Social Competence and Social Skills Training and Intervention for Children with Autism Spectrum Disorders

This study examined the effectiveness of a 30 week social competence and social skills group intervention program with children, ages 7–11, diagnosed with Autism Spectrum Disorders (ASD). Eighteen children with ASD were assessed with pretreatment and posttreatment measures on the Walker-McConnell Scale (WMS) and the MGH YouthCare Social Competence Development Scale. Each received the 30-week intervention program. For comparison, a matched sample of ten non-ASD children was also assessed, but received no treatment. The findings indicated that each ASD intervention group demonstrated significant gains on the WMS and significant improvement in the areas of anxiety management, joint attention, and flexibility/transitions. Results suggest that this approach can be effective in improving core social deficits in individuals with ASD. Portions of this paper were presented at the annual convention of the American Psychological Association, Boston, August 2008.     

Social Skills Development in Children with Autism Spectrum Disorders: A Review of the Intervention Research

Social reciprocity deficits are a core feature of the autism spectrum disorders (ASD). This review summarizes the state of research in group-based social skills training programs for school-age children and adolescents with ASD. All published studies of group social skills interventions between 1985 and 2006 were reviewed, as well as dissertations examining group-based social skills intervention programs. To assess the state of the science, a template developed by an NIMH work group was applied to 14 identified studies. Based on this review, the empirical support for this approach is incomplete, but promising intervention strategies were identified. Recommendations for the design of future treatment trials to guide clinical practice are offered.     

MEG premotor abnormalities in children with Asperger's syndrome: Determinants of social behavior?

Children with Asperger's syndrome show deficits in social functioning while their intellectual and language development is intact suggesting a specific dysfunction in mechanisms mediating social cognition. An action observation/execution matching system might be one such mechanism. Recent studies indeed showed that electrophysiological modulation of the “Mu-rhythm” in the 10–12 Hz range is weaker when individuals with Asperger's syndrome observe actions performed by others compared to controls. However, electrophysiological studies typically fall short in revealing the neural generators of this activity. To fill this gap we assessed magnetoencephalographic Mu-modulations in Asperger's and typically developed children, while observing grasping movements. Mu-power increased at frontal and central sensors during movement observation. This modulation was stronger in typical than in Asperger children. Source localization revealed stronger sources in premotor cortex, the intraparietal lobule (IPL) and the mid-occipito-temporal gyrus (MOTG) and weaker sources in prefrontal cortex in typical participants compared to Asperger. Activity in premotor regions, IPL and MOTG correlated positively with social competence, whereas prefrontal Mu-sources correlated negatively with social competence. No correlation with intellectual ability was found at any of these sites. These findings localize abnormal Mu-activity in the brain of Asperger children providing evidence which associates motor-system abnormalities with social-function deficits.     

A virtual reality-integrated program for improving social skills in patients with schizophrenia: A pilot study

Background and objectives

Social skills training (SST) intervention has shown its efficacy to improve social dysfunction in patients with psychosis; however the implementation of new skills into patients' everyday functioning is difficult to achieve. In this study, we report results from the application of a virtual reality (VR) integrated program as an adjunct technique to a brief social skills intervention for patients with schizophrenia. It was predicted that the intervention would improve social cognition and performance of patients as well as generalisation of the learned responses into patient's daily life.

Methods

Twelve patients with schizophrenia or schizoaffective disorder completed the study. They attended sixteen individual one-hour sessions, and outcome assessments were conducted at pre-treatment, post-treatment and four-month follow-up.

Results

The results of a series of repeated measures ANOVA revealed significant improvement in negative symptoms, psychopathology, social anxiety and discomfort, avoidance and social functioning. Objective scores obtained through the use of the VR program showed a pattern of learning in emotion perception, assertive behaviours and time spent in a conversation. Most of these gains were maintained at four-month follow-up.

Limitations

The reported results are based on a small, uncontrolled pilot study. Although there was an independent rater for the self-reported and informant questionnaires, assessments were not blinded.

Conclusions

The results showed that the intervention may be effective for improving social dysfunction. The use of the VR program contributed to the generalisation of new skills into the patient's everyday functioning.     

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.     

