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Effect of a brief online shared reading ıntervention to support communication skills of children with Autism Spectrum Disorder Otizm Spektrum Bozukluğu olan çocukların iletişim becerilerini desteklemeye yönelik etkileşimli kitap okuma müdahalesinin etkililiğinin incelenmesi

Article Type Research Article Abstract: Shared interactive book reading (SIBR) is an evidence-based practice for young children with developmental disabilities such as autism spectrum disorder (ASD). Children with ASD can benefit from structured activities such as SIBR, especially when they are supported by their parents. During SIBR, parents can support their children’s language and communication skills by engaging with them around a storybook. Parents can create opportunities for communication by commenting on the story, asking a question, and pointing at the pictures. In the current telepractice (internet-based) study, three parents and three children with ASD participated in the study. In a single-case multiple-baseline across subjects design, parents were trained to use expectant pause and mand-model strategy with their children. Parents’ frequency in use of the strategies increased during intervention. All three children increased their initiating and responding behaviors upon their parents’ use of strategies.


INTRODUCTION
Children with autism spectrum disorder (ASD) might have challenges developing and/or using communication skills. Communication skills are essential to request, reject, and protest something or someone. Challenges in communication may lead to lack of friendships and expression problems that may cause problem behaviors. For these reasons, developing and using communication skills effectively are very important. This is especially true for children with ASD (Warren, 2000). The development of communication skills in children with ASD remains a serious challenge for families and professionals. There is a great need for targeted communication interventions. Parents are essential in provision of naturalistic interventions because they can provide important social experiences and opportunities for the child to practice communication skills. Children with ASD may have difficulty in interaction and fewer opportunities for social communication activities such as storybook reading (Akemoglu, Meadan, & Towson, 2020a). Because communication skills are essential and functional, children with ASD should receive interventions that directly address this area of need. While the communication and language profiles of children with ASD may differ from other children, they have been shown to benefit from interventions that from natural, daily routines, such shared interactive book reading (SIBR).
Early communication interventions are proven to be effective for children with ASD and it is crucial to deliver these interventions as early as possible (Akamoglu & Meadan, 2018). Researchers reported that children with ASD benefit from early communication interventions that occur early in life, through their daily routines and activities, and with familiar people such as family members.
In this regard, parents can be key partners to facilitate these interventions. Parents can learn and implement naturalistic communication teaching (NCT) strategies such as mand-model and expectant pause (time delay) via parent-implemented interventions at home (Akamoglu & Meadan, 2018). Mand-model is a form of a request for a response, a question, or a choice (Akamoglu & Meadan, 2019).
Shared interactive book reading (SIBR), is a daily routine and a naturalistic activity in which parents can support language and communication of their children by using the NCT strategies. Reading storybooks with young children (ages between 0-6) is a commonly used strategy to promote language and emergent literacy skills. SIBR is a naturalistic activity in which families have in their routines. Thus, SIBR is an activity in which adults can promote a child's communication skills (Akemoglu & Tomeny, 2021). In shared reading, the goal is to exchange communication based on balanced interactions between an adult and a child (Akamoglu & Meadan, 2019). When a child actively participates in shared reading, he or she is more likely to improve communication skills such joint attention, pointing, and responding (Coogle et al., 2018;D'Agostino et al., 2020). In Although, parents can use SIBR as an ideal context to promote communication skills of young children with ASD, they may need individual support to learn to implement strategies with high quality. These supports can be in person (face-to-face) or online from a distance (telepractice).

| AKEMOĞLU
However, in person support may not always be possible, especially due to crisis such as pandemics  (2015) reported that children had higher rates of initiations in followup. In another telepractice study, Vismara et al. (2013) found that telepractice was effective to support children's verbal and nonverbal communication.
The current study is part of a series of telepractice-based shared reading interventions conducted with families of children with developmental disabilities. The main purpose of this study was to examine the effect of telepractice-based parent coaching on parents' correct use of NCT strategies with their children with ASD during SIBR. The second purpose of this study was to examine the effect of parent-implemented intervention on children's specific social communication outcomes such as responding and initiating. The following research questions were examined: 1. Is there a functional relation between coaching parents to use specific naturalistic language teaching strategies (mand-model and expectant pause) during SIBR and an increase in their frequency of their strategy use?
2. Does participation in parent-implemented communication strategies increase children's use of communication targets during SIBR?

