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.     

Atypical autonomic nervous system complexity accompanies social cognition task performance in ASD

BackgroundEmerging evidence suggests that autonomic nervous system (ANS) function is affected in ASD. Existing literature has focused on quantifying the activity of ANS components (i.e. sympathetic/parasympathetic systems) individually. To this end, measures such as respiratory sinus arrhythmia (RSA) and high- and low-frequency spectral components of heart rate variability have been employed. Recent findings indicate that these methods employ assumptions that do not fully consider the complexity of the ANS system and the interaction of its components. To this end, we propose a new method for examining ANS function in ASD.MethodsA sample of typically developing (TD) children (n = 34) and children with ASD (n = 45) performed the Reading the Mind in the Eyes Task (RMET), preceded and followed by periods of baseline movie-watching. Multiscale Entropy (MSE) was employed as a new tool to examine the complexity of the cardiac signal.ResultsSignificant group differences in MSE emerged to suggest atypicality in the regularity of the autonomic signal at short and long time scales in the ASD group during the RMET task.ConclusionsFor the RMET task, our results may suggest atypical activation of parasympathetic influences on the heart, which contributes to short-term patterns in the heartbeat signal, as well as atypicalities in the slower acting processes. Results also suggest that the coupling between the fast-acting and slow-acting influences may be atypical in ASD during the examined social cognition task.     

Examining the effectiveness of peer-mediated and video-modeling social skills interventions for children with autism spectrum disorders: A meta-analysis in single-case research using HLM

Social interaction is a fundamental problem for children with autism spectrum disorders (ASD). Various types of social skills interventions have been developed and used by clinicians to promote the social interaction in children with ASD. This meta-analysis used hierarchical linear modeling (HLM) to examine the effectiveness of peer-mediated and video-modeling approaches, the two approaches that are most commonly used for social skills training of children with ASD. The two approaches, with the average effect size of 1.27 (peer-mediated approach: mean = 1.3, 95% CL = 1.10–1.50, N = 9; video-modeling approach: mean = 1.22, 95% CL = 0.65–1.78, N = 5) were found to significantly and equally improve the social performance of children with ASD. In addition, age functioned as a significant moderator in the effectiveness of the intervention. Implications of the results and limitations of this study are discussed.     

Altered pre-ejection period response to social evaluative threat in adolescents with autism spectrum disorder

IntroductionThe autonomic nervous system (ANS) is involved in regulating social behavior; Autism Spectrum Disorder (ASD) is characterized by alterations in social behavior and reduced physiological response to threat. We hypothesized that adolescents with ASD would show reduced ANS response to social threat.MethodsEighteen males with ASD and thirteen males with typical development (TD), ages 12 to 17, completed a social threat paradigm while wearing an impedance cardiography apparatus. We calculated pre-ejection period (PEP) and tested for between-group differences in PEP response to social threat. We also conducted correlation analyses between PEP change scores and clinical symptom scales.ResultsThere was an effect of diagnosis on change in PEP from baseline to the onset of social threat (F = 7.60, p = 0.01), with greater changes in PEP in TD compared to ASD. PEP change score and the Social Communication Questionnaire (r = 0.634, p = 0.005) and the ADHD Problems Subscale of the Child Behavior Checklist (r = 0.568, p = 0.014) were correlated.ConclusionsThese findings suggest reduced arousal in response to social threat in ASD, with preliminary evidence that reduced sympathetic activation is associated with increased social behavior symptoms.     

Hyper-responsiveness to touch mediates social dysfunction in adults with autism spectrum disorders

This study investigated whether hyper-responsiveness to touch serves as a mediating variable that predicts social dysfunction in adults with autism spectrum disorders (ASD). Data were obtained from all adults with administratively defined intellectual disability in a region in Sweden (n = 915, where 143 had ASD). A multiple mediation modeling analysis revealed a well-fitted model (Satorra–Bentler scaled chi-square = 10.91, df = 7, p = 0.14, CFI = 0.99, RMSEA = 0.025), demonstrating that social dysfunction among adults with ASD was completely mediated by hyper-responsiveness to touch followed by impairment of speech and aggressive/destructive behavior. The results demonstrated that in adulthood, the tactile sensory system is foundational for social functioning in people with ASD, with diagnosis and intervention implications.     

