliefs

about important aspects of childhood more broadly.

The primary goals of the study were to determine participants’ perceptions

regarding the social communication evaluation, with a specific focus on the Dynamic

Assessment, and to obtain insight into what behaviors parents and teachers deemed

important for successful social functioning. Participants’ reactions to results were

influenced by two factors: (1) their own experiences and beliefs in regard to both

important aspects of childhood and interactions with the specific participant child, and

(2) the evaluation process, which was informed by the characteristics of the child as well

64
as information about the child provided by parents and teachers. Given that the goals of

evaluation are to provide information which provides greater understanding of the child

and his functioning, it is believed that the participants’ reactions to results would then

shape how the parent and teacher interact with, perceive, and support the child.

Model

Reaction to Results

Participant Experiences and

Beliefs
Evaluation
•Relationships and Interactions
with Child
•Beliefs about childhood

Intra-Individual Child
Characteristics

Figure 4-1. The grounded theory

Through information obtained in interviews with parents and teachers, many themes

that are represented in this model emerged, which allowed the researcher to analyze

perceptions and beliefs about the child, important aspects of childhood, the evaluation

process, and the results.

65
Table 4-1. List of themes which emerged from interview data
Theme Description
Participant experiences and beliefs
Interactions with  Frequent challenges
peers  Variability
 Child frustration
 Range of peer reactions to
the child
 Lack of OR misidentifying
friendships
 Limited opportunities
Relationships  Positive relationships with
with teacher child and with parents
 Frequent interactions
 Teachers facilitate
interaction
 Concern about future
teachers
Family  Important relationships for
child
 Family facilitates
interaction
 Influence of sibling
interaction
Experience with  Comparison to peers
child participant  Parents’ feelings and
perceptions
 Teacher feelings about
behavior
66
Supporting quotations
“He does get a little frustrated
[with other students] because he
doesn’t understand why they’re
not behaving the way they’re
supposed to be”
“I feel like he stays on the fringes
of it, so I would like him to be able
to be more of a participant in
things and feel more comfortable”
“He comes up to me, he tells me
everything, and I don’t think he’s
trying to impress me. I think he’s
just so excited about it”
“He’s a great guy. He really is a
great kid”
“He’s really connected to his
family, but I don’t sense...that
same connectivity to peers”
“[I] had to kind of like, make the
[peer interaction] for him.”
“Usually you think by [this age],
they’ve—even in a child with
autism—you know…they usually
have like, they know some of the
[social cues]”
“My first two kids I raised…it was
nothing like this”
“[There was] sort of the sense
that, you know, the kids saw him
as an oddball in some way
because he was getting out of his
chair and making noises,
and...that’s hard to watch”
“I think maybe [he’s] just
insecure...maybe he’s been
rejected, I feel, maybe in the past”
Table 4-1. Continued.
Theme Description
Academics  Spontaneously and
frequently discussed
 Parents varied in degree of
concern
 Current academic supports
(official and unofficial)
 Appropriateness of fit in
current class
Bullying  Concern about child being
bullied
 Child’s experience of
bullying
 Participant perceptions
about bullying
Future  Hope regarding the
evaluation/diagnosis
 Desire for
recommendations
 Hope for child’s improved
functioning
 Concerns about the future
Necessary  Ability to talk about social
social behaviors topics (e.g., feelings,
and context relationships, problems)
 Initiating interaction
 Reading social scenes
 Child’s areas of strengths
(responding to initiations
and expressing affection)
67
Supporting quotations
“He's such a smart boy … [it]
breaks my heart to see him sort of
like struggling in academics
where I know he's smart enough
to do it but he just I think I think he
can't maintain his own focus”
“[He was bullied] just because
he’s not on the same level with
the rest of the kids...the whole
social thing. He was withdrawn,
not talking to them, and they just,
I guess, they saw a weak link”
“There’s always some kids within
any class that, you know, want to
pick on other kids, and I think [my
child] could be a target”
“I kind of feel like if I knew what
he needed, I would be able to
help him”
“I’m looking for ways that I can
help him adjust socially...like
some recommendations”
“I think what he really needs is
some strategies that he can use
to sustain or even initiate
[conversations]”
“He clearly needs to learn some
of these nuances, whether it’s
through role playing or
observations”
Table 4-1. Continued.
Theme Description Supporting quotations
Intra-individual child characteristics
Non-ASD traits  Areas of difficulty “He does a lot of anxiety, worrying
o Anxiety about what’s going to happen,
o Inattention how it’s going to pan out, what are
o Memory we going to do today”
o Motor “It sort of breaks my heart to see
 Personality traits him…struggling in academics
where I know he’s smart enough
to do it but he just can’t maintain
his own focus”
“He’s very loving…it doesn’t seem
to me like there’s a malicious
bone in his body”
Restricted  Impact on social “If there were kids here, I think he
interests, communication would probably be thinking and
repetitive  Specific, intense interests talking about the fire alarms and
behaviors, and  Repetitive the elevators as opposed to, you
rigidity movements/sounds know, seeking interaction [about
 Difficulty with change in shared interests]”
routine “He’s very much a regimented
rule follower, almost to the point
of it being an issue…he can’t
bend”
Variability of  Progress over time “He was somewhat rebellious at
behavior  Day-to-day changes the beginning”
 Content of interaction “There are days when you would
 Interactions with specific think there’s nothing wrong with
individuals this child...other days it’s more
obvious that there is something
up here”
“[He is] best with adults,
especially ones that he knows. He
does not seem to communicate
well with other kids”
Social  Developing and “He doesn’t know how to insert
communication maintaining friendships himself into a situation”
challenges  Nonverbal communication “He struggles understanding the
 Understanding interactions meanings of stuff”
and social norms “I think if he was more aware,
 Perspective taking he’d probably be disappointed”
 Impact on child

68
Table 4-1. Continued.
Theme Description Supporting quotations
Evaluation
Evaluation  Concerns leading to “I kind of feel lost in this situation
referral because I don’t know. In
 Complex process everything else, I’ve been able to
 Outcome of assessment help him or talk to the doctor and
figure out what to do to help him”
“I guess...getting a label on him to
help us get the assistance he
needs...whatever kind of you
know piece of paper whatever it is
we can provide somebody that
says ‘No, there’s really something
different about him’”
Reaction to results
Reaction to  Accuracy “I found this really helpful because
results  Helpfulness you were able to observe him so
 Participant feelings from an outsider...I feel like you
 Questions/concerns were able to capture it really well
 Preferences but very objectively by observing
him”
“I felt um very naive about it until I
looked at the results you know
and saw the results from recess
and you know maybe he is
missing more social skills than I'm
picking up on”
“My thoughts on the school
observation was it wasn’t long
enough...I mean, what can you
really tell in the length of time you
observed him one day?”

Part I: Participant Experiences and Beliefs

The participants started the research study with pre-existing experiences,

knowledge, and thoughts about the specific child, but also with beliefs about what is

relevant and important during childhood. For example, participants often referenced

academics, although none of the interview questions specifically asked about school or

academic performance. Their interaction and experiences with the child and their beliefs

69
about childhood in general both provided a framework that influenced the evaluation

process, and the participant reactions to the results. Several themes emerged in both of

these areas.

Interaction and Relationships with the Child

Interactions with peers

Participants described the child’s interaction with peers in a variety of settings. All

children were reported to have variability in peer interactions (e.g., sometimes the child

engaged with peers willingly, sometimes the child kept to himself). Interactions were

also described as sometimes frustrating or puzzling for the child. For example, the child

would get frustrated by peers’ behaviors (e.g., games that didn’t make sense to the

child, like freeze tag, or peers not following rules). William’s teacher described, “He

does get a little frustrated...when other students are not on their best behavior [be]cause

he doesn’t understand why they’re not behaving the way they’re supposed to be”

Participants also described how peers reacted to the child. Parents described

how siblings or family friends reacted to the child, but this topic was brought up more

frequently by teachers. Calvin’s teacher reported that some classmates picked on him

due to differences. She noted, “There are some times that, because of being different,

that there are a couple kids that will be like, you know, they’re always trying to tell on

him to get him in trouble.” In some cases, the child had experienced bullying. David’s

mother reported, “[He was bullied] just because he’s not on the same level with the rest

of the kids...the whole social thing. He was withdrawn, not talking to them, and they just,

I guess, they saw a weak link.” However, in many cases, teachers described

classmates as relatively tolerant of the child’s behaviors. Some teachers noted that

70
classmates seemed to understand that the child functioned differently. Teachers also

noted that certain classmates were very patient and sometimes protective with the child.

Friendship was also a salient topic for participants. The children involved in the

study were generally described as not having many friends (if any, at all). Participants

reported that children often identified peers as friends who really were not friends.

David’s teacher expressed serious concerns about a child’s desire to befriend a peer

who appeared to be mocking the child behind the child’s back. In other cases,

participants reported that the child described acquaintances as friends. Many

participants noted that the child had limited interaction with peers outside of school

(e.g., limited access to peers in the community, limited participation in extracurricular

activities, few playdates established by parents). Participants also indicated that the

children had limited interest in participating in group activities across contexts of home

and school. However, participants frequently described children as being in close

proximity to peer interactions. Eric’s father observed, “I feel like he stays on the fringes

of it, so I would like him to be able to be more of a participant in things and feel more

comfortable.”

Relationships with teacher

During interviews, participants, both parents and teachers, frequently referenced

the relationship between the teacher and child, with some discussion of the relationship

between the parent(s) and teacher. The relationship between the child and the teacher

was generally described as very positive. Teachers reported having an affinity for the

child. William’s teacher stated, “He’s a great guy. He really is a great kid”. Parents and

teachers referenced the child’s positive regard for teachers. David’s teacher noted, “It

appeared to me that he just loved me to death.”

71
 The children were described as having more frequent interaction with teachers

than with peers. Several teachers noted that the child often initiated conversations with

them about topics of interest or recent events in the child’s life. Teachers also described

that the quality of interaction with the child was better between teacher and child than

between peer and child. Teachers often noted positive regard for the child, and

described that they may be more patient and gentle in their interactions with him.

David’s teacher stated, “He comes up to me, he tells me everything, and I don’t think

he’s trying to impress me. I think he’s just so excited about it.”

Most of the parents also reportedly had positive relationships with teachers,

although one parent reported concerns that the child’s current teacher was not doing

enough to provide social interaction support for her child. Participants discussed

frequent communication between parents and teachers, including conferences and

written communication. Calvin’s teacher noted that she and Calvin’s father frequently

kept in touch to discuss Calvin’s academic progress, due to his challenges in reading.

William’s mother reported that she and William’s teacher communicated to discuss

strategies to help William with difficulties regarding transitions and changes in routines.

Eric’s family had a particularly close relationship with the child’s teacher, to the degree

that the teacher was invited to a major religious ceremony that the family held (this was

the teacher of the child who was placed at a small, Christian school). Most participants

noted the current positive relationship between parents and teacher, and expressed

concern that the child’s teacher(s) in subsequent years would be less supportive of the

child. William’s mother stated, “He’s not guaranteed [this teacher] every year, so where

does that put him next year? With a teacher that may be a good teacher but my not cue

72
into his [needs]”? Teachers were also noted to sometimes facilitate or support social

interactions for the child, such as helping to solve social problems, structuring social

experiences, protecting the child from bullying, assigning the child to specific partners or

groups, and asking peers to be understanding regarding the child’s differences.

Family

Family was discussed as providing significant social relationships, as well as

impacting interaction with non-family members. Children were described as being

particularly close to their parents. Eric’s teacher noted that he is “crazy about his

daddy.” Participants reported that parents provide comfort (e.g., reassurance and

comfort) and guidance (e.g., giving advice, answering questions). Parents also helped

children to face problems, such as difficulty with change or social interactions.

Participants noted that children often stayed in close proximity to their parents.

Participants also discussed the children’s closeness with siblings and some

extended family members. Siblings offered much of the child’s “peer” interaction, and

were sometimes described as the child’s “friend”. With the exception of David’s mother

and teacher, the participants generally did not describe the child as having specific

friends in other social settings. It was noted that family members were more tolerant of

the child’s differences, although siblings sometimes became frustrated with the child’s

behaviors. Participants also discussed ways that the child learned through interactions

with siblings (e.g., learning how to play by playing with brothers, etc.). David’s teacher

observed, “He’s really connected to his family, but I don’t sense...that same connectivity

to peers”

Both parents and teachers noted that parents frequently facilitated social

interactions for children. Teachers gave examples of known or suspected situations in

73
which parents created or supported social interactions for their child. Parents encourage

the child to join group activities, set up playdates, and provide structure during

interaction. These social interactions were described as having limited success (e.g.,

the child would engage with peers inconsistently, peers did not come back for

subsequent play dates). David’s mother noted, “[I] had to kind of like make the situation

for him, I guess.” Participants also discussed ways that the family may have negatively

impacted social interaction. For example, two families had relocated, and parents

wondered if that affected the child’s ability to make friends. Additionally, participants

speculated about whether having built in “friends” in siblings would reduce the child’s

interest in seeking out other peers to befriend. Of note, only one child was said to have

any particularly close friends at school. This child’s mother described one peer as a

friend, although the teacher expressed significant concerns that this peer actually

teased the child. The teacher, in contrast, stated that a different peer was more of a

friend to the child, evidenced by the fact that she often invited the child to play or join

activities.

Idealizing Childhood

Comparing the child to expectations of typical children

Participants made many statements about their perspective of the child, including

their feeling about any possible diagnosis. One major influence for many participants

appears to be their comparison of this child to other children. Participants noted that this

child differed from peers in a variety of domains, including academics, intelligence,

interests, and relationships with others. Participants sometimes also described the

child’s development by comparing it to the development of siblings or other students.

David’s teacher noted, “Usually you think by 5th grade, they’ve...they--even in a child

74
with autism--you know, by 5th grade they usually have like, they know some of the

[social cues]”. Calvin’s father stated, “My first two kids I raised...it was nothing like this.”

