Examining the Effectiveness of an Outpatient Clinic–Based Social Skills Group for High-Functioning Children with Autism

Although social skills group interventions for children with autism are common in outpatient clinic settings, little research has been conducted to determine the efficacy of such treatments. This study examined the effectiveness of an outpatient clinic-based social skills group intervention with four high-functioning elementary-aged children with autism. The group was designed to teach specific social skills, including greeting, conversation, and play skills in a brief therapy format (eight sessions total). At the end of each skills-training session, children with autism were observed in play sessions with typical peers. Typical peers received peer education about ways to interact with children with autism. Results indicate that a social skills group implemented in an outpatient clinic setting was effective in improving greeting and play skills, with less clear improvements noted in conversation skills. In addition, children with autism reported increased feelings of social support from classmates at school following participation in the group. However, parent report data of greeting, conversation, and play skills outside of the clinic setting indicated significant improvements in only greeting skills. Thus, although the clinic-based intervention led to improvements in social skills, fewer changes were noted in the generalization to nonclinic settings.     

Training Paraprofessionals to Improve Socialization in Students with ASD

An important line of research relates to whether school personnel, such as paraprofessionals, who are present during unstructured social periods, such as lunch-recess, could successfully implement interventions to improve socialization between students with ASD and their typical peers in a group setting. Therefore, within the context of a multiple baseline across participants design, we assessed whether training paraprofessionals to provide social interventions would enhance social development in students with ASD in a group setting. Results showed that paraprofessionals who were not providing any social opportunities during baseline were able to meet fidelity of implementation following a brief training. Consequently, the children with ASD increased their levels of engagement and rates of initiation with typically developing peers following intervention. Implications for training paraprofessionals to implement effective social interventions for students with ASD are discussed.     

A peer-mediated intervention with clinic-referred socially isolated girls. Generalization, maintenance, and social validation

Peer-mediated interventions have been widely employed with seriously impaired autistic and handicapped children to modify social withdrawal. This study extends the literature by examining the impact of a peer intervention on the interactions of developmentally normal, socially isolated girls. Two to three actual classroom peers were trained to serve as helpers to initiate and maintain interactions with the subjects. The intervention was introduced sequentially across 2 girls in a multiple-baseline design, and a within-subject ABA withdrawal design was used to assess maintenance. Behavioral observations during recess periods indicated that both children's positive social interactions with peer helpers and other classmates were increased significantly during intervention and were maintained in return-to-baseline conditions and at 4-month follow-up. Increases in positive social interactions of both subjects generalized to a second recess setting, in which intervention was not introduced. Subjects' interactions in both recess settings reached levels comparable to those of social-comparison groups of peers. Teacher and self-report ratings suggested that both girls had fewer social problems and experienced less loneliness and dysphoria as a result of the intervention.     

A Comparison of Two Group-Delivered Social Skills Programs for Young Children with Autism

A social skills group intervention was developed and evaluated for young children with autism. Twenty-five 4- to 6-year-old (diagnosed) children were assigned to one of two kinds of social skills groups: the direct teaching group or the play activities group. The direct teaching group used a video-modeling format to teach play and social skills over the course of the intervention, while the play activities group engaged in unstructured play during the sessions. Groups met for 5 weeks, three times per week, 1 h each time. Data were derived and coded from videotapes of pre- and post-treatment unstructured play sessions. Findings indicated that while members of both groups increased prosocial behaviors, the direct teaching group made more gains in social skills.     

Implications of Aggressive Children's Positively Biased Relatedness Views for Future Relationships

The present study examined the tendency of aggressive children to generalize the positive bias in their perceptions of relatedness across different interpersonal relationships. Secondly, it examined the implications of distorted perceptions of relatedness for quality of aggressive children's future relationships. Subjects included 62 second and third grade children nominated and rated by teachers as aggressive. Self- and others' appraisals of relationship quality were gathered across four interpersonal domains (i.e., mother, teacher, mentor, and peer). Children's positively biased perceptions of social relatedness were concordant across adult relationship domains but not across the peer domain, suggesting that children's relationships with adults and peers represent somewhat distinct socialization contexts. As expected, children who inflate levels of social relatedness establish less close relationships with novel partners (mentors). The findings emphasize the need for clinicians to focus on mental representations while planning interventions with aggressive children.     

