School-based social skills training for young people with autism spectrum disorders

ABSTRACT

Background: The Secret Agent Society (SAS) Program, an intervention to enhance social–emotional skills, was provided by schools for children with autism spectrum disorder (ASD). The program was assessed to determine if it improved social skills at school and home, and whether improvements were maintained.

Methods: Eighty-four students participated. Key outcomes were parent and teacher ratings of emotion regulation, social skills, and direct child social problem-solving measures. The standard school curriculum served as the control condition. Phase 1 was a two-group waitlist-control comparison of SAS versus the standard curriculum. Phase 2 was a follow up of all participants before and after the intervention and at 12-months post-intervention.

Results: Parent and child measures improved after the intervention but not in the waitlist condition. Improvements in parent, child, and teacher measures were apparent at 12 months.

Conclusions: The SAS Program warrants further research as a potential program for schools that serve children with ASD.     

Peer-mediated social skills training program for young children with high-functioning autism

One of the most prevailing characteristics of children with autism is their deficit in social communication skills. The purpose of this study was to evaluate the effectiveness of a peer-mediated social skills training (SST) program combined with video feedback, positive reinforcement and token system in increasing social communication skills in young children with high-functioning autism. Four boys with high-functioning autism, ages 6-7 years, participated in the study. The social skills training, lasting 12 weeks, targeted six communication skills, selected after parent interviews and behavioral observation during a pre-training assessment period. One SST session was conducted each week, each session lasted 90min and had six structured activities. The training effectiveness was evaluated through direct observation of a structured interaction period, using an observational coding system. Improvement was observed in three out of four children, although individual differences among children were seen for changes in two global scales as well as subscales. These results suggest that the social skills training was effective in improving social communication skills for some children with high-functioning autism. Clinical and research implications and future directions for social skills training as well as this study's limitations are discussed.     

Feasibility of a skills training approach to reduce substance dependence among individuals with schizophrenia

A novel treatment for persons who have both schizophrenia and substance abuse was evaluated by incorporating cognitive-behavioral drug relapse prevention strategies into a skills training method originally developed to teach social and independent living skills to patients with schizophrenia. Thirty-four of 56 patients completed treatment and a three-month follow-up assessment. Participants learned substance abuse management skills and reported that they found the treatment relevant, useful, and satisfying, and their drug use decreased. Improvements were noted in medication adherence, psychiatric symptoms, and quality of life. This manual-driven therapy may play an important role in the treatment of substance abuse among patients with schizophrenia.     

Teaching play skills to young children with autism

Abstract

Background Play is critical for the development of young children and is an important part of their daily routine. However, children with autism often exhibit deficits in play skills and engage in stereotypic behaviour. We reviewed studies to identify effective instructional strategies for teaching play skills to young children with autism.

Method Empirical studies on teaching play skills to young children with autism published from 1990 to 2011 were located. These studies included single subject and group designs.

Results Twenty-six studies were reviewed. The majority of studies on teaching play skills used combined interventions. Children with autism improved their play skills, with direct intervention embedding their interests during play. Improvements in play skills increased positive social interactions and decreased inappropriate behaviour as collateral effects.

Conclusions Further research is needed to develop more effective play skill interventions that assess the functional use of play and are implemented in the natural environment.     

Applications of technology to teach social skills to children with autism

Children with autism spectrum disorder show deficits in social skills such as initiating conversation, responding in social situations, social problem-solving, and others. These deficits are targeted through the use of social skills interventions, some of which use a technology-based approach as a resource-efficient alternative to common forms of instruction. The current literature review aims to (a) determine the number of empirical studies using a technology-based social skills intervention, (b) explore the features of social skills targeted in these studies, and (c) analyze the number of studies reporting reliability of the dependent and independent variables. Results indicate that a majority of the studies relied on a video or DVD to deliver the intervention (modeling or feedback), were conducted in school settings, and targeted more than one social skill. The most common social skill addressed was initiating conversation followed by play skills. All but one study included standardized assessment before treatment; however, none of the studies used a published social skills assessment. Like previous research, reliability of the dependent variables was common; however, reliability of the independent variables was infrequent.     

Teaching individuals with autism spectrum disorder to ask questions: A systematic review

This review involved a systematic search and analysis of studies aimed at teaching individuals with autism spectrum disorder (ASD) to ask questions (i.e., teaching mands for information). A systematic search of databases, reference lists, and journals identified 21 studies that met predetermined inclusion criteria. Included studies were then summarized in terms of (a) participant characteristics, (b) dependent variables (e.g., types of question-asking skills that were taught), (c) intervention procedures, (d) research designs, and (e) outcomes. All 21 studies reported that participants acquired or improved in the targeted question-asking skills. The most common intervention components included (a) echoic prompts and systematic fading procedures (e.g., time delay), (b) positive reinforcement via provision of requested information and/or access to preferred items or activities, and (c) contriving situations to motivate specific questions (i.e., creating establishing operations). Implications for practitioners and directions for future research are discussed.     