Participants’ perspectives of the child were sometimes influenced by previous

experiences with other children with autism. David’s teacher reflected on the experience

of teaching children with ASD: “It’s hard. I’ve had children with autism before, and it’s

hard for them.” All participants believed that the child involved in the study was very

intelligent, although sometimes this intelligence appeared to be specific to specific areas

or topics. William’s teacher noted, “He’s very bright, he’s a very smart boy...he’s very

inquisitive, you know? He’s always curious about things...he’s a very logical thinker. He

kind of thinks outside of the box, and sometimes he even like, brings up points to me.”

Parents had a wide range of feelings about their child’s behavior. This ranges

from being satisfied with the child’s behavior in certain settings (such as at home), to

having significant concern and sadness about the child’s behavior. Eric’s father

reflected, “[There was] sort of the sense that, you know, the kids saw him as an oddball

in some way because he was getting out of his chair and making noises, and...that’s

hard to watch.” Related to the theme of variability of behavior, parents also noted that

their child’s behavior changes across settings. Parents sometimes reported

expectations of more typical behaviors and desires for future behavior. Additionally,

parents described their beliefs about the causes of behavior.

Teachers also discussed their feelings about the child’s behavior. Some teachers

felt like the child made excuses for certain behaviors, and that some of the child’s

behaviors are not to be tolerated. Teachers discussed how the child’s behavior differed

from the behavioral expectations for the class. Teachers had some concerns about the

75
child’s behavior, and expressed some sadness about it due to concerns that the child

may be struggling. Teachers also had their own hypotheses about causes of behavior.

Eric’s teacher stated, “I think maybe [he’s] just insecure...maybe he’s been rejected, I

feel, maybe in the past.”

Academics

Although academic functioning was not a specific area of focus during interviews,

both parents and teachers brought up issues surrounding school. Academic

performance was frequently discussed. Parents expressed greater concern about

academic progress. One child (Calvin) had significant difficulties and was facing a real

possibility of being retained. The other children were making adequate academic

progress, but with varying success in certain subjects. Eric’s father observed, “He's

such a smart boy … [it] breaks my heart to see him sort of like struggling in academics

where I know he's smart enough to do it but he just I think I think he can't maintain his

own focus”

All children are receiving some types of academic supports or accommodations.

These range from official 504 plans and Response-to-Intervention program involvement

to teachers offering additional “unofficial” supports (such as warnings of upcoming

changes, tolerance of certain behaviors, etc.). Class-wide norms and behaviors also

were discussed. Teachers discussed the ways that they managed behaviors for the

class and ways that they fostered positive social relationships among their students. In

most cases, teachers described class members as being positive and supportive of the

child participant. Teachers noted that class members were close to one another, and

tolerant of individual differences. Eric’s teacher reported, “I think this group has been

very accepting of him and his differences and nobody's ever said why are you letting

76
[him] do that and we can't or anything like that … they've just accepted that they knew

from the get go.”

Teachers also talked about classroom routines, including how the child

participant responded to classroom routines, and changes in routines. Parents

discussed their perceptions about the appropriateness of the child’s

placement/classroom, their feelings about the current teacher (which were mostly

positive), and their concerns about school environments in the future. Parents also

referenced the fact that they don’t often get to see the child’s behavior at school, and

compared current school experiences to previous school experiences.

Bullying

Participants generally expressed more concern about the child being a victim (or

potential victim) of bullying; minimal concerns were expressed about the child bullying

others. Participants also discussed their perceptions about bullying, such as their own

experiences with bullying in childhood, prevalence of bullying, and what types of

children are more likely to bully than others. Some participants seemed particularly

aware and worried about the likelihood about bullying. In particular, Calvin and Eric’s

fathers referenced the idea that bullying happens in childhood, and that they were highly

aware of the potential for their child to be a victim. Eric’s father expressed significant

concern about the possibility of Eric being bullied, stating, “If he has been bullied, he

can’t express it to me, [be]cause it’s a fear of mine and I sort of ask him about, you

know, is anyone...teasing you at school? Or I like to ask a lot of questions and he has

never expressed that that has occurred.” Calvin’s father noted, “There’s always some

kids within any class that, you know, want to pick on other kids, and I think he could be

a target, because he...to some extent, lacks the self-awareness.”

77
Future

Participants discussed the future with both hope and concern. Participants often

indicated that they believed that the evaluation would help provide direction for how to

proceed in a way to best help the child. For example, they noted that the evaluation

could help with decisions about school placement and relevant services. Participants

specifically discussed the importance of recommendations that would come as a result

of the evaluation. David’s mother stated her difficulties determining how to best help her

son. She observed, “I don’t know...I kind of feel like if I knew what he needed, I would

be able to help him.”

Participants discussed hopes for the child, including how the child may improve

in social awareness and interaction. Eric’s dad commented that his hope is that Eric

“learns a little bit more how to understand…the way that people see him…you know,

that he’s a little bit more self-aware…to be a little bit more social. I don’t want him to be

completely outwardly focused and different, but just a little bit more to help him

function.” However, participants expressed concerns about the future, as well.

Participants reported fears about difficulty with future educational placements (e.g.,

incompatible teachers, large school/class settings, etc.) and access to specific services.

Another area of concern related to social interaction difficulties. Specifically, participants

worried about increasingly critical peers and the potential for bullying.

Necessary social behaviors

Data regarding this theme was elicited through both responses to more general

questions, and responses to a question specifically written to ask participants what

behaviors are important for successful social interaction, and what the child’s strengths

and weaknesses are. The theme encompasses all the different ways that participants

78
suggested behaviors that contribute to successful social communication. Additionally,

although questions were not designed to elicit information about the variability of social

communication behaviors relative to context, participants sometimes spontaneously

discussed how context influences social interaction. For example, some participants

indicated that they think certain behaviors might be appropriate in the home setting, or

with family members, but that the behavior is not socially acceptable at school or in

settings with other peers.

In general, participants discussed the importance of communication across

audiences and topics. Specifically, participants noted that it is necessary to be able to

discuss feelings, solve social problems, and be more assertive. Participants stated that

it is important for children to be able to initiate with others and maintain interactions and

conversations. David’s teacher observed, “I think what he really needs is some

strategies that he can use to sustain or even initiate [conversations]”

Participants also noted that the children needed to improve in regard to social

awareness and understanding of the nuances of social interaction, such as reading

nonverbal cues and understanding context. Nonverbal communication elements that

participants discussed included eye contact, intonation, and facial expressions.

Participants discussed ways that children might learn about social communication,

including more practice in interaction, role play, and observations. Eric’s father

suggested, “He clearly needs to learn some of these nuances, whether it’s through role

playing or observations”

Participants did discuss some areas in which the children had stronger social

communication skills. In general, children were described as doing well with responding

79
to peers’ social initiations (e.g., being willing to join an activity when invited). Eric’s

teacher reported “If you invite him into the group, he’ll participate” Children were noted

to have greater success initiating interactions with adults. Several teachers noted that

the child appeared to prefer interacting with them (the teacher) as opposed to other

children. Children were also described as having a desire to get along with others,

including adults and peers. David’s mom stated that he is “very caring” and that he

“expresses love really well.”

Part II: Intra-individual Child Characteristics

Non-ASD Traits

Participants sometimes referenced attributes or traits of a child that are not

attributable to the profile of Autism Spectrum Disorder. The participants discussed some

of the areas of difficulty that the child experiences, including anxiety,

inattention/hyperactivity, difficulty with memory, and difficulty with fine motor skills. One

participant also referenced that fact that he felt his child had difficulty with “listening”.

Two of the children also seemed to have frequent somatic complaints or physical

injuries.

Participants also discussed the child’s personality characteristics. Children were

described as having many positive attributes, and some less positive attributes.

Participants noted that the children were generally loving and funny. They also noted

that some of the children were very logical and curious. Children were sometimes

described as being sensitive and affectionate. Some of the less positive attributes that

were sometimes noted were stubbornness, naiveté, and passivity. Of note, these

attributes might be related to ASD diagnoses, but participants did not seem to connect

these traits to the diagnosis. One theme that many participants referenced was the

80
uniqueness of the child in the study. This was often referenced in a positive way (e.g.,

participants described the child as being “special”, but different compared to peers).

Restricted Interests, Repetitive Behaviors, and Rigidity

Restricted interests and repetitive behaviors were described as significantly

impacting the child’s functioning in a variety of domains, including social

communication. Participants noted that the child did have some overlapping interests

with peers (e.g., Legos, cars). However, several of the children were noted to have very

specific interests, including electricity, weather, birds, and fire alarms. Participants

described the child’s attempts to communicate with others about restricted interests,

noting that these interactions were not very successful and that the child often became

frustrated by the conversations (e.g., others were not interested, or did not have

knowledge about the subject). Eric’s father noted, “If there were kids here, I think he

would probably be thinking and talking about the fire alarms and the elevators as

opposed to, you know, seeking interaction [about shared interests].” Some of the

children were noted as having repetitive behaviors, including hand flapping or walking in

circles. Participants also described repetitive language or repetitive noises that the child

would make, which irritated others around him.

Children were often described as having significant difficulty with changes in

routine. Participants noted that children expressed significant anxiety when they knew

about impending changes to routine, and that changes often led to meltdowns. William’s

mother stated, “If things get changed on him, like a routine gets changed, he starts to

meltdown...he has a very difficult time putting [his feelings] into words.” The children

were also described as being very concerned with honesty and following rules.

Participants reported that children experience distress when others make statements

81
that are untrue or break rules. Finally, participants noted that some of the children

experienced sensory sensitivities, particularly in regard to loud noises.

Variability of Behavior

Participants described the child’s behavior as highly variable, across time and

contexts. Teachers often described the change in the child’s behavior over the duration

of the school year (e.g., a child’s behavior had improved or declined since the beginning

of the year). Parents also discussed progress in behavior over time. Additionally,

participants reported that the child’s behavior varies greatly from day-to-day. Eric’s

teacher noted, “There are days when you would think there’s nothing wrong with this

child--or, I don’t say wrong...I don’t like that word; I don’t even like the word

normal...different...other days it’s more obvious that there is something up here”

Participants also described the child’s social communication abilities as varying

greatly by context. Children were described as more socially successful during

structured interactions around academics or topics of specific interests. Participants

also noted that children were more or less successful when interacting with different

people (e.g., more comfortable with familiar peers, family members, etc.). William’s

mother noted that William is “best with adults, especially ones that he knows. He does

not seem to communicate well with other kids, at least with initiating it...he may respond,

but he doesn’t tend to initiate” Participants also described children’s behavior during

free time, including interest in typical activities or restricted and unexpected interests.

William’s teacher stated, “He’ll play with other kids, but then he gets bored with them

and then he ends up just going off by himself and like, picking up rocks. He’s very

scientific.”

82
Social Communication Challenges

Participants described social communication challenges in a variety of different

contexts, including offering responses when asked specific questions about the child’s

strengths and weaknesses, and commenting about general social skills necessary for

successful interactions. Frequently mentioned areas of difficulties included getting along

with peers (developing and maintaining friendships), nonverbal communication (such as

personal space, eye contact, reading body language, etc.), and understanding

interactions and social norms (naiveté, understanding contexts).

Participants often reported that children had significant difficulty initiating

interactions with peers, although they stated children were generally more responsive to

peer initiations. One participant noted, “If you invite him into the group, he’ll participate”,

but reported that the child rarely initiated. The children involved in the study were

reported to have difficulty with nonverbal communication behaviors, such as eye

contact, personal space, and reading body language. Participants also noted that

children sometimes exhibited socially unexpected behaviors that impacted their

interactions with peers, such as having food on their face or clothing, interrupting others,

screaming, or making various noises. Additionally, the children were described as

having difficulty understanding others’ perspectives. For example, one teacher

discussed how her student had difficulties understanding the rules of certain playground

games which seemed pointless to him.

Participants discussed some potential factors that influenced the child’s social

communication difficulty. They hypothesized that children experienced anxiety, became

overstimulated, or had difficulty recovering from social errors, which contributed to

difficulties initiating and maintaining social interactions with peers. Challenging social

83
communication was also noted to cause outbursts or distress for the child. Social

communication difficulties were perceived as causing the child to become more

isolated. Participants believe that this isolation was sometimes appreciated by the child,

but that at other times the child seemed to desire more social interactions. Participants

reported that the child seemed to have limited awareness of their own social

communication difficulties, but some participants noted that this may potentially serve

as a protective factor. For example, David’s mother noted, “I think if he was more

aware, he’d probably be disappointed”. Children did not communicate awareness of

difficulties verbally, but participants did note some nonverbal behaviors that may

indicate awareness of lack of social relationships (e.g., crying when isolated from

peers).

Part III: Evaluation

Participants’ reactions to results were largely influence by factors related to the

evaluation. This includes the actual evaluation process, as well as previously held

experiences with the child and beliefs about childhood. The evaluation was influenced

by multiple factors, including referral questions and established assessment

procedures. Additionally, participants’ perceptions of the child’s functioning influenced

the evaluation process (i.e., children were identified as likely to benefit from social skills

and ASD assessment based on reports of parents and teachers).

One of the major influences on the way participants reacted to results was the

experience with the evaluation process, including how the child wound up being referred

and the benefits that they believed would arise from the evaluation process. Participants

described concerns they had about the child, including difficulty understanding the

child’s behavior or social interaction challenges. These concerns, as well as guidance

84
from school or medical professionals, influenced the parents’ decision to seek out the

current evaluation. Some children were also waiting to receive an evaluation through

their school. One child had already received multiple evaluations, with incomplete

diagnoses and recommendations for further assessment. The process of seeking the

evaluation was described as complex and sometimes confusing. As David’s parent

stated, “I kind of feel lost in this situation because I don’t know. In everything else, I’ve

been able to help him or talk to the doctor and figure out what to do to help him.”

Participants also discussed the benefits of the current evaluation (through the

university psychology clinic). Participants noted that thoroughness of the evaluation,

and the perception that this assessment will help them to better understand the child.