An experimental investigation of mentalization ability in borderline personality disorder

ObjectiveDeficits in mentalization ability have been theorized to underlie borderline personality disorder (BPD) and have led to mentalization-based treatments. Yet there has been little empirical investigation into whether mentalization deficits do differentiate the BPD population from healthy controls, and the specific nature of these differences.MethodFive pre-existing Theory of Mind (ToM) tasks that assessed simple to complex mentalization capacity in both the affective and cognitive domains were administered to the same groups of age and gender matched patients with BPD and controls. Self-report measures assessed cognitive and affective empathy and childhood trauma and abuse.ResultsThe BPD group did not differ significantly from the healthy control group on basic cognitive false-belief picture-sequencing tasks, or on overall accuracy when discriminating mental states from viewing images of eyes, and attributing emotions based on social events. They were, however, significantly less accurate in identifying positive mental states on the Reading the Mind in the Eyes (RME) task and showed significantly more mentalization errors on affective and cognitive understanding of faux pas (faux pas total score p < .01) and on a Joke Appreciation task (p = .01), that required integration of multiple perspectives. They also self-reported less empathic perspective taking (p < .01). Observation of patterns of performance hinted at specific underlying biases (e.g. a default tendency to use superficial black-and-white attributions to others, such as, “he is mean”, when explaining behavior). It was also found that as childhood experiences of punishment increased, adulthood mentalization ability decreased on all affective ToM tasks and on the cognitive and affective components of understanding faux pas.ConclusionsThe BPD group was as capable as controls in undertaking simple mentalization. However, deficits in mentalization capacity became evident when mentalization tasks became more complex and required the integration of multiple perspectives. Increasing childhood experiences of punishment were related to decreasing mentalization ability in adulthood. Findings support the use of treatments to improve mentalization skills in BPD, however, further research is needed to better specify the nature of underlying mentalizing biases in this population.     

Implicit and explicit motor learning: Application to children with Autism Spectrum Disorder (ASD)

Aims and objectivesThis study aims to determine whether children with Autism Spectrum Disorder (ASD) are capable of learning a motor skill both implicitly and explicitly.MethodsIn the present study, 30 boys with ASD, aged 7–11 with IQ average of 81.2, were compared with 32 typical IQ- and age-matched boys on their performance on a serial reaction time task (SRTT). Children were grouped by ASD and typical children and by implicit and explicit learning groups for the SRTT.ResultsImplicit motor learning occurred in both children with ASD (p = .02) and typical children (p = .01). There were no significant differences between groups (p = .39). However, explicit motor learning was only observed in typical children (p = .01) not children with ASD (p = .40). There was a significant difference between groups for explicit learning (p = .01).DiscussionThe results of our study showed that implicit motor learning is not affected in children with ASD. Implications for implicit and explicit learning are applied to the CO-OP approach of motor learning with children with ASD.     

Gaze patterns during scene processing in typical adults and adults with autism spectrum disorders

BackgroundLittle is known about how adults with autism spectrum disorder (ASD) process dynamic social scenes.MethodWe studied gaze behavior in 16 adults with ASD without intellectual impairment and 16 sex- and age-matched controls during passive scene processing.ResultsAdding more characters to a scene resulted in a drop in time spent looking at faces, and an increase in time spent looking at bodies (static trials) or off-person (dynamic trials) [Scene Type × AOI × Mode: F(2, 60) = 3.54, p = .04, η²_p = .11]. Unlike controls, adults with ASD showed only a small drop in the number of fixations made [Mode × Group: F(1, 30) = 11.30, p = .002, η²_p = .27] and no increase in the duration of face fixations [Mode × AOI × Group: F(2, 60) = 3.50, p = .04, η²_p = .11] when dynamic cues were added. Thus, particularly during dynamic trials, adults with ASD spent less time looking at faces and slightly more time looking off-person than did controls [Mode × AOI × Group: F(2, 60) = 3.10 p = .05, η²_p = .09]. Exhibiting more autistic traits and being less empathic were both associated with spending less time fixating on faces [.34 < |r| < .55, p < .05].ConclusionsThese results suggest that adults with ASD may be less sensitive to, or have more difficulty processing, dynamic cues—particularly those conveyed in faces. The findings demonstrate the importance of using dynamic displays in studies involving this clinical population.     