Using Peer-Mediated LEGO® Play Intervention to Improve Social Interactions for Chinese Children with Autism in an Inclusive Setting

The purpose of this study was to examine the effects of a peer-mediated LEGO® play intervention on improving social skills for children with ASD in an inclusive preschool in China. Three boys with ASD and 13 typically developing children participated in this study. A multiple-probe across participants design was used. The intervention consisted of LEGO® construction activities incorporated with peer-mediated strategies for one child with ASD and two typically developing peers. The intervention sessions were conducted two sessions per week with a total of 28–31 sessions for each participant. Results indicated that all three children with ASD increased their social initiations and responses following the completion of the intervention. Social validity was also obtained.     

Parent-to-parent teaching

The effectiveness of using parents as interventionists for their children and other parents was examined. A multiple baseline design was employed to measure the effects of specific intervention techniques on teaching skills of three parents of toddler-aged children with Down syndrome. The first parent was trained by a professional interventionist on the use of the techniques. This parent then trained a second parent, who then trained a third parent. A fidelity-of-implementation measure indicated that the parents implemented the training procedures appropriately when training another parent. The effectiveness of the intervention techniques was measured through an observational code that assessed parent and child behavior during teaching sessions. Results suggest that training had a functional effect on the parents' use of the selected intervention techniques. The intervention also had a functional effect on the children's percentage of correct responding during the teaching session.     

Randomized trial of a program to enhance the competencies of children with epilepsy

A randomized, controlled trial was conducted in Santiago, Chile to test the impact of a child-centered, family-focused educational program for children aged 7-14 years with epilepsy and for their parents. The objectives of the program developed and pilot-tested in Los Angeles, California were to increase the children's knowledge, perceptions of competency, and skills related to dealing with seizures. Children in the experimental group (n = 123) and their parents separately attended four 1 1/2-h sessions and then met together at the end of each session to share learning experiences. Control children (n = 113) and their parents attended three 2-h sessions with a traditional lecture followed by question-and-answer format. All participants were pretested and then retested 5 months after completion of the educational intervention. Although there was some knowledge increase among children in the control group, the knowledge of children in the experimental group was significantly enhanced in a variety of areas related to management of their seizures and unnecessary restriction of their social and play activities. There was a significant increase in the self-perceptions of social competency of children in the experimental group. Children in the experimental group without serious behavioral problems also reported significantly better behavior after the intervention than did control children. There was no impact on children's disclosure of their diagnosis to friends and others.     

Effects of peer-mediated social initiations and prompting/reinforcement procedures on the social behavior of autistic children

Peer-mediated social initiations and prompting/reinforcement procedures were evaluated (in training and generalization sessions) as interventions for increasing the positive social behavior of four autistic children. During base-line, the peer trainer made few social initiations and did not prompt or socially reinforce subjects. For two subjects, baseline was followed by social initiation intervention, and for the other two, baseline was followed by prompting and social reinforcement. Both interventions produced dramatic and comparable increases in positive social behavior in training sessions. Post-treatment responding was not observed for either intervention. When interventions terminated in a second baseline period, the subjects' behavior returned to the level observed during the initial baseline. The subjects were then exposed to the intervention procedure they had not yet experienced. Again, there were positive and comparable behavior changes in the treatment setting, but no increase in positive social behavior was observed during generalization assessment.     

Increasing social skills and pro-social behavior for three children diagnosed with autism through the use of a teaching package

This study assessed the effectiveness of a Teaching Interaction procedure for four social skills across three participants diagnosed with autism. All social skills fell into four broad domains (i.e., social-communication, play, emotion skills, and choice/selection skills). In addition, a teaching package was used to increase communication between the three participants and three selected target peers. The teaching package consisted of the Teaching Interaction procedure, reinforcement, and priming of participants to demonstrate social skills and to engage with their target peers. Prior to intervention, participants displayed near zero levels of the four social skills that were targeted; after intervention, all three participants were able to demonstrate these skills. Prior to intervention, participants did not communicate or play with their selected target peer; after intervention, participants were able to increase the amount of play and communication. A multiple baseline design showed that the teaching package was effective in teaching both the targeted social skills and in increasing the development of initial associations that could lead to friendships for three children diagnosed with autism.     