This evaluation was discussed as an important tool in the process of accessing help,

such as providing a child (and family) with accommodations, services, and more

understanding from educational professionals regarding a child’s social and behavioral

difficulties. Eric’s parent noted,

I guess...getting a label on him to help us get the assistance he needs in

particular in school with the flexibility, ‘cause he’s run into teachers who
want him to fit in the box and without that label or whatever kind of you
know piece of paper whatever it is we can provide somebody that says
‘No, there’s really something different about him.’

The outcome of the evaluation was also discussed by participants, including the

impact of receiving the diagnosis. The parents expressed beliefs that the diagnosis

would be helpful in regard to obtaining access to services and understanding from

teachers. In contrast, one teacher expressed concern that the diagnosis could be used

as an excuse to for the child to get away with certain behaviors. Other teachers

expressed varying levels of understanding of the diagnosis, and perceptions about the

likelihood that their student would receive a diagnosis.

85
 Part IV: Reaction to Results

Participant reactions to the results were guided by their experiences and beliefs

about childhood and the evaluation process and outcome. In their initial responses,

parents and teachers both communicated that they were grateful to receive the results.

They noted that the results helped to clarify the child’s functioning. In some cases, the

results gave validity to the parent or teacher’s perceptions. In some cases, the results

were enlightening because they demonstrated the severity of a child’s difficulty in social

functioning. Participants had varying reactions to seeing the documentation of the

child’s social communication difficulties. William’s teacher stated, “I felt um very naive

about it until I looked at the results you know and saw the results from recess and you

know maybe he is missing more social skills than I'm picking up on.” In contrast,

William’s mother felt that the report accurately captured her son’s struggles with social

communication, which was also difficult for her. She said,

As a mother this this report um kind of hurt my heart in the sense that it
just really shows to me how his inability to really function socially and I
want that for my child for him to be able to socially be appropriate and
function and I would rather--I'm fine with him having autism spectrum and
all the rest of that but you know to think that he can't really communicate
with his peers.

Generally, participants reported that the results are helpful and accurate. Several

participants described results as “on target” or “spot on”. One parent, Eric’s mother,

described the results as “a book on [her child] in a short, condensed version”. Parents

and teachers reported general a preference for the Dynamic Assessment and school

observations as the more useful pieces of information in the results. They appreciated

the idea of the direct observation of a child’s functioning. Eric’s father explained, “I found

86
this really helpful because you were able to observe him so from an outsider...I feel like

you were able to capture it really well but very objectively by observing him.”

Participants had some questions or concerns while reading results. Sometimes

the questions related to understanding the content of the results (e.g., not

understanding some of the terminology, not understanding what descriptors meant,

etc.). Questions were addressed and resolved during the interview process. There were

also concerns about the fact that the results represented brief observations of the child,

in limited contexts. Eric’s teacher questioned, “My thoughts on the school observation

was it wasn’t long enough...I mean, what can you really tell in the length of time you

observed him one day?”

In particular, teachers expressed a desire to obtain recommendations. Several

teachers’ responses indicated that, from their perspective, it was more important to

understand how to help the child, compared to why the child was behaving the way that

he was. David’s teacher noted, “As a teacher, I’m looking for ways that I can help him

adjust socially...like some recommendations [for] how I can help him feel more

comfortable when he’s interacting with peers.” Due to the structure of the study (i.e.,

giving participants the results of the social assessment prior to giving the full evaluation

report that included recommendations), several teachers expressed concerns at not

having recommendations provided. It was explained to these teachers (and all

participants) that the final evaluation report would include recommendations, as well.

Calvin’s teacher initially stated, “I mean to me if there are no suggestions for what [the

parents] or I can do to help him...it does me no good at all.” She expressed relief when

she learned that recommendations would come out of the full evaluation report.

87
Responses from participants indicate overall satisfaction with results. Some participants

provided specific examples of how results represented their child or student. Others

described the experience of reading the results and how the information resonated with

them. In the instances in which participants expressed concerns about the results,

further explanation of the specific language generally provided clarity that seemed to

reassure participants. Overwhelmingly, participants reported that the results are both

accurate and helpful in increasing their understanding of the child.

88
 CHAPTER 5
DISCUSSION

Discussion and Implications

Social communication is a core area of difficulty for individuals with ASD, and

thus an important focus of intervention. To provide appropriate intervention that will

allow for meaningful change for the child and those who care for the child, we must first

identify the child’s current functioning, including strengths and weaknesses. A significant

challenge for professionals conducting research and working with individuals with ASD

is the lack of consensus about what social skills are and the most appropriate way to

measure them. Without having agreement on defining and measuring social

communication, researchers cannot compare the effectiveness of interventions, thus

limiting the availability of evidence-based treatment (Cunningham, 2012).

The purpose of this study was to investigate parent and teacher perspectives on

a measure of social communication functioning, the Dynamic Assessment. A second

purpose was to obtain insight into parent and teacher perspectives of behaviors

important for children’s successful social functioning, as this might inform future

development of social skill assessments. Specifically, five questions were addressed:

(1) Does the profile obtained through the results of the Dynamic Assessment accurately

reflect informants’ perspectives of the child’s social functioning? (2) What behaviors do

teachers report as being important for successful social interactions that are not

captured on the Dynamic Assessment? (3) What behaviors do parents report as being

important for successful social interactions that are not captured on the Dynamic

Assessment? (4) What social functioning characteristics are accurately described based

on the results of the Dynamic Assessment? (5) To what extent do other measures,

89
including a direct observation of social communication and the administration of the

SRS-2 questionnaire, capture the informants’ perspectives of the child’s social

functioning? This chapter will provide an overview of the findings, discuss implications,

and outline limitations to the current study and recommendations for future research.

Although the literature has not reached consensus on a single definition of social

communication, some behaviors or traits have often been discussed as elements of

successful social communication functioning. Researchers often define and measure

social communication by measuring initiations and responses, which may include

frequency and topography of these behaviors (Oke & Schreibman, 1990; Jahr et al.,

2007; Knott et al., 2007). Another skill that has been often studied in social

communication research is joint attention, including the ability to others’ attempt to direct

one’s attention as well as the ability to use nonverbal communication to direct another

person’s attention (Martins & Harris, 2006; Remington et al., 2007, Hobson & Hobson,

2007). Theory of mind and perspective taking abilities have also been conceptualized

as elements of social communication, as has social cognition. Both of these abilities are

often measured through assessments, rather than observed performance (van Buijsen

et al., 2011; Feng et al., 2008; Embregts & van Nieuwenhuijzen, 2009, Coleman et al.,

2008).

Social competency is inherently evaluative (Gresham, 1983); the success of a

person’s social functioning is judged by the individuals who interact with him or her.

However, limited research has been conducted on the social validity of previously used

measures of social communication abilities. Gresham and Elliott (1988) conducted

research on the social validity of the SSRS by evaluating the social importance of

90
behaviors being measured by their rating scale, but the notable finding is that teachers

ranked academic behaviors higher than peer interaction skills. Examining the social

validity of an assessment involves determining the extent to which a measure indicates

an individual’s functioning in society (Gresham, 1983). Hughes (1990) noted that

obtaining others’ perspectives of behaviors that are important for social functioning is a

crucial step in determining social validity.

An important implication that emerged through this study is the contextual nature

of the social communication assessment. The evaluation was heavily influenced by

participants’ perspectives of the child, in the form of information gathered through

interviews, as well as responses to questionnaires. As Gresham (1983) previously

noted, social competency is based on the appraisal of others. Therefore, it is impossible

to separate a person’s perception about a child’s social competency from the child’s

actual social behaviors—if a behavior is not judged to be appropriate by the audience

member, it is a less-than-competent behavior, no matter how effectively the child

performed it. Based on this premise, it is impossible to fully evaluate child’s social

communication functioning without gathering perspective from those who interact with

him or her on a daily basis.

One strategy to provide some initial support for the social validity of the Dynamic

Assessment is to talk to individuals who interact with the child being assessed to

determine whether the results reflect their experiences with the child. This strategy was

used in the current study to determine what aspects of a social communication

assessment were the most valid and important from the eyes of parents and teachers of

children with social communication challenges. Qualitative methods, including the use

91
of semi-structured interviews, allows for deep and holistic examination of the

phenomenon in a natural setting, using participants’ own voices. This permits open-

ended investigation, which can help uncover potentially unanticipated findings, and can

help facilitate understanding of multifaceted and complex concepts (Leko, 2014).

Caregiver Perspectives and the Validity of the Assessment

Five parents and four teachers of children who were referred for evaluation of

social communication difficulties were interviewed to obtain their perspectives on a

measure of social communication functioning and their beliefs about behaviors

important for successful social interaction. Participants described the child’s strengths

and weaknesses, their feelings about the evaluation process, and reactions to the

results. During the evaluation process the participants completed a questionnaire

regarding the child’s social functioning, the child was observed in an unstructured

setting with peers at school, and the child was administered the Dynamic Assessment.

The grounded theory presented in the previous chapter suggested that

participants’ reactions to the results were influenced by pre-existing beliefs about social

communication, including behaviors perceived to be necessary for successful social

interaction and areas of weakness exhibited by the child. Participants’ reactions to

results were also influenced by the evaluation itself, including the factors that went into

the evaluation, such as intra-individual child characteristics and others’ perception of the

child’s functioning which influenced the evaluation (e.g., information obtained during the

interview process, and through questionnaires). It is also believed that having received

the information in the results would in turn influence how the participants perceive and

experience the child.

92
 Through a series of interviews, the researcher learned about parent and teacher

experiences with the participating child, including their views about the child’s strengths

and weaknesses and how the child interacts with different individuals. By considering

what the participants discussed, the researcher was able to obtain insight about what

behaviors the participants feel are important for successful social interaction functioning.

The participants also discussed factors related to the child that were not specifically

targeted in the interview, such as academic functioning or other behavioral difficulties.

This suggested that participants may have some pre-existing perceptions about

important behaviors and experiences that are relevant during childhood. These two

factors—participant experiences with the particular child and beliefs about childhood—

influenced the evaluation process as well as participant reactions to the results.

The child’s individual characteristics also influenced the evaluation process and

results. The child was referred due to parent and, in some cases, teacher concerns

about various difficulties, including challenges with social communication. The child’s

individual characteristics were then evaluated through multiple methods, including

obtaining information from teachers and parents via interview and the completion of a

rating of social communication, as well as direct assessment during the Dynamic

Assessment and observation during unstructured time with peers. The child’s

characteristics significantly influenced the evaluation in that their difficulties led to the

referral for assessment, as well as the actual results of the assessment.

Through the interviews, the researcher also obtained information about the

participants’ perceptions about the evaluation. This included the process of identifying

the need and referral for evaluation, the process of obtaining the evaluation, and the

93
impact they believed the evaluation would have. Participants described their concerns

about the child that led to evaluation, including their difficulty understanding the child’s

current presentation (i.e., participants did not know what, if any, diagnosis would

account for the child’s behaviors and challenges). In both pre-assessment and post-

assessment interviews, participants also discussed the potential impact of the

evaluation, including increased understanding of the child and potential access to

services. The process of the evaluation, including the observation, questionnaires, and

Dynamic Assessment, also influenced the results, which in turn influenced participant

reactions to results.

Finally, in discussing their reactions to the results, participants provided

additional insight into their feelings about the assessment and their beliefs about social

communication. Participants discussed the many aspects of the evaluation that they felt

provided an accurate picture of the child. Several parents noted that the results

confirmed some of their perceptions or concerns about their child, while several

teachers indicated that they were surprised to see the extent of the child’s social

communication challenges. Some participants discussed certain areas of concern about

aspects of the results, although these concerns were generally ameliorated when the

researcher explained some of the language used in the results. Participants also noted

the aspects of the results that were particularly salient, which provides insight into what

behaviors they viewed as important for successful social functioning.

Accuracy of the Dynamic Assessment

Consistent with previous research (Crane et al., 2016), participants reported that

they were generally pleased with the amount and comprehensiveness of information

provided in the results. In particular, parents reported that the results were an accurate

94
description of their child. One parent stated that the results were like “a book on [her

child]”. In addition to noting the similarity between their child or student and the results,

some participants discussed how they felt when faced with an accurate and detailed

summary of the child’s challenges. One parent reflected, “This report kind of hurt my

heart in the sense that it just really shows to me how his inability to really function

socially…it was tough.” Several participants also noted that the results captured their

concerns about bullying or future peer rejection. Specifically, several parents expressed

concern that their child would be bullied at some point, and in the results of the Dynamic

Assessment, one dimension that is discussed is the experience of being bullied, or the

possible risk of being bullied in the future.

Participants often identified specific phrases that stood out as being particularly

salient in describing the child, including phrases that highlighted the difficulty that the

child had with nuanced social communication, or the child’s anxiety when trying to

understand social rules. Participants discussed certain aspects of the evaluation that

resonated with them, including the child’s difficulties with self-awareness, relating to

others, understanding subtext of others’ messages, and reading nonverbal social cues.

These elements that participants reported as being particularly salient are consistent

with several models of social communication, including the model proposed by Rao et

al. (2008), which identified specific behaviors including eye contact and initiating and

responding, as well as the model by Prizant et al. (2006), in which social communication

competence is described as communicating, playing, and sharing pleasure in social

relationships.

95
 One of the challenges of writing reports to communicate the results of a

psychological assessment is in the need to present information in a way that is

understandable to the consumer (Harvey, 2006). During this study, participants

occasionally expressed a concern about a phrase that was included in the results of the

Dynamic Assessment. One parent expressed disagreement with a phrase in the results

that indicated that her child was capable of lying, because she stated that he was a very

honest child and would not lie. However, once the researcher clarified that the phrase

indicated a child’s ability to participate in deception for socially appropriate reasons

(e.g., keeping a secret about a surprise birthday party), the parent agreed with the

statement. Another parent had questions about the category of social communication

ability that was given to her son, and asked the researcher what the various categories

represented. Again, the parent reported feeling satisfied once an explanation was

provided.