Brief report: Game day: A novel method of assessing change in social competence in students with autism spectrum disorder (ASD)

BackgroundGroup social skills programs for autism spectrum disorder (ASD) have been shown to improve social skills knowledge and parent and teacher survey ratings, but have been limited by a lack of directly observed measures of social skills in unstructured settings.MethodsThe goal of this study was to examine the feasibility of using a novel, directly observed measure (“game day”) to monitor changes in social skills in students with ASD participating in a 16-week, school-based social skills program (Program for the Education and Enrichment of Relational Skills - PEERS). Game day occurred once a month and consisted of the instructor placing a set of board games in the room and then leaving. Videos of the game day sessions were rated by three reviewers (blinded to the video sequence) using a modified version of the Contextual Assessment of Social Skills (CASS).ResultsSix students (age range 13–22, 5 male) enrolled and completed all PEERS instruction and 5 monthly game day sessions. Reviewers were able to complete ratings for all scale items except frequency of initiations and responses. The remaining nine CASS items were used to generate a summary score for each child; the mean score improved from 38.5 to 43.6 (p = 0.011). Validated surveys also showed statistically significant improvements in social skills knowledge, problem behaviors, and ASD behaviors.ConclusionsThis study provides initial evidence that a directly observed measure detects changes in social competence in ASD and may provide a broader assessment of social ability.     

A pilot randomised controlled trial of a group based social skills intervention for adults with autism spectrum disorder

BackgroundSocial skills training is commonly used for children and adolescents with ASD. There are few studies considering its efficacy in adults and those that exist usually compare it to standard treatment, as opposed to controlling for non-specific improvements that may result from receiving an intervention. We conducted a pilot study to investigate whether social skills training is more effective than non-specific support for adults with ASD.Methods19 adults with ASD were randomised to either social skills training or non-specific social interaction groups for 16 weeks. The Reading the Mind in the Eyes and Reading the Mind in the Voice Tasks were used to assess social cognition while the Social Responsiveness Scale (SRS-2) and the Weiss Functional Impairment Rating Scale (WFIRS-S) were used to measure real-life change pre- and post-treatment.ResultsTaken together, both groups improved across the course of the study on the ‘Eyes’ task (p = 0.049), SRS-2 (p = 0.03) and WFIRS-S (p = 0.053). However, there were no significant differences between the groups. There was some trend-level evidence that the social skills group improved more on the tests of social cognition (p ≤ 0.1 for group x time interaction). This was not the case for the SRS-2 (p = 0.25) and for the WFIRS-S there was a trend for the social interaction group to show greater improvements (p = 0.07).ConclusionsThis study did not show clear evidence of benefit from social skills training compared to facilitated social interaction, although larger studies are required to draw firm conclusions about efficacy.     

A treatment comparison study of a photo activity schedule and Social Stories for teaching social skills to children with Autism Spectrum Disorder: brief report

Purpose: To compare the efficacy of two procedures, a photo activity schedule intervention and Social Stories, to teach social skills to four children diagnosed with Autism Spectrum Disorder (ASD).

Methods: An adapted alternating treatments design with an additional multiple baseline control was used, and two social skills were targeted for each of the four participants, one under each intervention condition.

Results: Results indicated that all four participants learned the target social behaviours with the photo activity schedule intervention, but did not learn target social behaviours with Social Stories.

Conclusions: Findings support the use of a photo activity intervention for teaching social skillsto children with ASD; we discuss the implications of inconsistent findings of effectiveness of Social Stories.     

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.     

Group Intervention to Promote Social Skills in School-age Children with Pervasive Developmental Disorders: Reconsidering Efficacy

A consistent result in the evaluation of group-delivered intervention to promote social reciprocity in children with PDDs is that outcome data are inconclusive. Lack of robust evidence of efficacy confounds understanding of these interventions and their value to the field. It is conceivable that the construct of impaired social reciprocity in PDD presents unique circumstances that require special consideration when evaluating the evidence base. Social reciprocity and impairment in social functioning are complex constructs, which require a multi-dimensional, multi-method approach to intervention and measurement of gains. The existing paradigm for evaluating the evidence base of intervention may need modification to permit a more intricate analysis of the extant research, and increase the sophistication of future research.