Group Play Therapy for Young Children Exposed to Major Stressors: Comparison of Quantitative and Qualitative Evaluation Methods

Examined the outcome of a 16-week play group therapy intervention for six highly stressed preschool-aged children compared to a preschool-aged control group. The focus of the group was to help the children build social skills, learn to express emotions appropriately, increase understanding of stress events, and learn new coping skills. The results indicated a significant increase in anxious and externalizing behaviors during the course of the intervention for the treatment group subjects compared to controls. Furthermore, group treatment subjects also indicated a significant increase in social skills during the group intervention. However, there were no significant differences on the psycho-social measure from pre-test to post-test. Despite the lack of differences on quantitative measures of children's functioning, parent report on a qualitative measure indicated improvement in children's psycho-social functioning at the end of treatment. Implications of the play therapy group approach for children exposed to major stressors are discussed.     

Promoting the peer-related social development of young children with mild developmental delays: effectiveness of a comprehensive intervention

To address the unusual peer-related social competence difficulties characteristic of young children with mild developmental delays, we conducted a randomized clinical trial to evaluate the effectiveness of a comprehensive, developmentally oriented, highly individualized intervention extending over a 2-year period. Outcome measures emphasized generalization of peer interactions in unfamiliar playgroups. Results revealed modest effects of the intervention, with children who had lower cognitive levels benefiting most. Intervention effects were best conceptualized as preventative, minimizing the negative features and atypical patterns of children's social play with peers. Our discussion of future work was focused on alternative implementation models to enhance intervention intensity, inclusion of specific subgroups of children, and direct measurement of children engaging in social tasks.     

The social behavior of autistic children with younger and same-age nonhandicapped peers

Results of a study observing autistic children's interactions with nonhandicapped and autistic peers are reported. Six 8- to 12-year-old autistic children played in dyads with younger, normally developing kindergarten children and with nonhandicapped peers matched on chronological age for 10 15-minute sessions spaced over 3 weeks and then with a playmate of the alternate age for another 10 sessions. After intervention, all subjects showed gains in proximity, orientation, and responsiveness when playing with nonhandicapped peers and with autistic classmates. Same-age nonhandicapped playmates initiated more frequently than did younger nonhandicapped playmates and were better able to modify their initiations in ways that increased the likelihood of response from the autistic children.     

Enhancing Social Initiations Using Naturalistic Behavioral Intervention: Outcomes from a Randomized Controlled Trial for Children with Autism

Deficits in social skills are common in children with Autism Spectrum Disorder (ASD), and there is an urgent need for effective social skills interventions, especially for improving interactions with typically developing peers. This study examined the effects of a naturalistic behavioral social skills intervention in improving social initiations to peers through a randomized controlled trial. Analyses of multimethod, multi-informant measures indicated that children in the active group (SIMI) demonstrated greater improvement in the types of initiations which were systematically prompted and reinforced during treatment (i.e., behavior regulation). Generalization to joint attention and social interaction initiation types, as well as collateral gains in broader social functioning on clinician- and parent-rated standardized measures were also observed.

     

Prefrontal cerebral blood volume patterns while playing video games--a near-infrared spectroscopy study

Video game playing is an attractive form of entertainment among school-age children. Although this activity reportedly has many adverse effects on child development, these effects remain controversial. To investigate the effect of video game playing on regional cerebral blood volume, we measured cerebral hemoglobin concentrations using near-infrared spectroscopy in 12 normal volunteers consisting of six children and six adults. A Hitachi Optical Topography system was used to measure hemoglobin changes. For all subjects, the video game Donkey Kong was played on a Game Boy device. After spectroscopic probes were positioned on the scalp near the target brain regions, the participants were asked to play the game for nine periods of 15s each, with 15-s rest intervals between these task periods. Significant increases in bilateral prefrontal total-hemoglobin concentrations were observed in four of the adults during video game playing. On the other hand, significant decreases in bilateral prefrontal total-hemoglobin concentrations were seen in two of the children. A significant positive correlation between mean oxy-hemoglobin changes in the prefrontal region and those in the bilateral motor cortex area was seen in adults. Playing video games gave rise to dynamic changes in cerebral blood volume in both age groups, while the difference in the prefrontal oxygenation patterns suggested an age-dependent utilization of different neural circuits during video game tasks.     