Relevant Social Behaviors Identified by Participants

Parents and teachers often overlapped in identifying behaviors that are important

for successful social functioning, and provided responses that are consistent with some

of the existing literature regarding the assessment of social communication behaviors.

Similar to research by Rao et al. (2008) and Weiss and Harris (2001), both parents and

teachers noted the importance of having the ability to initiate and maintain social

interactions. Participants expressed concerns about the child’s difficulty persisting

during social interactions, particularly if the interaction became challenging due to the

child’s social error or an embarrassing social exchange. Consistent with research by

White et al. (2007), participants also discussed the importance of having social

awareness, including understanding nonverbal communication, such as tone of voice or

96
the intention of the other person in the interaction. Participants also referenced the

importance of interpreting social cues or nuances that relate to the context of the

interaction. These behaviors are similar to those described by White et al. (2007),

including social pragmatics, the ability to understand emotions, and to interpret non-

literal language.

In some instances, behaviors emphasized by parents and behaviors emphasized

by teachers did differ. Although parents referenced it, teachers more frequently

discussed the importance of the ability to initiate interaction. They specifically described

the need to be able to start a conversation or join group activities. Teachers also

mentioned more concrete nonverbal communication behaviors, such as the use of eye

contact or directed facial expressions, and the child’s ability to interpret these behaviors

in others. Finally, teachers more often discussed the child’s perspective on social

interactions and how that impacted relationships with peers (i.e., difficulty understanding

when peers violated classroom rules, difficulty understanding the purpose of games at

recess). These behaviors are consistent with the difficulties that Weiss and Harris

(2001) have identified as being particular challenges for children with autism, including

using appropriate greetings, understanding facial expressions and humor, and engaging

in spontaneous and pretend play.

Similar to previous research by White et al. (2007), parents often focused more

on the child’s challenges with the content of interactions. Parents described the child’s

difficulty identifying relevant topics, and responding appropriately to others’ initiations.

Parents also discussed the child’s difficulty expressing feelings. In regard to the child’s

difficulty recovering during challenging social interaction, parents often went into greater

97
detail about how the child responds by “shutting down” or “acting awkward” when a

social exchange went awry. Parents also noted the child’s inability to adapt to social

situations, or reactions when overstimulated.

Social behaviors identified by teachers

Previous research regarding teacher perceptions about social functioning often

emphasize the relationship between social skills and academic success (Lane, Wehby,

& Cooley, 2006). Research also suggests discrepancies can exist between the

behaviors that teachers identify as relevant for successful social communication and the

behaviors that peers identify (Kwon, Kim, & Sheridan, 2012). The current study

attempted to determine what behaviors the participating teachers identified as being

important for social functioning, without any emphasis on the child’s academic

functioning.

Teachers identified a variety of behaviors that they feel are important for

successful social interactions. Broadly, teachers reported the importance of being

socially active and outgoing. Several of the teachers discussed the importance of being

able to initiate social interaction, including starting a conversation or joining a group

activity. Additionally, teachers expressed belief in the importance of maintaining

interactions. Similar to these skills, teachers described a need for the child to assert

himself and be persistent in social interactions. One teacher also described the

importance of being able to recover from difficult or embarrassing social exchanges.

Teachers discussed the necessity of using and understanding appropriate

nonverbal communication. Specific areas of importance included the use of eye contact

and facial expressions. Teachers also noted the importance of interpreting nonverbal

communication of others, such as reading facial expressions and emotions in others.

98
Some teachers noted that their student demonstrated naïveté in social interactions.

More broadly, teachers expressed the importance of understanding social cues and

having social awareness.

Teachers also noted the importance of understanding social rules, and having a

relaxed attitude toward social interactions. For example, teachers discussed the

importance of being able to tolerate situations in which other students do not follow the

rules, or in cases when students develop imaginative games with no discernible

purpose. One teacher described the importance of being able to “let things go”.

Teachers reported that is important to have social awareness and independently solve

social problems.

Generally, several of the behaviors identified by the teachers were discussed in

the results of the Dynamic Assessment, including initiating and maintaining social

interactions, interpreting nonverbal social communication and social cues, the ability to

solve social problems. However, several other behaviors that teachers identified as

important are not discussed in the Dynamic Assessment, such as the ability to be

assertive in social interactions and the ability to be more tolerant or permissive of social

interactions that may not be preferred by the child being assessed.

Of note, when asked specifically if any important behaviors were not discussed in

the results of the Dynamic Assessment, teachers generally did not identify important

social behaviors that were omitted. One teacher suggested that it might be helpful to

have better understanding of how much a child’s social interaction difficulties impacted

him. The teacher stated that she felt that the child was not disappointed by his limited

99
interaction with peers, or the fact that he has different opinions about the

appropriateness of certain social games or social behaviors.

Social behaviors identified by parents

In designing this study, one factor that was important to understanding caregiver

perspectives on social functioning was the potential difference between the parent and

teacher beliefs about what behaviors are most important for social interactions. To

examine this, the researcher sought to examine what behaviors teachers identified as

being important as well as what behaviors parents believe are important. Previous

research suggests that parents and teachers may identify different behaviors when

considering the social functioning of a particular child (Murray, Ruble, Willis, & Molloy,

2009) and may report that a particular children displays different behaviors with varying

ability or frequency (Renk & Phares, 2004).

Parents and teachers perspectives about behaviors necessary for successful

social interactions often overlapped. Like teachers, parents indicated that they believe it

is important for children to be more active in initiating interactions. Parents noted that it

is important for children to be able to manage the content of conversations. For

example, parents reported that children need to be better able to identify conversation

topics that are relevant for their audience. Parents also noted the importance of their

child being able to express his own feelings. Parents indicated that they wanted their

child to be able to show interest in other children, which would facilitate making friends.

Parents also described the importance of their child being able to respond appropriately

to peer initiations to maintain interactions.

Parents also described the importance of their child having more knowledge

about social interactions, including social nuances. Parents noted that their child

100
frequently misinterpreted social scenarios, and discussed the importance of being able

to understand tone of voice, the intentions of others, and the context of the interaction.

Examples that parents provided included instances in which their child did not

understand that a peer was not a true friend, or not recognizing how his appearance

affected other peoples’ perspectives of him (e.g., one parent stated that his child often

walked around with his hair uncombed and pants that didn’t fit). Parents often discussed

the importance of this child having stronger social awareness.

Several parents also discussed the importance of the child being adaptable in

social situations. Some parents noted that their child easily becomes overstimulated in

large groups. Some of the children were described as acting more awkwardly or

shutting down when they felt overwhelmed by a crowd. Two parents expressed concern

about their child’s ability to recover from a difficult social interaction, and stated that he

gives up too easily. Overall, parents discussed the importance of the child being able to

adjust his behavior based on the context of the social interaction.

Many of the behaviors parents viewed as important to successful social

interaction functioning were captured in the Dynamic Assessment, including the child’s

ability to initiate and maintain interactions and the ability to read social scenarios. The

Dynamic Assessment focused less on a child’s ability to recover from difficult social

interactions or being overwhelmed in large groups. It also did not discuss a child’s ability

to persist in social interactions when he is challenged.

When directly asked about any behaviors missed in the Dynamic Assessment,

parents responded that many of the relevant social behaviors are adequately captured.

Parents indicated appreciation of the volume of information provided, and that it was

101
accurate. One parent expressed an interest in increased discussion of his child’s

repetitive behaviors, as they do affect the child’s interaction (e.g., the child repeatedly

asks questions about areas of restricted interest). One interesting difference between

the way that teachers and parents discussed social behaviors is the contexts in which

they are evaluating the child’s behavior. Parents often discussed the child’s behavior

around siblings, who were sometimes described as the child’s “friend.” This likely

influenced their perceptions about behaviors, as social expectations for siblings may be

very different from expectations when interacting with non-related peers. Parents

offered some insight into the child in other social settings (e.g., family events, time spent

at playgrounds, birthday parties, etc.), but made frequent references to the way in which

the child interacted with siblings, without speaking about the differences between sibling

and friend relationships.

Measuring Social Communication with the Dynamic Assessment

Participants noted several areas of social functioning that were accurately

described by the results of the Dynamic Assessment. Several of the behaviors that

participants described as being well captured are also consistent with research literature

on social communication challenges that are consistent with difficulties experienced by

individuals with ASD. Participants indicated that one important finding from the Dynamic

Assessment is that the child struggles to engage in conversation, and has difficulty

sustaining interaction. For example, several participants discussed a phrase in the

results that described the child as “often talking without actually interacting with the

conversational partner.” The participants indicated that the Dynamic Assessment also

captured the child’s difficulties with making social errors. These behaviors being

102
measured are consistent with social communication challenges described by White et

al. (2007) and Zenko and Hite (2014).

Participants also noted that the results of the Dynamic Assessment described

ways that the child struggled with nonverbal communication or reading social situations.

Several participants identified with statements in the Dynamic Assessment results that

related to the child’s difficulties with eye contact. Participants also noted that the

Dynamic Assessment captured the child’s naïveté, difficulty with perspective taking, and

challenges related to recognizing and reacting to social cues. These behaviors are

consistent with areas of difficulty that Rao et al. (2008) identified as challenges for

individuals with ASD. The Dynamic Assessment also accurately captured and described

the child’s anxiety about not knowing social rules or becoming upset in busy social

situations. Several participants also noted the results that described the child’s

misinterpretation in social situations that led the child to identify individuals as “friends”

who were not actually friends, which aligns with research by Bauminger and Kasari

(2000) on the differences between “friends” described by children with ASD and their

mothers’ description of the relationship.

Participants also reported that the results of the Dynamic Assessment reflected a

lot of the beliefs or fears that they had for the child. One parent felt that the results

actually portrayed her child as more socially successful than she thought he was. In

contrast, several participants expressed concern about the portion of the results that

indicated that child experiences anxiety about social interactions, and that an

awareness of limited social connections caused the child additional stress. Parents in

particular noted their concern about this possibility, and several stated that the results

103
written in the Dynamic Assessment confirmed their fears. Participants noted that results

discussed the possibility of increased peer rejection for the child in the future. They also

expressed concern regarding the portion of the results that discussed the possibility of

the child being bullied. Of note, only one child had actually experienced bullying at the

time of the study, but many of the participants were significantly concerned about the

possibility of future bullying.

As previously discussed, researchers have not come to consensus about how to

measure social communication. Across the literature, different methods used include

direct observation of target behaviors (e.g., initiations and responses, joint attention,

etc.), testing of constructs like social cognition and theory of mind, the use of autism

symptomology assessments such as the ADOS-2, and the use of norm-referenced

questionnaires, such as the SSIS or SRS-2. This lack of consensus is problematic

because it limits the ability to develop bases of empirical research on intervention

(Cunningham, 2012). The difficulty in establishing systematic evaluation of social

communication makes it challenging to determine whether an intervention targeting

specific behaviors provides meaningful and generalizable change in functioning. As a

result, researchers are often forced to choose between measuring specific skills related

to the intervention and more general measures that would likely be affected by these

skills (Lord et al., 2005).

Social Validity of Observation and Questionnaires

When asked to discuss how the Dynamic Assessment, observation, and

questionnaires compared to one another, participants demonstrated a strong preference

for the Dynamic Assessment and school observations. This is consistent with previous

research which indicates that in evaluating social competency, naturalistic peer

104
interactions are helpful in identifying which children have social difficulty, while clinically

administered assessments are more useful to gain additional insight about the specific

nature of social challenges (Bierman & Welsh, 2000). Generally, participants reported

that the direct observation of social communication was much more helpful than the

questionnaires. This observation, conducted at lunch or recess at the child’s school, and

focused specifically on the proportion of time that the child was engaged with peers,

including the proportion of time the child was initiating interactions and responding to

others’ initiations. Parents reported that they felt that the observation helped to provide

direct insight into how the child performs around peers, which helped the parents to feel

that the results of the evaluation were more accurate, as this was in line with their

previous experiences with the child. This suggests that parents viewed the observation

as being socially valid (Gresham, 1983). Several teachers noted that the observation

revealed that the child was engaged less frequently than previously thought, but did not

disagree with the findings of the observation.

In regard to the questionnaires, some participants expressed concerns that the

questions were difficult to answer, because the wording seemed sometimes unclear.

The approach to writing results of the questionnaire was to identify areas in which the

child was significantly impaired, or at-risk of impairment, based on T-scores, and to then

describe specific items that participants rated as being the most accurate for that child.

One participant actually noted the possibility that questionnaires are less valid because

respondents answer questions with preconceived perceptions of the child that might

influence the results (e.g., the respondent could make the child look more or less

socially competent based on their pre-existing beliefs about the child). This is consistent

105
with previous research by Locke et al. (2013), which suggested that rating scales may

be less informative because the raters may have limited ability to respond based on

actual knowledge of the child’s social interactions. The participants also did not describe

the information from the questionnaires reported in the results as providing significant

insight in the child’s functioning. Of note, consistent with previous research (Renk &

Phares, 2004), parent and teacher responses to the questionnaires were often

inconsistent, with parents generally rating the child as having more significant social

impairment than teachers did.

Implications and Directions for Future Research

The literature regarding the measurement of social communication has not

reached consensus about how to assess this construct (Cunningham, 2012). Across

and within various fields, researchers are using different methods to attempt to measure

various social behaviors and cognition, which significantly limits the ability to develop

and study the effectiveness of interventions. The lack of ability to measure social

functioning is also particularly problematic for the many individuals, including those with

ASD, who experience significant challenges in their social functioning, as it limits the

ability to identify targets for intervention. The current study attempts to add to the

existing knowledge base regarding social communication assessment by exploring the

Dynamic Assessment as one potential option for evaluating social communication, and

by determining what behaviors are important functioning from the perspectives of

caregivers who observe the child across various settings in daily life.