A pilot study of combining social skills training and parenting training for children with autism spectrum disorders and their parents in Japan

The purpose of this study is to investigate the effects of a program containing a combination of social skills training (SST) and parenting training (PT) for the enrichment of social interaction skills and reduction of parenting stress for children with high-functioning autism spectrum disorder (HFASD) and their parents in Japan. Twenty-two patients with HFASD from second to fourth grade and their parents were assigned to a training group (TG) or treatment as usual (TAU) and compared. The children with HFASD and their parents who were assigned to the TG participated in the manualized program for over a period of five to six months. Subjects provided demographic and medical information and completed teacher and parent-rating scales for social competence (Social Responsiveness Scale-2: SRS-2) and parent-rating of parenting stress (Parental Stress Index: PSI) and mental health (General Health Questionnaire-28: GHQ-28). The participants exhibited some improvements pre-, middle-, and post-treatment, particularly regarding the GHQ, PSI and SRS-2, as reported by parents. However, the social skills improvement reported by teachers was not significant. At the three-month follow-up, parent-rated GHQ and PSI maintained improvement, and SRS-2 achieved the greatest improvement from the baseline rating. Although some findings indicate that a program combination of SST and PT might be useful for enhancing social skills and improving parental stress and mental health, some subscales did not show a sufficient effect. Future research should consider program contents and provide longitudinal follow-up data to test the durability of the treatment.     

Long-term social skills group training for children and adolescents with autism spectrum disorder: a randomized controlled trial

Social skills group training (SSGT) is widely used for intellectually able children and adolescents with autism spectrum disorder (ASD). Previous studies indicate small to moderate effects on social communication capacities. The duration of most available programs is relatively short, and extended training might lead to further improvement. This randomized controlled trial compared an extended 24-week version of the SSGT program KONTAKT with standard care. The weekly sessions gradually shifted in content from acquisition of new skills to real-world application of the acquired skills. A total of 50 participants with ASD (15 females; 35 males) aged 8–17 years were included. The study was conducted at two child and adolescent psychiatry outpatient units in Sweden. The primary outcome was the Social Responsiveness Scale–Second Edition (SRS-2) rated by parents and blinded teachers. Secondary outcomes included parent- and teacher-rated adaptive behaviors, trainer-rated global functioning and clinical severity, and self-reported child and caregiver stress. Assessments were made at baseline, posttreatment, and at 3-months follow-up. Parent-rated SRS-2 scores indicated large effects posttreatment [− 19.2; 95% CI − 29.9 to − 8.5; p < .001, effect size (ES) = 0.76], which were maintained at follow-up (− 20.7; 95% CI − 31.7 to − 9.7; p < .0001, ES = 0.82). These estimates indicate substantially larger improvement than previously reported for shorter SSGT. However, the effects on teacher-rated SRS-2 and most secondary outcomes did not reach statistical significance. Our results suggest added benefits of extended SSGT training, implying that service providers might reach better results by optimizing the delivery of SSGT.

     

Teaching two household safety skills to children with autism

Appropriate reactions to potentially hazardous situations may help prevent children from incurring injury or abduction. However, children with autism and other developmental disorders may not develop safety skills without explicit intervention. This study used a simple behavioral skills training package for teaching children with autism to respond in a safe manner to doorbells and to the presence of household cleaning chemicals.     

Further evidence of benefits of thought-bubble training for theory of mind development in children with autism spectrum disorders

Children with autism spectrum disorders (ASDs) routinely fail false belief tests of theory of mind (ToM), even at advanced chronological and mental ages. Initial training efforts were largely disappointing for those with ASD, suggesting an intractable deficit. However, more recently, children with ASD trained with various pictorial strategies (like thought bubbles to depict beliefs) have made modest gains on trained ToM tasks, despite poor generalization and unanswered methodological questions. The present study therefore aimed to further examine the possible benefits of thought-bubble training for children with ASD while overcoming past methodological limitations. Our design advanced upon past thought-bubble studies by incorporating: (a) a non-intervention control group to test specificity of gains to the training intervention, (b) a broad ToM Scale to examine generalization of gains to other steps in ToM growth besides (trained) false belief, (c) a comprehensive assessment of children's verbal and nonverbal abilities, and (d) a delayed follow-up test. Results from 24 children with ASD aged 4.67–12.25 years revealed even stronger evidence than previously that thought-bubble training is genuinely beneficial in the context of autism. Statistically significant gains were made by trained children that, furthermore, (a) generalized beyond false-belief to other ToM concepts and (b) were maintained for at least 3 weeks. Control children showed no significant gains of any kind despite their close match to trained children at pretest. Theoretical and practical implications of the findings are discussed.     