METHOD Participants
Participants were three children with ASD and their parents. Participants were recruited via early intervention programs and clinics, other early intervention providers, and disability groups in the State of Alabama (United States). Interested parents contacted the researcher. The researcher made eligibility determination based on the following inclusion criteria for participation: (1) chronological age between 3-5 years; (2) diagnosis of ASD based on their Individualized Education Plan; (3) minimally verbal children with a vocabulary of at least 25 words reported by the parent; (4) interest in storybooks; (6) access to high-speed internet. Six parents contacted the researcher and three children with ASD, and their mothers were eligible to participate in the study.

Child Participants
The three children (two males and one female) who participated in this study ranged in age from  (Fenson et al., 2002) assessment. See Table 1 for more demographic and assessment information.

Parent Participants
Three mothers participated in the study, and they ranged in age from 29 to 37 years. Kelsey's mother Jenna and Kyle's mother Rita had bachelor's degree and were stay-at-home moms, Alex's mother Peggy had a master's degree and she worked full-time outside of the home. Pseudonym names were used to maintain confidentiality. See Table 2 for demographic information.

Storybooks
The researcher sent storybooks to each family. Two books were used for the baseline and maintenance sessions and four books were used during the intervention sessions. All dyads used the same storybooks for each phase of the study. The books were age appropriate, had more illustration than text, and allowed for communication opportunities between parents and children.
Each book had a different story about cars, animals, or other characters.

Research Design
A single-subject, multiple-baseline design across three parent-child dyads was used (Kazdin, 2011).
By using this design, we aimed to examine whether the independent variable (parents' use of SIBR intervention) was effective on teaching children new communication skills. We used a multiple baseline design that introduced the intervention in three points across three subjects which allowed to prevent threats to internal validity (Kazdin, 2011).

Baseline
During the baseline sessions, parents were provided two books that was different from those used during the intervention sessions. Parents were instructed to "read the book as you normally would." The number of baseline sessions varied across participants and each session lasted 4 min on average.

Intervention
Target Strategies. Parents learned two strategies: expectant pause and mand-modeling. Expectant pause is a form of waiting expectantly. the parent pauses to give the child an opportunity to initiate communication. The parent must do the following while using expectant pause strategy: point to an illustration on the book, leave a phrase or sentence blank, and look at the child expectantly for at least 5 seconds. For example, the parent points at the picture of a "gorilla", says, "This is a______," and the child fills in the blank by saying, "Gorilla." Mand-model is a verbal prompt that is used to elicit responses from the child. It can be used as an open-ended question (e.g., "What do you see on the book?"), a choice question (e.g., "Is this a car or a train?"), or a mand (e.g., "Say 'car").

Procedural Fidelity
Fidelity of implementation of the training session was measured. A fidelity checklist with all procedural steps of the training was completed by the researcher during each session. A master's student in special education served as the secondary observer and independently completed the checklist. Fidelity of implementation for the training sessions was measured as 100%.

Maintenance
Maintenance data was collected to assess whether parents continued using the strategies after the intervention and if effects of the intervention continued. Two maintenance sessions were conducted two weeks after the intervention ended. The procedures were identical to the baseline sessions and parents were provided the same books as in baseline.

Social Validity
Social validity was measured by having parents complete a written questionnaire after the intervention phase to indicate whether the intervention was acceptable and feasible for them and whether they would maintain using the strategies. All three parents completed a Likert-type scale questionnaire about training, strategies, and outcomes. Parents were also asked if they enjoyed the intervention with their children.