An important conclusion of this study is that social communication is a complex,

transactional construct. When parents and teachers talked about the child’s current

functioning and the behaviors that are important for social functioning, they often

106
discussed the variability across settings and with various social partners. Given that

social competency is inherently evaluative and context-dependent, it may not be

possible to distill social functioning into a single score, using one specific measure.

However, it remains crucial that clinicians find appropriate strategies to measure social

functioning to determine appropriate intervention. The goals of assessment include

describing current functioning, identifying treatment needs, assisting in the

determination of diagnosis or eligibility, and monitoring progress of intervention over

time (Meyer et al., 2001). For an assessment to be considered valid, it is important to

consider the meaning, relevance, and utility of the information obtained, as well as the

functional and social value of the results (Messick, 1989).

The purpose of the assessment is also relevant when considering the evaluation

process. To obtain results regarding eligibility or diagnosis, it is important to use

assessments that provide overall profiles of functioning within given domains. However,

when administering assessments to inform educational programming or intervention, it

is necessary to know specific skills that the child does or does not have (Salvia,

Ysseldyke, & Bolt, 2010). It is important to understand both the child’s areas of

weakness that are in need of additional support, as well as the child’s areas of strengths

which can be built upon. When assessment measures are vague or not meaningful to

the caregivers in the child’s life, the ability to identify relevant intervention strategies are

limited. By examining the potential appropriateness and benefits of using the Dynamic

Assessment and identifying important social behaviors from the perspective of

caregivers, the findings of the current study can inform methods that may be helpful in

determining a child’s profile of social communication strengths and weaknesses.

107
 The Dynamic Assessment is a semi-structured assessment that includes: (1) a

short interview with the child, after which the child is instructed to then interview the

examiner, (2) tasks requiring the child to interpret the examiner’s eye gaze, (3) asking

the child to sequence a series of pictures and describe the narrative and social

interaction in the story, and (4) having the child describe a scene from a picture that

involves a more nuanced social scenario (e.g., a child putting salt into a sugar bowl)

(Winner, 2007). The Dynamic Assessment is not designed to inform decisions about

diagnosis or eligibility; instead, it is specifically described as an evaluation to assist with

identifying a profile of functioning to determine appropriate areas for intervention

(Winner, 2007).

Results of the current study indicate that parents and teachers of children who

were administered the Dynamic Assessment felt that this evaluation tool provided

relevant and accurate information about the child’s social functioning. Of note, when

participants were asked to compare the three elements of the social communication

assessment in this study, the Dynamic Assessment and observations with peers were

consistently reported as being more helpful and informative than the questionnaire,

despite the fact that the questionnaire has been deemed valid and reliable based on

traditional psychometric properties. Although the Dynamic Assessment is not yet fully

standardized and developed for administration by any generally trained practitioner, the

current study suggests that this may be one very valuable method to gather important

and socially valid insight into a child’s social communication functioning.

As described previously, assessing children’s social communication is

necessarily a complex and challenging task. As discussed in her comprehensive review

108
of social communication assessments, Cunningham (2012) notes that many widely

used methods fall short of meaningful assessment in this regard. Results of this study

suggest that Dynamic Assessment may address some of these challenges. Participants

universally described strong preferences for the Dynamic Assessment and observation

with peers, as opposed to the SRS-2. Several of the participants discussed how these

pieces of evaluation are more important and informative because they provide a direct

reflection of the child’s functioning, from the perspective of a trained professional. This

suggests that participants may have more confidence in the perspective of the

researcher as a perceived expert. However, participant perspectives also played a role

in influencing both the assessment process and outcome, as information provided by

participants significantly impacted decisions about data collection and integration of

findings. Norm-referenced questionnaires, including the SRS-2, are frequently included

in assessments of a child’s social functioning, but exploratory findings of this study

suggest that further research may be necessary to determine their actual utility and

social validity based on perspectives of consumers of assessment results.

Another important contribution of the current study is the identification of

behaviors that parents and teachers believe are important for a child’s successful social

functioning. Given the transactional and contextual nature of social interaction,

knowledge of what behaviors others deem to be necessary to be successful can be

invaluable in informing strategies to measure social communication abilities. This study

provides some initial evidence for determining what behaviors are socially valid in

measuring social communication functioning. This adds to the current understanding of

this construct, and allows researchers and clinicians to both identify tools that currently

109
exist to measure these behaviors and develop new strategies to assess social

communication.

The current study was exploratory in nature. Future research should be

conducted regarding the accuracy and helpfulness of social communication assessment

tools, as well as perceptions about necessary behaviors for successful social

functioning. Though this study provides in-depth examination of parents’ and teachers’

experiences and beliefs about an evaluation including the use of the Dynamic

Assessment, it will be beneficial to gain more comprehensive understanding about how

this measure compares to other tools that can be used to accurately identify a child’s

strengths and weaknesses in social communication, as well as caregivers’ ideas about

relevant social behaviors. One important possibility to consider for future research is to

obtain social validity evidence related to other measures of social communication. The

prevalence rates of children with social communication difficulties are increasing

steadily, which indicates the need for having measures that can examine the various

patterns of strengths and weaknesses that these children can have. Social skill

interventions should be closely linked to the child’s profile of functioning, targeting

specific areas of difficulty for the child. Currently, many of the frequently used

assessments broadly indicate that the child has good or poor social skills, without going

into details about ways in which the child struggles. Additional research is needed to

determine whether currently existing assessments can accurately capture the child’s

profile of functioning, or if additional measures need to be developed to better identify

strengths and weaknesses.

110
 Another line of research that could help to inform social communication

assessment and intervention would be to examine the relationship between the

Dynamic Assessment and intervention. Measures of a child’s social functioning,

including observations and caregiver questionnaires, could be given prior to the

implementation of intervention determined by the Dynamic Assessment, and then

similar tools could be used for progress monitoring to determine whether the

intervention is effective in improving the quality of the child’s social communication

abilities over time. If results indicate that intervention implemented based on the results

of the Dynamic Assessment has improved the child’s social communication, this would

support the ecological validity of the information obtained through this measure.

Although it was not explicitly examined in the current finding, culture likely plays

an important role in perceptions about social functioning. In the current study, the

participants were all Caucasian, middle class adults who lived in or near the metropolis

of the university, which is in the southeastern United States. The educational attainment

of these adults ranged from having completed high school to having graduate degrees.

The two male participants reported having experienced bullying as a child, which may

have influenced their concerns about their children being bullied. Several of the

participants also referenced outdoor activities (e.g., playing basketball, going fishing)

that could have served as social interaction opportunities for the children being

evaluated in the study. Behaviors that demonstrate social competency vary based on

cultural expectations. For example, sociability, shyness, cooperation, and aggression

are evaluated within a framework of cultural norms and values (Chen & French, 2008).

The cultural beliefs and expectations of families and teachers may not always align with

111
those of the examiner, which can largely influence the examiner’s conclusions about the

appropriateness or success of a child’s social communication.

Additionally, culture and previous experience can affect participants’ perceptions

regarding the SRS-2 questionnaire. Several participants noted concerns about

understanding the meaning of various test items on the questionnaire, and a level of

discomfort in providing a response to items that they felt may have not fully captured a

child’s behavior. Questionnaires, including the SRS-2, can be influenced by education

level of the respondent (Hus et al., 2013b). Participant reports and expectations played

important roles in gathering information for the assessment process, including the

completion of the SRS-2, as well as information obtained during pre- and post-

assessment interviews. Therefore, recognizing the participants’ cultural identification

and experiences could provide increased insight into their perceptions about behaviors

important for successful social functioning, as well as the target child’s strengths and

weaknesses. Future research could be conducted to examine the role of culture and

perceptions about social communication could inform assessment strategies and

behaviors related to successful social functioning.

The preliminary findings of support for the Dynamic Assessment as a measure of

social functioning also has implications for implementation within schools. Although this

specific measure is not ready for mass distribution, the information obtained through it

may indicate promising options for gathering data related to identifying children who are

in need of additional supports in their social communication functioning. For example,

the Dynamic Assessment allows for the direct evaluation of specific social behaviors,

such as the ability of the child to read eye contact, to assess social scenes, and to

112
identify appropriate conversational topics to discuss with the examiner. Additionally, the

Dynamic Assessment requires discussion with caregivers about aspects of social

functioning that may not be evident by simply interacting with the child. For example,

this evaluation requires information from caregivers about bullying, social awareness

with peers, and the child’s ability to develop and maintain social relationships.

Based on response-to-intervention models, currently implemented in many

school systems, schools are required to identify children who are struggling in social

behavior, regardless of diagnosis or eligibility for special education services (Hawken,

Vincent, & Schumann, 2008). Based upon this model, children who are struggling with

social functioning and need intensive services could benefit from the use of an

assessment similar to the Dynamic Assessment. This type of evaluation allows for the

determination of the child individual needs, which provides opportunities for more

intensive instructional approaches that can be offered before going through the process

of special education referral. Although Functional Behavioral Assessments (FBAs) have

previously been utilized in evaluating a child’s social communication functioning

(Hawken, Vincent, & Schumann, 2008), the methods used in the current study,

including the Dynamic Assessment, offer alternative assessment options to determine a

child’s more specific profile of social communication strengths and weaknesses, which

could inform more relevant intervention strategies. Although it is not generally measured

in standardized testing, social functioning is a particular area of importance in

education, as social intelligence, including interpersonal skills, adaptability and

communication, are important aspects of work readiness (Caballero, Walker, & Fuller-

Tyszkiewicz, 2011).

113
 One unexpected finding that emerged throughout this study is the discrepancy

between how teachers observe and report social communication functioning in contrast

to parent-report and direct assessment measures. In the current study, teachers often

reported children as being more socially successful, and indicated surprise when

assessment results indicated more impaired functioning. Previous research has often

focused on how teachers perceive social skills in relation to academic functioning (Lane

et al., 2006; McClelland, Morrison, & Holmes, 2000). Teachers also may identify certain

behaviors (e.g., aggression in response to peer provocation) as disruptive, where peers

may find these behaviors to be socially appropriate (Kwon et al., 2012). Although adults

may rate compliance and pro-academic behaviors as being preferable, in social

scenarios, there is often a “hidden curriculum” of expectations that allow peers to feel

more positively about a child’s behavior (Winner, n.d.), which may or may not be

consistent with adult expectations.

Future research might be conducted to determine how teachers perceive social

functioning and how or if they are able to identify children who are struggling with social

communication independent of the relationship between social skills, problem

behaviors, and/or academic success. Teachers are often relied upon to identify children

who need additional supports or services. It is important to understand how well

teachers are able to identify children who need support in social and emotional learning.

This line of research could inform future training for educators about various aspects of

social communication behaviors and how to determine when a child is not

demonstrating age-appropriate skills.

114
 Finally, this study did not include the perspective of peers in evaluating the child’s

social functioning. Research suggests that peers may actually be more effective at

assessing social skills in other children than teachers (Kwon et al., 2012). Future

studies to evaluate what behaviors children perceive as being most important in social

communication functioning may shed additional light on what behaviors should be

considered when conducting a social communication evaluation. Additionally, peer

report may be a useful tool within a response to intervention framework to determine

which children are in need of intervention to support their development of social

functioning.

Limitations

One of the frequently discussed limitations in qualitative research is the need for

caution in assuming that results are generalizable people outside of the study. Because

qualitative research includes theoretical sampling, as opposed to representative

sampling, the presumption is that qualitative research may not reflect the experiences of

everyone in a given population. The goal of quantitative research is to find results that

are applicable to a larger group, based on responses of a limited but representative

sample. In contrast, the goal of qualitative research is to obtain situational

representativeness, which should provide a theory developed in one study that offers

some explanation for the experiences of others in comparable situations (Horsburgh,

2003). Future research could be conducted incorporating the theory developed in the

current study to further examine the generalizability of the findings presented here.

In the current study, participants were recruited during the process of attempting

to obtain a neuropsychological evaluation of a child who was suspected of having social

communication difficulties and possibly Autism Spectrum Disorder. To obtain an

115
appointment for evaluation, parents had to first contact a provider, either a pediatrician

or the Psychology Clinic directly to request an assessment. The parents had to attend

multiple appointments to participate in the study, and had to provide consent to allow

the child’s teacher to be approached about participation in the study. This suggests that

these parents were highly motivated to learn more about their child’s social

communication functioning. It is possible that these parents may have had more time to

reflect about their child’s behaviors, and what skills are necessary in social interaction.

Teachers who participated were advised about the purpose of the study prior to

participation, which may have given them reason to reflect more about the child’s social

communication functioning prior to being interviewed. For example, David’s teacher

noted that she had started paying more attention to the child’s interactions with peers

after being contacted about participating in the study.

The purpose of this qualitative research study is not to generalize finding of all

parents and teachers of children with ASD, and thus should not be interpreted as such.

This study has obtained rich descriptions of the participants’ experiences and beliefs, to

allow readers to determine the degree to which these findings are relevant to their own

circumstance. The findings of this study indicate that significant commonalities exist in

regard to participant experiences, as well as their beliefs about social communication

functioning. Additionally, the findings are consistent with previous research on related

topics.

The chosen research methodology, grounded theory, involves engagement with

participants over multiple sessions, to understand their experiences and beliefs. During

interviews, the researcher established rapport and attempted to generate a trusting

116
relationship to facilitate understanding of the participants’ experiences with social

communication, the child, and the evaluation process. One factor that likely influenced

participants’ reporting on their experiences and beliefs regarding social communication

is their knowledge of the range and appropriateness of different social behaviors.

Participants likely had a range of understanding of social communication prior to

participating in the study. For example, one teacher noted she didn’t know much about

social skills at the beginning of her first interview. Results may be more informative if the

researcher could have determined the participants’ pre-existing understanding of social

communication.

Another possible limitation of the present study is the amount of information

obtained during the observation. The structure of the assessment included one ten-

minute observation during unstructured time such as lunch or recess. This may have

limited the ability to have a more comprehensive of the child’s functioning around peers.

Several teachers reported concerns about the duration and location of the observation.