Neural disruption to theory of mind predicts daily social functioning in individuals at familial high-risk for schizophrenia

Theory-of-mind (ToM) ability is foundational for successful social relationships, and dependent on a neurocognitive system, which includes temporoparietal junction and medial prefrontal cortex. Schizophrenia is associated with ToM impairments, and initial studies demonstrate similar, though more subtle deficits, in unaffected first-degree relatives, indicating that ToM deficits are a potential biomarker for the disorder. Importantly, the social consequences of ToM deficits could create an additional vulnerability factor for individuals at familial high risk (FHR). However, behavioral studies of ToM are inconsistent and virtually nothing is known about the neural basis of ToM in FHR or the relationship between ToM and social functioning. Here, FHR and non-FHR control participants underwent functional MRI scanning while reasoning about a story character’s thoughts, emotions or physical appearance. Afterwards, participants completed a 28-day online ‘daily-diary’ questionnaire in which they reported daily social interactions and degree of ToM reasoning. FHR participants demonstrated less neural activity in bilateral temporoparietal junction when reasoning about thoughts and emotions. Moreover, across all participants, the degree of neural activity during ToM reasoning predicted several aspects of daily social behavior. Results suggest that vulnerability for schizophrenia is associated with neurocognitive deficits in ToM and the degree of deficit is related to day-to-day social functioning.     

Toilet training individuals with autism and other developmental disabilities: A critical review

The following article reviews the current literature addressing toilet training individuals with autism and other developmental disabilities. The review addresses programs typical to toilet training the developmental disability population, most of which are modeled after the original Foxx and Azrin [Azrin, N. H., & Foxx, R. M. (1971). A rapid method of toilet training the institutionalized retarded. Journal of Applied Behavior Analysis 4, 89–99; Foxx, R. M., & Azrin, N. H. (1973). Toilet training persons with developmental disabilities: A rapid program for day and nighttime independent toileting. Harrisburg, PA: Help Services Press] rapid toilet training methods. Components of such programs are isolated and described in their contribution to toilet training models. Studies are then reviewed and compared for participant and study characteristics. Individual studies validating toilet training programs are then discussed in light of their program components and efficacy. Shortcomings to currently available programs are highlighted and future areas of study are suggested.     

Unauthorized minds: how "theory of mind" theory misrepresents autism

Recent representations of autism frequently include an assumption that autism is the result of a "theory of mind" deficit (i.e., an inability to understand others' mental states). This notion is examined using a social constructionist perspective. The belief that autism is a sort of "mind-blindness" has much in common with earlier representations of autism that depict it as a puzzle and, paradoxically, as a single entity defined by core characteristics. Theory of mind theorists also, like their predecessors, define autism as a form of insufficiency and as requiring fixing rather than accommodation. Alternative narratives about autistic minds that incorporate the perspectives of people labeled autistic are an important counterbalance to the limitations of such professional viewpoints.     

孤独症和Asperger综合征儿童的心灵理论对照研究

目的探讨孤独症和Asperger综合征(AS)儿童的心理推测能力。方法应用表情识别和虚假信念课题分别对21例高功能孤独症(HFA)儿童、54例AS儿童和70名正常健康儿童进行测试。结果表情识别题中, HFA组通过率明显低于正常组(P<0．01),AS组与正常组无显著差异;虚假信念题通过率为正常儿童组>AS组> HFA组(P<0．01)。结论 HFA和AS儿童基本能识别简单表情,但存在理解虚假信念的缺陷,说明他们的心理推测能力低下。     

Analysis of social referencing skills among children with autism

Social referencing, a form of nonverbal communication, involves seeking out discriminative stimuli provided by others about contingencies in an ambiguous context in order to respond in a manner that produces reinforcement. Although demonstrated by typically developing infants, social referencing is notably absent or impaired in individuals with autism. In this study, behavioral procedures including verbal, visual, and manual prompting and reinforcement were used to teach four children with autism to exhibit a social referencing response chain composed of an observing response and a conditional discriminative response in the presence of variants of standard academic materials. Observing was defined as looking at the experimenter when presented with unfamiliar handwriting materials, verbal models, and video models. Conditional discriminative responding was defined as completing the handwriting task or imitating the verbal and video models in the presence of a head nod and a smile, and placing the handwriting materials or Language Master cards aside, or remaining seated in a chair in the presence of a headshake and a frown. All four children learned to exhibit social referencing. The ambiguous materials were then interspersed among the standard materials. One of the children showed discriminated social referencing, observing in the presence of the ambiguous stimuli and not in the presence of the standard materials. The other children were taught to discriminate the ambiguous and standard stimuli and to exhibit social referencing only in the presence of the ambiguous materials. The effectiveness of the teaching procedures used is discussed in the context of a learning theory analogue of social referencing.