Observational Data Coding
Each strategy (expectant pause and mand-model) was tally coded based on occurrence using a coding form. Thus, we collected data on how many times the parent used each strategy within each phase. Child data was collected on verbal (e.g., responding) and nonverbal (e.g., gesturing, pointing) initiations and responses. Child responses were coded per occurrences upon the parent's use of a strategy Each number of child response or initiation behavior was tally coded and recorded to measure frequency.

Interobserver Agreement (IOA)
IOA was collected on observed data, and it was assessed by coding the data by two team members.
The author (researcher) coded all the observational parent and child data based on a coding manual.
Then, the author trained a secondary coder (master's student) to code the data. To train the

Effect of a brief online shared reading ıntervention to support communication skills…
Erken Çocukluk Çalışmaları Dergisi Cilt 5· Sayı 2· Ekim 2021 Journal of Early Childhood Studies Volume 5· Issue 2· October secondary coder, the author met with the secondary coder to code a video together. Next, he assigned her another video to code, and they met and discussed the agreements and disagreements.
Then, the secondary coder was assigned 30% of all the sessions. IOA calculation formula was agreements divided by agreements and disagreements and multiplied by 100. Overall, IOA ranged between 80% and 96% with a mean of 88%.

Data Analysis
Parents' implementation of strategies was specifically measured for (a) expectant pause; and (b) mand-model. Visual analysis was conducted to analyze if there a functional relation between the intervention and parent and child outcomes (Kazdin, 2011). For example, visual inspection (analysis) of the slope helped us to interpret the data trends. Visual inspection of changes in the slope was used to measure variability in the data. Levels and intervention effect was measured by looking at the means of the intervention sessions.

Ethical Approval of Research
All rules stated to be complied with within the scope of "Higher Education Institutions Scientific Research and Publication Ethics Directive" were followed in this study. None of the actions mentioned under the heading of "Actions Against Scientific Research and Publication Ethics", which is the second part of the directive, have been carried out.

Ethics committee approval information (Institutional Review Board approval):
Ethical approval committee name= The University of Alabama Date of ethical approval decision= December 19, 2019 Ethical approval document number= 18-011-R1 and 20-03-3411 As demonstrated through visual inspection, all three parents consistently increased their frequency of strategy use. While Alex's mother had an increasing trend during intervention, Kelsey's mother made the largest overall level gain in intervention phase compared to baseline level. She had an overall increasing trend with a higher level in mand-model strategy. As shown in Figure 1, all three parents demonstrated some decrease in their mand-model strategy use in the maintenance phase.

Figure 1 depicts that Alex and
However, their use of expectant pause and mand-model strategy was at the same average mean as in the intervention phase. Overall, there was a clear increase in parents' frequency of strategy use from baseline to intervention. Parents also maintained their frequency of strategy use at a higher rate than baseline level during the maintenance phase.

Child Results
Children The difference between responses and initiations was not significant yet still expected due to the nature of ASD.
As shown in Figure 2, all three children had stable baseline data with limited variability. In terms of mean frequency, Alex's mean level was the lowest with one or fewer communication skills.
Although Alex and Kyle's initiation data had minimal immediate increases from baseline to intervention during intervention, their data demonstrated an upward trend. Moreover, their mean frequencies were higher in intervention compared to the baseline phase. As such, while Alex's response data showed an increase and variability during intervention phase, his data was followed with a decrease during maintenance phase. Similarly, Kyle's response act data showed an upward trend, and his level was higher during intervention compared to the baseline phase. Kyle's frequency of targets was at a steady level. Kelsey's data on communication targets were followed with upward trends during intervention with the level of initiation being lower than the response level. She maintained both targets in the maintenance phase.

Social Validity Data
The satisfaction survey was completed by all three parents. The participating parents reported satisfaction with goals, procedures, and outcomes. The parents noted that the training they received was effective to enhance their knowledge and refine their implementation skills. They also noted that they observed positive progress in their children's communication outcomes. All three