One teacher lamented that the researcher had not seen the student interact in the

classroom. Another teacher stated that she did not see how a single, brief observation

could be helpful. Having seen the child interact with peers in multiple locations or

multiple time periods may have allowed the researcher to ask different or additional

follow-up questions during interviews with participants. It may also have influenced the

amount of confidence participants had in the accuracy of the results of the evaluation or

the comprehensiveness of the researcher’s understanding of the child’s functioning.

Although the current study was not designed to include multiple observations, this fact

117
may have influenced some participants’ responses to interview questions or reactions to

the results.

118
 APPENDIX A
INTERVIEW GUIDES

Pre-Assessment Interview Guide

In this interview I want to talk to you about your impressions of your

child/student’s social functioning, as well as social skills that are important for him/her. I

would like to ask you a few questions.

1. Please tell me about your child/student.

2. In what skills or abilities you think this child/student is most successful, in regards

to social/communication ability?

3. What skills do you think this child/student struggles the most with, in regards to

social/communication ability?

4. Please describe how this child interacts with peers in a typical, non-structured

setting.

5. Does this child experience bullying, or participate in bullying others? If so, please

describe this.

6. Based on your experience observing this child, what skills or abilities do you think

are most important for the child to have positive social experiences with peers?

7. To what extent, if any, do you think this child is aware of the social challenges

he/she experiences?

a. How has the child communicated this awareness or lack of awareness to

you?

119
 Post-Assessment Interview Guide

In this interview, I would like to discuss the results of the social battery, and in particular,

the Dynamic Assessment, that was recently administered to your child/student, as well

as social skills that you think are important for him/her. I would like to ask you a few

questions.

1. What did you hope to learn through the process of this social skills evaluation?

2. Please tell me your thoughts about the results of the Dynamic Assessment.

a. To what degree do you think the results accurately depict this child’s

social functioning?

3. Were there aspects of your child/student’s social functioning that you believe

were well captured through this Dynamic Assessment? If so, what are they?

4. Were there aspects of your child/student’s social functioning that you believe

were not well captured through this Dynamic Assessment? If so, what are they?

5. Please describe how the results of the Dynamic Assessment reflect the child’s

social functioning as compared to the results of the direct observation and the

SRS-2 Questionnaire results?

6. What elements do you think are most important to consider when evaluating your

child/student’s social functioning?

7. What behaviors do you think are important for this child to be successful in social

interactions with peers?

120
 APPENDIX B
SOCIAL COMMUNICATION ASSESSMENT

Dynamic Assessment
1. The Double Interview

Part 1: Interviewing the student: Interview the student about his/her life (awareness of
strengths/weaknesses, friendships, personal interests, etc.)

During the interview, observe the following skills and check if they are problematic for the student:
□ Avoids eye contact
□ Too much fluctuation in prosody
□ Voice is too loud or too soft
□ Looks depressed
□ Pronoun confusion
□ Poorly narrated stories or sequences
□ Language is tangential, or very literal
□ Fails to read your intentions
□ Very self-oriented
□ Has odd mannerisms:
_________________________________
_________________________________
□ Body or shoulders turned away from you
□ Voice is monotone
□ Looks very nervous
□ Is using echolalia
□ Provides limited, unelaborated responses
□ Constantly talking but not regulating to interviewer
□ Needs explicit instruction to stay with the task
□ Fails to ready body language or facial expression
□ Laughs inappropriately
□ Talks a lot about a specific topic:
_____________________________________
_____________________________________

Questions:
What are your hobbies?

Do you have siblings?

Do you have pets?

What chores do you have to do at home?

What are good things about school?

What are harder things that you have to do at school?

Who are your friends?

What do you do with them at lunch or recess?

If your mom had a day to herself, when she did not have to focus on being a mom, what would she
choose to do on that day?

If your dad had a day to himself, when he did not have to focus on being a dad, what would he
choose to do on that day?

121
Other comments/observations:

Part 2: Picture Interpretation/The Student Interviews the Evaluator

Picture Interpretation: Tell the student, “Now that I have learned about you, you know little about
me”. Place pictures of yourself engaging in activities, with family, etc. on the table and ask the students,
“Why do you think these pictures are on the table?”

Ask the student to tell you about the pictures (relationships between people in the photos, activities, etc.)If
the student makes errors in discussing pictures, help reveal deficits related to the ability to recognize
faces and make functional inferences. After the student interprets the pictures, clarify any confusion
before moving on.

Picture One Student response:

Picture Two Student response:

Picture Three Student response:

Check off which observation is/are most accurate:

□ Student described all pictures in a timely manner, appropriately
□ Student struggled to figure out the people and/or relationships in the pictures
□ Student could not infer the theme of the pictures (family portrait, party, etc.)

Comments/observations:

The Student Interviews the Evaluator: Begin by reviewing the steps involved in an interview. Remind
the student that he/she was just interviewed by you, and he can ask questions about the three pictures
you just discussed with him, or anything in the room. Do virtually nothing to help the student with the
interview beyond describing what an interview is and how it differs from comments.

You may present a cue card with question words (who, what, when, where, why, how) if necessary. If the
student needs additional structure, you can provide a square with four boxes in it, telling the student they
have to ask four questions to complete the interview. If the student still struggles, you may show one
picture and encourage the student to ask a question about a specific person in the photograph.
Questions the student asks (Note if you had to Briefly note your response
prompt any part of the question)

122
Check off which of the following observations are most accurate:

□ The student generated novel questions easily, within 1-3 seconds

□ The student was noticeably uncomfortably during the task when compared to the first part of the double
interview
□ The student could not initially generate a question; you had to write out the wh- questions to help
him/her think of ways to start questions
□ You needed to draw four squares on a piece of paper to remind the student that the task would end
after he/she asked four questions
□ The student was unable to generate a question so you gave him/her a specific cue (showed a specific
picture)
□ The student was unable to generate a question so you gave him/her a verbal cue or start to form the
question for him/her
□ The student told you he/she had no interest in talking to you
□ The student commented on what he/she knew about you but did not ask questions
□ The student asked the same questions you asked
□ The student asked a question but failed to ask any follow-up questions
□ The student mostly asked questions about his/her own area of interest
□ The student went on to talk about what was interesting to him/her, ceasing to interview you
□ The student shut down with body language and eye contact; you had to help him/her through the entire
process
□ The student told you he/she couldn’t do it and refused to participate in the task

Other observations:

** See appendix for error analysis

2. Thinking with Our Eyes

Tell the student, “We are going to play a game with our eyes”. Have the student look at your eyes and
tell when you are looking at:
1. The student
2. The clock
3. Another adult/object in the room
4. The door handle

Note whether the student looks in the direction you are looking and then checks back to confirm where
you are looking.
Conduct 4-5 trials and record whether the student is correct or incorrect. If the child is correct 50% of the
time or more, look at the objects again, but this time, ask the student what you are thinking about based
on where you are looking.
Mark a “+” in the box if the student easily can follow your eye gaze, or a “-“ if the student struggles with
the task or provides an incorrect response.
Student looks at Looking at Looking at clock Looking at other Looking at door
your eyes and student adult/object handle
where you are

123
 looking to
determine what
you are looking at
Student tells you
what you are
thinking about
based on where
you are looking

Checklist for analyzing the student’s actions:

□ The student was able to easily and quickly engage in all parts of the task
□ The student required explicit redirection to stay connected to the task
□ The student does not appear to understand reading the direction of eye-gaze, or does so with poor
accuracy
□ The student could read the eye gaze direction, but was far less sure of how to answer when having to
guess the thoughts of the evaluator
□ Recommend further work in this area

** See appendix for error analysis

3. Sequencing Pictures

Children 2nd through 5th grade

* The student must have an understanding of the concepts of “first” and “last” to complete this task
* For younger or lower functioning students, socially themed events may be too challenging, but they may be able to sequence
functional tasks

Select a set of pictures (preferably 6-8) to present to the student to sequence. Create interest by saying
something like, “You get to do some magic! You are going to magically create a story out of these
pictures by putting them in correct order.” Remind the student that this is a non-talking task. If the
student is overwhelmed with all pictures presented at once, you may remove the second half of the
pictures until the student has sequenced the first half.
Take note of the following:
Does the student verbally mediate the task? ___________________________________________

What strategy is used to figure out the sequence?

___________________________________________
Is the student able to move pictures around
effectively or does he/she get lost in the process?
___________________________________________

Mark which pictures are placed in error by putting a slash through the letter corresponding to the picture.
A B C D E F G H
Once the student indicates he/she is done, do not correct errors. Ask the student, “How sure are you?”
Have the student narrate the story. Do not interrupt or make any corrections.
If an error has been made, tell the student, “You did a good starting job, but you have to fix a couple
of spots.” See if the student can figure out what to fix. If not, touch the pictures incorrectly sequenced.
Observe how the student goes about fixing the sequence:
Can he/she hold the main idea? Y N Does he/she get lost? Y N
Ask the student create a name for the story. You can also describe this as creating a title, like for a book.
Does the title represent the gestalt? Y N Is the title tangential? Y N
Note if you have to cue the student to create a title that is more on target. Write down all examples the
student generates:
_____________________________________________________________________
____________________________________________________________________________________
_

124
Once the story is properly sequenced, ask the student to give you an example of the type of conversation
that may be happening or what the person may have been thinking, in each picture in the sequences.
Notice if the student understands that conversations are contextually bound.
*Continue to page 7

Pre-teens through Adults

Select a set of pictures (preferably 6-8) to present to the student to sequence. Tell the student, “You get
to create a story from these pictures by putting them in the correct order.” Remind him/her that this
is a non-talking task.
Take note of the following:

Does he/she verbally mediate the task? ___________________________________________

What strategy is used to figure out the sequence?

___________________________________________
Is the student able to move pictures around
effectively or does he/she get lost in the process?
___________________________________________

Mark which pictures are placed in error by putting a slash through the letter corresponding to the picture.
A B C D E F G H
Once the student indicates he/she is done, do not correct errors. Ask the student, “How sure are you?”
Have the student narrate the story. Do not interrupt or make any corrections.
If an error has been made, tell the student, “You did a good starting job, but you have to fix a couple
of spots.” See if the student can figure out what to fix. If not, touch the pictures incorrectly sequenced.
Observe how the student goes about fixing the sequence:
Can he/she hold the main idea? Y N Does he/she get lost? Y N
Ask the student create a name for the story. You can also describe this as creating a title, like for a book.
Does the title represent the gestalt? Y N Is the title tangential? Y N
Note if you have to cue the student to create a title that is more on target. Write down all examples the
student generates:
_____________________________________________________________________
____________________________________________________________________________________
_
Once the story is properly sequenced, ask the student to give you an example of the type of conversation
that may be happening or what the person may have been thinking, in each picture in the sequences.
Notice if the student understands that conversations are contextually bound.

Analyzing Picture Sequencing Findings:

Check off which of the following observations are most accurate:
□ The student sequenced pictures, narrated story, summarized the title and identified conversations as
expected for his/her age
□ The student could not sequence the pictures but successfully reorganized them with an initial cue
□ The student required significant cues to help sequence the pictures appropriately
□ The student was able to narrate the story appropriately
□ The student’s narration was tangential, hard to follow
□ The student was able to efficiently label the story
□ The student’s title was tangential
□ The student could appropriately identify the conversation being held in each picture
□ The student could not identify the conversation from the social context

** See appendix for error analysis

4. Social Scenario Pictures

125
Social scenario pictures are shown to the student, one at a time. Ask the student to, “Explain what is
happening in the picture.”Listen to determine if:
1. The student accurately captures the overall social theme in the picture
2. The student is able to appropriately label the environmental context
3. The student is able to identify any emotions while describing the pictures.

Present the student with four pictures total, selected based on age and developmental levels. Write a
brief summary of the pictures in the left column, and the student’s response in the right column.

Check off which of the following observations are most accurate:

□ The student was able to quickly and efficiently interpret all pictures
□ The student struggled to identify the emotional context or roles of the people in some pictures
□ The student could not easily identify the intentions of one of the persons in the picture, meaning the
student was not easily picking up on the nonverbal cues of the character’s body and face
□ The student did not use a range of emotion words to describe how the characters felt in the different
scenarios, even when directly asked about their feelings

126
Social Communication Observation

127
Social-Responsiveness Scale, 2nd Edition

128
129
 LIST OF REFERENCES

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental

disorders (4th ed., text rev.). Washington, DC: American Psychiatric Publishing.

American Psychiatric Association. (2013a). Autism Spectrum Disorder. Retrieved from

http://www.dsm5.org/Documents/Autism Spectrum Disorder Fact Sheet.pdf

American Psychiatric Association. (2013b). Diagnostic and statistical manual of mental

disorders (5th ed.). Washington, DC: American Psychiatric Publishing.

Assouline, S. G., Nicpon, M. F., & Doobay, A. (2009). Profoundly gifted girls and autism
spectrum disorder: A psychometric case study comparison. Gifted Child
Quarterly, 53 (2), 89-105.

Autism Diagnostic Interview, Revised (ADI-R). (n.d.). Retrieved from

http://portal.wpspublish.com/portal/page?_pageid=53,70436&_dad=portal&_sche
ma=PORTAL

Autism Diagnostic Observation Schedule (ADOS). (n.d.). Retrieved from

http://portal.wpspublish.com/portal/page?_pageid=53,288971&_dad=portal&_sch
ema=PORTAL

Autism Research Institute. (2013). DSM-V: What changes may mean. Retrieved from
http://www.autism.com/index.php/news_dsmV

Autism Society. (n.d.). Facts and Statistics. Retrieved from http://www.autism-

society.org/about-autism/facts-and-statistics.html

Autism Speaks. (2013). Answers to frequently asked questions about DSM-5. Retrieved
from http://www.autismspeaks.org/dsm-5/faq

Baron-Cohen, S. (2002). The extreme male brain theory of autism. Trends in Cognitive
Sciences, 6 (6), 248-254.

Baron-Cohen, S., & Belmonte, M. K. (2005). Autism: A window onto the development of
the social and the analytic brain. Annual Review of Neuroscience, 28, 109-126.

Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory
of mind”? Cognition, 21, 37-46.

Bauminger, N., & Kasari, C. (2000). Loneliness and friendship in high-functioning

children with autism. Child Development, 71 (2), 447-456.

130
Bauminger, N., Solomon, M., Aviezer, A., Heung, K., Brown, J., & Rogers, S. J. (2008).
Friendship in high-functioning children with autism spectrum disorder: Mixed and
non-mixed dyads. Journal of Autism and Developmental Disorders, 38 (7), 1211-
1229.

Bennett, T. A., Szatmari, P., Bryson, S., Duku, E., Vaccarella, L., & Tuff, L. (2013).
Theory of mind, language, and adaptive functioning in ASD: A neuroconstructivist
perspective. Journal of Canadian Academic Child Adolescent Psychiatry, 22 (1),
13-19.

Berger, H. J. C., Aerts, F. H. T. M., van Spaendonck, K. P. M., Cools, A. R., & Teunisse,
J. (2003). Central coherence and cognitive shifting in relation to social
improvements in high-functioning young adults with autism. Journal of Clinical
and Experimental Neuropsychology, 25 (4), 502-511.

Biermann, K. L. & Welsh, J. A. (2000). Assessing social dysfunction: The contributions

of laboratory and performance-based measures. Journal of Clinical Child
Psychology, 29 (4), 526-539.

Bӧlte, S., Poustka, F., & Constantino, J. N. (2008). Assessing autistic traits: Cross-
cultural validation of the Social Responsiveness Scale (SRS). Autism Research,
1 (6), 354-363.

Burck, C. (2005). Comparing qualitative research methodologies for systemic research:

The use of grounded theory, discourse analysis, and narrative analysis. Journal
of Family Therapy, 27 (3), 237-262.

Caballero, C. L., Walker, A., & Fuller-Tyszkiewicz, M. (2011). The Work Readiness
Scale (WRS): Developing a measure to assess work readiness in college
graduates. Journal of teaching and learning for graduate employability, 2 (2), 41-
54.

Centers for Disease Control and Prevention. (2014). 10 things to know about new
autism data. Retrieved March 24, 2016 from
http://www.cdc.gov/features/dsautismdata/index.html

Charman, T., Baird, G., Simonoff, E., Loucas, T., Chandler, S., Meldrum, D., & Pickles,
A. (2007). Efficacy of three screening instruments in the identification of autistic-
spectrum disorders. The British Journal of Psychiatry, 191, 554-559.

Charmaz, K. & Belgrave, L. L. (2003). Qualitative interviewing and grounded theory

analysis. In J. F. Gubrium (Ed.), The SAGE handbook of interview research: The
complexity of the craft (pp. 247-266). Thousand Oaks, CA: SAGE Publications.

Chen, X., & French, D. C. (2008). Children’s social competence in cultural context.
Annual Review of Psychology, 59, 591-616.

131
Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & Schultz, R. T. (2012). The social
motivation theory of autism. Trends in Cognitive Science, 16 (4), 231-239.

Coleman, N., Hare, D. J., Farrell, P., & Van Manen, T. (2008). The use of the Social
Cognitive Skills Test with children with autistic spectrum disorders. Journal of
Intellectual Disabilities, 12 (1), 49-57.

Conroy, M. A., Boyd, B. A., Asmus, J. M., & Madera, D. (2007). A functional approach
for ameliorating social skills deficits in young children with autism spectrum
disorders. Infants & Young Children, 20 (3), 242-254.

Constantino, J. N., & Gruber, C. P. (2012). Social Responsiveness Scale, Second

Edition (SRS-2). Torrance, CA: Western Psychological Services.

Corbin, J. & Strauss, A. (1990). Grounded theory research: Procedures, canons, and
evaluative criteria. Qualitative Sociology, 13 (!), 3-21.

Coyne, I. T. (1997). Sampling in qualitative research. Purposeful and theoretical

sampling; merging or clear boundaries?. Journal of advanced nursing, 26(3),
623-630.

Crane, L., Chester, J. W., Goddard, L., Henry, L.A., & Hill, E. L. (2016). Experiences of
autism diagnosis: A survey of over 1000 parents in the United Kingdom.” Autism,
20 (2), 153-162.

Crosby, J. W. (2011). Test review: F. M. Gresham & S. N. Elliott Social Skills

Improvement System Rating Scales. Minneapolis, MN: NCS Pearson, 2008.
Journal of Psychoeducational Assessment, 29(3), 292-296.

Cunningham, A. B. (2012). Measuring change in social interaction skills of young

children with autism. Journal of Autism and Developmental Disorders, 42 (4),
593-605.

Dawson, G., Toth, K., Abbott, R., Osterling, J., Munson, J., Estes, A., & Liaw, J. (2004).
Early social attention impairments in autism: Social orienting, joint attention, and
attention to distress. Developmental Psychology, 40 (2), 271-283.

Drew, A., Baird, G., Taylor, E., Milne, E., & Charman, T. (2007). The Social
Communication Assessment for Toddlers with Autism (SCATA): An instrument to
measure the frequency, form, and function of communication in toddlers with
autism spectrum disorder. Journal of Autism and Developmental Disorders, 37
(4), 648-666.

132
Dworzynski, K., Happé, F., Bolton, P., & Ronald, A. (2009). Relationship between
symptom domains in autism spectrum disorders: A population based twin study.
Journal of Autism and Developmental Disorders, 39 (8), 1197-1210.

Dykstra, J. R., Boyd, B. A., Watson, L. R., Crais, E. R., & Baranek, G. T. (2012). The
impact of Advancing Social-communication and Play (ASAP) intervention on
preschoolers with autism spectrum disorder. Autism, 16 (1), 27-44.

Eaves, L. C., Wingert, H., & Ho, H. H. (2006). Screening for autism: Agreement with
diagnosis. Autism, 10 (3), 229-242.
Embregts, P. & van Nieuwenhuijzen, M. (2009). Social information processing in boys
with autistic spectrum disorder and mild to borderline intellectual disabilities.
Journal of Intellectual Disability Research, 53 (11), 922-931.

Feng, H., Lo, Y., Tsai, S., & Cartledge, G. (2008). The effects of theory-of-mind and
social skill training on the social competence of a sixth-grade student with autism.
Journal of Positive Behavior Interventions, 10 (4), 228-242.

Flick, U. (2009). An Introduction to Qualitative Research (4th ed.). Thousand Oaks, CA:
SAGE Publications.

Gibson, J., Hussain, J., Holsgrove, S., Adams, C., & Green, J. (2011). Quantifying peer
interactions for research and clinical use: The Manchester Inventory for
Playground Observation. Research in Developmental Disabilities, 32 (6), 2458-
2466.

Gillis, J. M., Callahan, E. H., & Romanczyk, R. G. (2011). Assessment of social

behavior in children with autism: The development of the Behavioral Assessment
of Social Interactions in Young Children. Research in Autism Spectrum
Disorders, 5 (1), 351-360.

Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure
of severity in autism spectrum disorders. Journal of Autism and Developmental
Disorders, 39 (5), 693-705.

Gotham, K., Pickles, A., & Lord, C. (2012). Trajectories of autism severity in children
using ADOS scores. Pediatrics, 130 (5), e1278-e1284.

Glaser, B. G. & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for
qualitative research. . New York, NY: Aldine de Gruyter.

Green, S. A., Ben-Sasson, A., Soto, T. W., & Carter, A. S. (2012). Anxiety and sensory
over-responsivity in toddlers with autism spectrum disorders: Bidirectional effects
across time. Journal of Autism and Developmental Disorders, 42 (6), 1112-1119.

133
Gresham, F. M. (1983). Social validity in the assessment of children’s social skills:
Establishing standards for social competency. Journal of Psychoeducational
Assessment, 1 (3), 299-307.

Gresham, F. M. & Elliott, S. N. (1988). Teachers’ social validity ratings of social skills:
Comparisons between mildly handicapped and nonhandicapped children.
Journal of Psychoeducational Assessment, 6 (3), 225-234.

Gresham, F. M., & Elliott, S. N. (2008). Social Skills Improvement System: Rating
scales manual. Minneapolis, MN: Pearson.

Harvey, V. S. (2006). Variables affecting the clarity of psychological reports. Journal of

Clinical Psychology, 62 (1), 5-18.

Hawken, L. S., Vincent, C. G., & Schumann, J. (2008). Response to intervention for
social behavior: Challenges and opportunities. Journal of Emotional and
Behavioral Disorders, 1-13.

Hobson, J. A. & Hobson, R. P. (2007). Identification: The missing link between joint
attention and imitation?. Developmental Psychopathology, 19 (02), 411-431.

Hobson, R. P., Lee, A., & Hobson, J. A. (2009). Qualities of symbolic play among
children with autism: A social-developmental perspective. Journal of Autism and
Developmental Disorders, 39 (1), 12-22.

Horsburgh, D. (2003). Evaluation of qualitative research. Journal of Clinical Nursing, 12.

307-312.

Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A
comparison of intensive behavior analytic and eclectic treatments for young
children with autism. Research in Developmental Disabilities, 26 (4), 359-383.

Hughes, J. (1990). Assessment of social skills: Sociometric and behavioral approaches.

In C. Reynolds & R. Kamphaus (Eds.), Handbook of psychological and
educational assessment of children (pp. 423-444). New York: Guilford.

Hus, V., Bishop, S., Gotham, K., Huerta, M., & Lord, C. (2013a). Commentary:
Advancing measurement of ASD severity and social competence: a reply to
Constantino and Frazier (2013). The Journal of Child Psychology and Psychiatry,
54 (6), 698-700.

Hus, V., Bishop, S. Gotham, K., Huerta, M., & Lord, C. (2013b). Factors influencing
scores on the Social Responsiveness Scale. Journal of Child Psychology and
Psychiatry, 54 (2), 216-224.

134
Isaksen, J., Diseth, T. H., Schjølberg, S., & Skjeldal, O. H. (2013). Autism spectrum
disorders--are they really epidemic?. European Journal of Pediatric Neurology,
17 (4), 327-333.

Jahr, E., Eikeseth, S., Eldevik, S., & Aase, H. (2007). Frequency and latency of social
interaction in an inclusive kindergarten setting: A comparison between typical
children and children with autism. Autism, 11 (4), 349-363.

Johnson, C. P., Myers, S. M., & the Council on Children with Disabilities. (2007).
Identification and evaluation of children with autism spectrum disorders.
Pediatrics, 120 (5), 1183-1215.

Kaczmarek, L. A. (2002). Assessment of social-communication competence: An

interdisciplinary model. In H. Goldstein, L.A. Kaczmarek & K. M. English (Eds.),
Promoting social communication: Children with developmental disabilities from
birth to adolescence (1st ed., Vol. 10, pp 55-115). Baltimore, MD: Paul H. Brooks
Publishing Co.

Kanne, S. (2013, May 28). [Web log message]. Retrieved from

http://www.autismspeaks.org/blog/2013/05/28/dsm-5-clinicians-perspective

Kasari, C., Paparella, T., Freeman, S., & Jahromi, L. B. (2008). Language outcomes in
autism: Randomized comparison of joint attention and play interventions. Journal
of Consulting and Clinical Psychology, 76 (1), 125-137.

Knott, F., Lewis, C., & Williams, T. (2007). Sibling interaction of children with autism:
Development over 12 months. Journal of Autism and Developmental Disorders,
37 (10), 1987-1995.

Kramer, J. M. (2011). Using mixed methods to establish social validity of a self-report

assessment: An illustration using the Child Occupational Self-Assessment
(COSA). Journal of Mixed Methods Research, 5 (1), 52-76.

Kwon, K., Kim, E. M., & Sheridan, S. M. (2012). A contextual approach to social skills
assessment in the peer group: Who is the best judge?. School Psychology
Quarterly, 27 (3), 121-133.

Laing, E., Butterworth, G., Ansari, D., Gsӧdl, M., Longhi, E., Panagiotaki, G., Paterson,
S., & Karmiloff-Smith, A. (2002). Atypical development of language and social
communication in toddlers with Williams syndrome. Developmental Science, 5
(2), 233-246.

Lane, K. L., Wehby, J. H., Cooley, C. (2006). Teacher expectations of students’

classroom behavior across the grade span: Which social skills are necessary for
success?. Exceptional Children, 72 (2), 153-167.

135
Laugeson, E. A., Frankel, F., Gantman, A., Dillon, A. R., & Mogil, C. (2012). Evidence-
based social skills training for adolescents with autism spectrum disorders: The
UCLA PEERS Program. Journal of Autism and Developmental Disorders, 42 (6),
1025-1036.

Le Couteur, A., Haden, G., Hammal, D., & McConachie, H. (2008). Diagnosing autism
spectrum disorders in pre-school children using two standardised assessment
instruments: The ADI-R and the ADOS. Journal of Autism and Developmental
Disorders, 38 (2), 362-372.

Leech, N. L. & Onwuegbuzie, A. J. (2007). An array of qualitative data analysis tools: A

call for data analysis triangulation. School Psychology Quarterly, 22 (4), 557-584.

Leko, M. M. (2014). The value of qualitative methods in social validity research.

Remedial and Special Education, 35 (5), 275-286.

Locke, J., Kasari, C., & Wood, J. J. (2013). Assessing social skills in early elementary-
aged children with autism spectrum disorders: The Social Skills Q-Sort. Journal
of Psychoeducational Assessment, XX (X), 1-15.

Lord, C., Wagner, A., Rogers, S., Szatmari, P., Aman, M., Charman, T.,…Yoder, P.
(2005). Challenges in evaluating psychosocial interventions for autistic spectrum
disorders. Journal of Autism and Developmental Disorders, 35 (6), 695-708.

Luiselli, J. K., Cannon, B. O., Ellis, J. T., & Sisson, R. W. (2000). Home-based
behavioral intervention for young children with autism/pervasive developmental
disorder: A preliminary evaluation of outcome in relation to child age and intensity
of service delivery. Autism, 4 (4), 426-438.