Group cognitive behaviour therapy (CBT) for social interaction anxiety in adults with autism spectrum disorders (ASD)

BackgroundGroup social skills interventions (SSI) are partially effective for addressing the communication and social interaction impairments experienced by individuals with autism spectrum disorders (ASD). Social anxiety has been found to be a moderating mechanism for SSI in young people with ASD. Comparatively few studies have investigated the effectiveness of SSI in the adult ASD population, and none so far have investigated group approaches incorporating SSI and anxiety management techniques.MethodThe present study describes the design and evaluation of a non-randomised single-arm, 11 week group interaction anxiety and social skills intervention, piloted on three occasions during routine clinical practice at an adult ASD service. The intervention was informed by a cognitive behaviour therapy (CBT) framework. Eighteen cognitively-able adult males with ASD attended. Outcome measures were completed pre- and post-intervention.ResultsSelf-reported social anxiety improved (p = 0.01, d = 0.65). Low mood, general anxiety and functioning did not change significantly (p > 0.05, d < 0.20). Qualitative feedback indicated that participants found the intervention to be acceptable and useful for improving social knowledge and coping strategies, and reducing avoidance behaviours. Attrition was low (n = 2).ConclusionsThese results suggest that integrating SSI and anxiety management techniques in a group format is acceptable to adults with ASD, and can reduce symptoms of social anxiety. Whether SSI enhance social skills in adults requires further investigation. In clinical practice, consideration should be given to augmenting SSI with CBT techniques designed to target concurrent symptoms of social anxiety.     

Social anxiety and self-concept in children with epilepsy: A pilot intervention study

PurposeThe purpose of this study was to assess the impact of a cognitive behavioral therapy (CBT) anxiety intervention on social phobia, social skill development, and self-concept.MethodFifteen children with epilepsy and a primary anxiety disorder participated in a CBT intervention for 12 weeks plus a 3-month follow-up visit. Children were assessed at baseline, week 7, week 12, and 3 months post treatment to measure changes in social phobia using the Screen for Child Anxiety Related Emotional Disorders (SCARED). Self-concept was also assessed by using the Piers-Harris Children's Self-Concept Scale II (Piers-Harris 2).ResultsThere was a significant reduction in symptoms of social phobia and improved self-concept at the end of the 12-week intervention and at the 3 month follow-up. Repeated measures ANOVA's of child ratings revealed significant change over time on the SCARED-Social Phobia/Social Anxiety subscale score (p = 0.024). In terms of self-concept, significant change over time was detected on the Piers-Harris 2-Total score (p = 0.015) and several subscale scores of Piers-Harris 2, including: Physical Appearance and Attributes (p = 0.016), Freedom from Anxiety (p = 0.005), and Popularity (p = 0.003).ConclusionThis pilot investigation utilized an evidenced based CBT intervention to reduce symptoms of social phobia, which in turn provided a vehicle to address specific social skills improving self-concept in children with epilepsy.     

Validity and reliability of the Korean Version of Autism Spectrum Disorders-Diagnostic for Children (ASD-DC)

The purpose of the present study was to develop and evaluate the psychometric properties of the Autism Spectrum Disorders-Child (ASD-DC). Mothers of children with Autism spectrum disorders (N = 333) and mothers of typically developing children (N = 223) ages from 2 to 16 years completed the ASD-DC. The confirmatory factor analysis revealed that the 4-factor structure of the ASD-DC fits the data well, comprising the following factors: nonverbal communication/socialization, verbal communication, social relationships, and insistence of sameness/restricted interests. The ASD-DC was associated with high internal consistency and test–retest reliability. The discriminant validity was demonstrated by the mean differences between ASD and control group. High correlations between several subscales of ASD-DC and Social Communication Questionnaire (SCQ) were found, showing concurrent validity. High correlations between several subscales were found. Optimal cutoff scores for Autism, Asperger's disorder, and PDD-NOS were found via ROC curve analysis. Clinical and research implications as well as limitations are discussed.     