Parent-child predictors of social competence with peers in children with and without autism

The current study investigated the relations among parent-child joint engagement, dyadic interactive behaviors, and children's subsequent social competence with peers. Participants were 40 children (20 children with autism, and 20 developmentally-matched typical children) between the ages of 2.75 and 6.5 years. Observational coding was conducted to assess children's joint engagement initiations, global interactive behaviors with parents, and parents’ responsiveness, behavior regulation, and attention regulation. Children's social competence with peers was measured approximately one year later. Group differences were observed in child-initiated joint engagement, children's interactive behaviors in the parent-child context, and individual aspects of social competence. Child-initiated joint engagement with parents was positively related to social competence with peers overall, and with less exclusion by peers and hyperactive-distractible behaviors with peers, in particular. In addition, parent attention regulation emerged as the most salient predictor of children's behaviors within the parent-child context. Findings are discussed with respect to implications for future research and intervention.     

Measuring Changes in Social Behavior During a Social Skills Intervention for Higher-Functioning Children and Adolescents with Autism Spectrum Disorder

The social behavior of children and adolescents with Autism Spectrum Disorder was evaluated weekly over 19 weeks of a social skills training program. Participants’ vocalizations were coded as initiating, responding, or other (e.g., self-talk). Participants’ interactions were coded as dyadic peer interactions, dyadic leader interactions, interactions with a group of peers, interactions with a group of peer(s) and leader(s), or time spent by self. Over the course of the intervention, participants made fewer initiating and other vocalizations, more responding vocalizations, spent more time interacting with a group of peers, and spent marginally less time interacting with a leader. Gender, age, and intervention attendance effects on social behavior are also noted.     

Group intervention for children bereaved by the suicide of a relative

OBJECTIVE: This study evaluated efficacy of a manual-based bereavement group intervention for children who suffered suicide of a parent or sibling. METHOD: Seventy-five families (102 children) were screened from medical examiners' lists of suicide victims. Fifty-two families (75 children) were eligible and assigned in alternating order to receive (27 families, 39 children) or not to receive (25 families, 36 children) the intervention. Intervention efficacy was evaluated as change in children's symptoms of anxiety, depression, posttraumatic stress, social adjustment, and parents' depressive symptoms from initial to outcome assessments. RESULTS: Changes in anxiety and depressive symptoms were significantly greater among children who received the intervention than in those who did not. A greater dropout of children assigned not to receive (75%) than to receive (18%) intervention led to an imbalance in retention of intervention and nonintervention participants. CONCLUSIONS: A bereavement group intervention focusing on reactions to death and suicide and strengthening coping skills can lessen distress of children bereaved after parental or sibling suicide. Such intervention may prevent future morbidities.     

Enhancing social problem solving in children with autism and normal children through computer-assisted instruction

Children with autism have difficulty in solving social problems and in generating multiple solutions to problems. They are, however, relatively skilled in responding to visual cues such as pictures and animations. Eight distinct social problems were presented on a computer, along with a choice of possible solutions, and an option to produce alternative solutions. Eight preschool children with autism and eight matched normal children went through 10 training sessions interleaved with 6 probe sessions. Children were asked to provide solutions to animated problem scenes in all the sessions. Unlike the probe sessions, in the training sessions problem solutions were first explained thoroughly by the trainer. Subsequently these explanations were illustrated using dynamic animations of the solutions. Although children with autism produced significantly fewer alternative solutions compared to their normal peers, a steady increase across probe sessions was observed for the autistic group. The frequency of new ideas was directly predicted by the diagnostic category of autism. Results suggest young children with autism and their normal peers can be taught problem-solving strategies with the aid of computer interfaces. More research is required to establish whether such computer-assisted instruction will generalize to nontrained problem situations in real-life contexts.