Lyst, A. M., Gabriel, S., O’Shaughnessy, T. E., Meyers, J., & Meyers, B. (2005). Social
validity: Perceptions check and connect with early literacy support. Journal of
School Psychology, 43 (2005), 197-218.

Martin, P. Y. & Turner, B. A. (1986). Grounded theory and organizational research. The
Journal of Applied Behavioral Science, 22 (2), 141-157.

Martins, M. P., & Harris, S. L. (2006). Teaching children with autism to respond to joint
attention initiations. Child & Family Behavior Therapy, 28 (1), 51-68.

Matson, J. L. (2007). Current status of differential diagnosis for children with autism
spectrum disorders. Research in Developmental Disabilities, 28 (2), 109-118.

Matson, J. L., Kozlowski, A. M., Neal, D., Worley, J. A., & Fodstad, J. (2011). Cutoffs for
the Matson Evaluation of Social Skills with Youngsters-II (MESSY-II) for typically
developing children and for children diagnosed with autism spectrum disorders.
Research in Autism Spectrum Disorders, 5 (2), 798-802.

136
Matson, J. L., & Smith, K. R. M. (2008). Current status of intensive behavioral
interventions for young children with autism and PDD-NOS. Research in Autism
Spectrum Disorders, 2 (1), 60-74.

Matson, J. L., & Wilkins, J. (2007). A critical review of assessment targets and methods
for social skills excesses and deficits for children with autism spectrum disorders.
Research in Autism Spectrum Disorders, 1 (1), 28-37.

McClelland, M. M., Morrison, F. J., Holmes, D. L. (2000). Children at risk for early
academic problems: The role of learning-related social skills. Early Childhood
Research Quarterly, 15 (3), 307-329.

Merrell, K. W. (2001). Assessment of children’s social skills: Recent developments, best

practices, and new directions. Exceptionality, 9 (1 & 2), 3-18.

Messick, S. (1989). Meaning and values in test validation: The science and ethics of
assessment. Educational Researcher, 18 (2), 5-11.

Meyer, G. J., Finn, S. E., Eyde, L. D., Kay, G. G., Moreland, K. L., Dies, R. R., … Reed,
G. M. (2001). Psychological testing and psychological assessment: A review of
evidence and issues. American Psychologist, 56 (2), 128-165.

Montgomery, P. & Bailey, P. H. (2007). Field notes and theoretical memos in grounded
theory. Western Journal of Nursing Research, 29 (1), 65-79.

Mukaddes, N. M., Kaynak, F. N., Kinali, G., Besikci, H., & Issever, H. (2004).
Psychoeducational treatment of children with autism and reactive attachment
disorder. Autism, 8 (1), 101-109.

Mundy, P. & Crowson, M. (1997). Joint attention and early social communication:
Implications for research on intervention with autism. Journal of Autism and
Developmental Disorders, 27(6), 653-676.

Mundy, P., Delgado, C., Block, J., Venezia, M., Hogan, A., & Siebert, J. (2003). A
manual for the abridged Early Social Communication Scales (ESCS). Coral
Gables, FL: University of Miami.

Mundy, P., Sigman, M., Ungerer, J., & Sherman, T. (1986). Defining the social deficits
of autism: The contribution of non-verbal communication measures. Journal of
Child Psychology and Psychiatry, 27(5), 657-669.

Murray, D. S., Ruble, L. A., Willis, H., Molloy, C. A. (2009). Parent and teacher report of
social skills in children with autism spectrum disorders. Language, Speech, &
Hearing Services in Schools, 40 (2), 109-115.

137
National Research Council. (2001). Educating children with autism. Washington, DC:
National Academy Press, Committee on Educational Interventions for Children
with Autism, Division of Behavioral and Social Sciences and Education.

Oke, N. J., & Schreibman, L. (1990). Training social initiations to a high-functioning

autistic child: Assessment of collateral behavior change and generalization in a
case study. Journal of Autism and Developmental Disorders, 20 (4), 479-497.

Ozonoff, S., Goodlin-Jones, B. L., & Solomon, M. (2005). Evidence-based assessment

of autism spectrum disorders in children and adolescents. Journal of Clinical
Child & Adolescent Psychology, 34 (3), 523-540.

Perry, A., Flanagan, H. E., Geier, J. D., & Freeman, N. L. (2009). Brief report: The
Vineland Adaptive Behavior Scales in young children with autism spectrum
disorders at different cognitive levels. Journal of Autism and Developmental
Disorders, 39 (7), 1066-1078.

Peterson, C. C., Wellman, H. M., & Slaughter, V. (2012). The mind behind the message:
Advancing theory-of-mind scales for typically developing children, and those with
deafness, autism, or Asperger Syndrome. Child Development, 83 (2), 469-485.

Philofsky, A., Fidler, D. J., & Hepburn, S. (2007). Pragmatic language profiles of school-
age children with autism spectrum disorders and Williams Syndrome. American
Journal of Speech-Language Pathology, 16, 368-380.

Pinto-Martin, J. A., Levy, S. E., Feldman, J. F., Lorenz, J. M., Paneth, N., & Whitaker, A.
H. (2011). Prevalence of autism spectrum disorder in adolescents born weighing
<2000 grams. Pediatrics, 128 (5), 883-891.

Pollio, H., Henley, T., & Thompson, C. (1997). The phenomenology of everyday life.
Cambridge, England: Cambridge University Press.

Prizant, B. M., Wetherby, A. M., Rubin, E., Laurent, A. C., & Rydell, P. J. (2006). The
SCERTS model: A comprehensive educational approach for children with autism
spectrum disorders. Baltimore, MD: Paul Brookes.

Rao, P. A., Beidel, D. C., & Murray, M. J. (2008). Social skills interventions for children
with Asperger’s Syndrome or high-functioning autism: A review and
recommendations. Journal of Autism and Developmental Disorders, 38(2), 353-
361.

Reamer, R. B., Brady, M. P., & Hawkins, J. (1998). The effects of video self-modeling
on parents’ interactions with children with developmental disabilities. Education &
Training in Mental Retardation & Developmental Disabilities, 33 (2), 131-143.

138
Remington, B., Hastings, R. P., Kovshoff, H., degli Espinosa, F., Jahr, E., Brown, T.,
Alsford, P., Lemaic, M., & Ward, N. (2007). Early intensive behavioral
intervention: Outcomes for children with autism and their parents after two years.
American Journal on Mental Retardation, 112 (6), 418-438.

Renk, K., & Phares, V. (2004). Cross-informant ratings of social competence in children
and adolescents. Clinical Psychology Review, 24 (2004), 239-254.

Richman, D. M., Reese, R. M., & Daniels, D. (1999). Use of evidence-based practices
as a method for evaluating the effects of secretin on a child with autism. Focus
on Autism & Other Developmental Disabilities, 14 (4), 204-211.

Rojahn, J., Matson, J. L., Mahan, S., Fodstsad, J. C., Knight, C., Sevin, J. A., & Sharp,
B. (2009). Cutoffs, norms, and patterns of problem behaviors in children with an
ASD on the Baby and Infant Screen for Children with aUtism Traits (BISCUIT-
Part 3). Research in Autism Spectrum Disorders, 3 (4), 989-998.

Romanczyk, R. G., Diament, C., Goren, E. R., Trunell, G., & Harris, S. L. (1975).
Increasing isolate and social play in severely disturbed children: Intervention and
postintervention effectiveness. Journal of Autism and Childhood Schizophrenia, 5
(1), 57-70.

Roulston, K. (2010). Reflective interviewing: A guide to theory & practice. Los Angeles,
CA: SAGE Publications.

Salvia, J., Ysseldyke, J. E., &amp; Bolt, S. (2010). Assessment in special and inclusive
education. (11th ed.). Belmont, CA: Wadsworth Cengage Learning.

Schanding, G. T., Nowell, K. P., & Goin-Kochel, R. P. (2012). Utility of the Social
Communication Questionnaire-Current and the Social Responsiveness Scale as
a teacher-report screening tools for autism spectrum disorders. Journal of Autism
and Developmental Disorders, 42 (8), 1705-1716.

Seltzer, M. M., Krauss, M. W., Shattuck, P. T., Orsmond, G., Swe, A., & Lord, C. (2003).
The symptoms of autism spectrum disorders in adolescence and adulthood.
Journal of Autism and Developmental Disorders, 33 (6), 565-581.

Sheridan, S. M., Hungelmann, A., & Maughan, D. P. (1999). A contextualized

framework for social skills assessment, intervention, and generalization. School
Psychology Review, 28 (1), 84-103.

Social Communication Questionnaire (SCQ). (n.d.). Retrieved from

http://portal.wpspublish.com/portal/page?_pageid=53,70432&_dad=portal&_sche
ma=PORTAL

139
Soke, G. N., Philofsky, A., Diguiseppi, C., Lezotte, D., Rogers, S., Hepburn, S. (2011).
Longitudinal changes in scores on the Autism Diagnostic Interview-Revised (ADI-
R) in pre-school children with autism: Implications for diagnostic classification
and symptom stability. Autism, 15 (5), 545-562.

Sparrow, S. S., Cicchetti, D. V., &amp; Balla, D. A. (2005). Vineland-II, Vineland

Adaptive Behavior Scales, Second Edition: Survey Forms Manual. Bloomington,
MN: Pearson.

Stavropoulos, K. K. M. & Carver, L. J. (2013). Research review: Social motivation and

oxytocin in autism -- implications for joint attention development and intervention.
Journal of Child Psychology and Psychiatry, 54 (6), 603-618.

Strain, P. S., Kerr, M. M., & Ragland, E. U. (1979). Effects of peer-mediated social
initiations and prompting/reinforcement procedures on the social behavior of
autistic children. Journal of Autism and Developmental Disorders, 9 (1), 41-54.

Strauss, A. & Corbin, J. (1990). Basics of Qualitative Research. Newbury Park, CA:
SAGE Publications.

Szatmari, P., Bryson, S. E., Boyle, M. H., Streiner, D. L., & Duku, E. (2003). Predictors
of outcome among high functioning children with autism and Asperger
Syndrome. Journal of Child Psychology and Psychiatry, 44 (4), 520-528.

van Buijsen, M., Hendriks, A., Ketelaars, M., & Verhoeven, L. (2011). Assessment of
theory of mind in children with communication disorders: Role of presentation
mode. Research in Developmental Disabilities, 32, 1038-1045.

Weiss, M. J. & Harris, S. L. (2001). Teaching social skills to people with autism.
Behavior Modification, 25(5), 785-802.

White, S. W., Keonig, K., & Scahill, L. (2007). Social skills development in children with
autism spectrum disorders: A review of the intervention research. Journal of
Autism and Developmental Disorders, 37(10), 1858-1868.

White, S. W., Ollendick, T., Scahill, L., Oswald, D., & Albano, A. M. (2009). Preliminary
efficacy of a cognitive-behavioral treatment program for anxious youth with
autism spectrum disorders. Journal of Autism and Developmental Disorders, 39
(12), 1652-1662.

White, S. W. & Roberson-Nay, R. (2009). Anxiety, social deficits, and loneliness in

youth with autism spectrum disorders. Journal of Autism and Developmental
Disorders, 39 (7), 1006-1013.

140
Whitehouse, A. J. O., Barry, J. G., & Bishop, D. V. M. (2007). The broader language
phenotype of autism: A comparison with specific language impairment. Journal of
Child Psychology and Psychiatry, 48 (8), 822-830.

Wimpenny, P. & Gass, J. (2000). Interviewing in phenomenology and grounded theory:

Is there a difference?. Journal of Advanced Nursing, 31 (6), 1485-1492.

Winner, M. G. (n.d.). Why do we use the expected-unexpected Social Thinking

vocabulary? Retrieved June 4, 2016, from
https://www.socialthinking.com/Articles?name=Why%20do%20We%20Use%20t
he%20Expected-Unexpected%20Social%20Thinking%20Vocabulary%20Article

Winner, M. G. (2007). Thinking about you, thinking about me. San Jose, CA: Think
Social Publishing, Inc.

Witzel, A. (2000). The problem-centered interview. Forum Qualitative Sozialforschung /

Forum: Qualitative Social Research, 1 (1). Retrieved
from http://www.qualitative-research.net/index.php/fqs/article/view/1132
Zenko, C. B., & Hite, M. P. (2014). Here’s how to provide intervention for children with
autism spectrum disorder: A balanced approach. San Diego, CA: Plural
Publishing, Inc.

141
 BIOGRAPHICAL SKETCH

Colleen Margaret Butcher was born in Albuquerque, New Mexico. Daughter of

James (Jim) and Mary Beth, she grew up as the oldest of three children. She spent her

late childhood and adolescent years in Cooper City, Florida, and graduated from St.

Thomas Aquinas High School in 2002. From there, she went on to attend the University

of Florida, in Gainesville, Florida. Colleen graduated in 2006, earning a Bachelor of

Science degree (B.S.) in psychology, and a minor in education. Afterward, Colleen

began her graduate studies at the University of Florida, earning a Master of Arts in

Education degree in 2008, in foundations of education. She then taught elementary

school, in Broward County, Florida. She returned to graduate school at the University of

Florida, in 2010, in the School Psychology Program. Through the last six years, she has

completed several practicum experiences across public schools and clinical and

hospital settings. Throughout these experiences, she acquired training in the areas of

assessment, intervention, and consultation. Specifically, she specialized in working with

children with neurodevelopmental disabilities, and in particular, children with Autism

Spectrum Disorder. To finalize her graduate training, Colleen completed a 12-month

internship at the University of New Mexico Health Sciences Center, in Albuquerque,

New Mexico, with an emphasis in neurodevelopmental disabilities. Colleen obtained her

Doctor of Philosophy degree (Ph.D.) in school psychology from the University of Florida

in August 2016. She will be completing post-doctoral training as a clinical fellow in the

Department of Behavioral Pediatrics at the Medical University of South Carolina.

142