Efficacy of a computer-assisted cognitive-behavior therapy program for treating youth with anxiety and co-occurring autism spectrum disorder: Camp Cope-A-Lot

BackgroundIn a crossover design the current study describes the efficacy of a computer-assisted intervention program for youth with autism spectrum disorder (ASD) who also experience co-occurring anxiety.MethodsThe computer-assisted cognitive behavior therapy (CBT) program for treating anxiety, Camp Cope-A-Lot (CCAL) was compared to control intervention, another computer-assisted program, The Social Express (TSE), that does not employ CBT nor is targeted for the treatment of anxiety. TSE is designed to improve social skills in youth with ASD. Participants had a principal anxiety disorder and a current diagnosis of ASD. Participants received 12-sessions of CCAL or 12-sessions of TSE. Outcome measures were obtained at intake, upon completion of the first intervention of the trial and upon completion of the second intervention of the trial.ResultsCCAL was efficacious for treating anxiety. Participants who completed CCAL demonstrated significant and clinical reductions in anxiety when compared to participants who completed TSE. Both interventions, CCAL and TSE, resulted in some limited improvement in social skills.ConclusionsThe current study showed that anxiety symptoms in youth with ASD and co-occurring anxiety disorders can benefit from computer-assisted CBT employing CCAL. This expands previous literature employing computer-assisted CBT interventions in youth, and more specifically, youth with ASD.     

Motor difficulties are associated with impaired perception of interactive human movement in autism spectrum disorder: A pilot study

Introduction: The ability to accurately perceive human movement is fundamental to social functioning and known to be influenced by one’s own motor skills. In Autism Spectrum Disorder (ASD), there is ongoing debate about whether human movement perception is impaired. Given that motor skills vary considerably among these individuals, it may be that human movement perception is differentially affected as a function of motor proficiency. The aim of the current study was, thus, to explore whether individuals with ASD with and without motor difficulties differ in the way they visually attend to and perceive human movement.

Method: Three groups of children aged 6 to 14 completed the study: an ASD group with motor difficulties (ASD_MD), an ASD group without motor difficulties (ASD_NMD), and a typically-developing control group (TD). All participants (N = 31) underwent eye-tracking while they viewed communicative interactions performed by two point-light actors. Primary analyses considered group differences in perceptual accuracy and gaze patterns.

Results: Results revealed poorer perceptual accuracy in the ASD_MD group compared to the ASD_NMD and TD groups. Both ASD groups also exhibited gaze anomalies. Unlike the ASD_NMD and TD groups who preferentially allocated their gaze to the actor initiating the interaction, the ASD_MD group gazed at both actors equally. In contrast, the ASD_NMD group shifted their gaze between the actors more frequently than the other groups.

Conclusions: These preliminary findings suggest that individuals with ASD and co-occurring motor difficulties employ an atypical attentional style that may hinder accurate human movement perception, whereas those without motor difficulties may employ a compensatory attentional style that facilitates typical perception. Improving our understanding of how attention and perception are affected across the ASD spectrum has the potential to provide insight into the mechanisms that underlie the core social deficits that define this disorder.     

Effects of music-based social stories on comprehension and generalization of social skills in children with autism spectrum disorders: A randomized effectiveness study

The purpose of this randomized controlled study was to examine the effects of music-based social stories on the comprehension and generalization of social skills in children with autism spectrum disorders. The principle investigator (PI) collected data during three separate one-week summer camps. Participants (N = 30) were randomly assigned by cluster to one of three non-music control groups (social story read to them) or one of three experimental music therapy groups (social story sung to them). Participants’ parents completed the autism social skills profile (ASSP) at pre- and posttest and five comprehension check (CC) questions over time pertaining to their child's assigned social story. The only main effect for the ASSP that was significant was subcategory but there were numerous significant two- and three-way interactions confounding results. Main effects for time on the CC were significant, with scores being highest on the posttest. Overall, the lack of significant main effects was likely a function of minimal treatment dose. Although results of the study were confounded by numerous significant interactions, clinicians might pair social stories with music to facilitate comprehension, generalization, and on-task behaviors conducive to learning social information. Implications for clinical practice, limitations, and suggestions for future research are provided.     

Effectiveness of a Manualized Summer Social Treatment Program for High-Functioning Children with Autism Spectrum Disorders

This paper presents findings from the final two years of a four-year study investigating a manualized social treatment program for high-functioning children with autism spectrum disorders. The study sought to (1) replicate and expand findings from years one and two; (2) compare outcomes of participants who received response-cost feedback versus non-categorical feedback; and (3) provide further evidence of program feasibility. Results indicated significant improvements in social skills and problem behaviors, however no significant differences for face emotion recognition. Measures of several socially-related behaviors yielded mixed results based on rater. While parent ratings did not appear to favor one feedback format, staff ratings appeared to favor the response-cost format on some measures. Results also provided support for program feasibility.