Psychometric properties of the French Version of the Social Responsiveness Scale in autism spectrum disorder with or without attention deficit hyperactivity disorder

ObjectivesThe Social Responsiveness Scale (SRS) is an instrument that is commonly used to screen for Autism Spectrum Disorder (ASD). Attention Deficit Hyperactive Disorder (ADHD) frequently occurs with ASD and both disorders share some phenotypic similarities. In the present study, we aimed to determine the psychometric properties of the French version of the Social Responsiveness Scale (SRS) and its 5 subscales (social awareness, social cognition, social communication, social motivation, and autistic mannerisms) to discriminate between children with ADHD and those with ASD (differential diagnosis) and children with ADHD from those with a dual diagnosis of ADHD and ASD (comorbid diagnosis).MethodSRS total scores and the 5 subscores of the SRS were compared between 4 groups of children: ADHD (n = 32), ASD + ADHD (n = 30), ASD (n = 31) and typical neurodevelopment (TD; n = 30) children. The discriminant validity was estimated using the Area Under the ROC Curves (AUC).ResultsSRS Social cognition (AUC = 0.73) and Autistic mannerisms (AUC = 0.70) subscores were the most discriminating for differential diagnosis of ASD and ADHD. SRS total scores (AUC = 0.70), and Social communication (AUC = 0.66) and Autistic mannerisms (AUC = 0.75) subscores were the most discriminating for comorbid diagnosis of ASD among ADHD children.ConclusionThe SRS autistic mannerisms subscore was found to be clinically relevant for both differential diagnosis of ASD and ADHD and comorbid diagnoses of ASD among ADHD children but with a modest discriminant power.     

Inattention and hyperactivity in association with autism spectrum disorders in the CHARGE study

BackgroundAttention deficits in young children with autism spectrum disorder (ASD) are not well understood. This study sought to determine: 1) the prevalence of ADHD symptoms in young children with ASD, typical development (TD), and developmental delay (DD) and 2) the association between ADHD symptoms and cognitive and behavioral functioning in children with ASD.MethodADHD symptoms, defined according to Aberrant Behavior Checklist (ABC) hyperactivity subscale scores, were compared across children aged 2–5 from a large case-control study with ASD (n = 548), TD (n = 423), and DD (n = 180). Inattention and hyperactivity items within this subscale were also explored. Within the ASD group, linear and logistic regression were used to examine how ADHD symptoms were associated with cognition as assessed by the Mullen Scales of Early Learning and adaptive functioning as assessed by the Vineland Adaptive Behavior Scales.ResultsMean hyperactivity subscale scores were lowest in children with TD (mean = 3.19), higher in children with DD (12.3), and highest in children with ASD (18.2; between-group p < 0.001). Among children with ASD, significant associations were observed with higher ADHD symptoms and poorer adaptive and cognitive functioning (adjusted beta for hyperactivity score in association with: Vineland composite = −5.63, p = 0.0005; Mullen visual reception scale = −2.94, p = 0.02; for the highest vs. lowest quartile of hyperactivity score, odds of lowest quintile of these scores was approximately doubled). Exploratory analyses highlighted associations with inattention-related items specifically.ConclusionThese results suggest ADHD symptoms may play a key role in the functioning of young children with ASD.     

Short-term impact of alcohol detoxification on facial emotions recognition

Background and aimsAlcohol use disorder (AUD) is associated with impaired social cognition, including the disturbance of facial emotion recognition (FER). Previous studies have focused on the assessment of basic emotions decoding among patients with AUD, but the evolution of these performances in the early phase of alcohol withdrawal remains unknown.MethodsThis study was based on evolution of social cognition over a period of 21 days in two groups of individuals: a group of 20 AUD patients and a control group of 25 healthy individuals. AUD patients were tested on admission in a detoxification ward and after a 3-week stay. We evaluated FER with the Reading the Mind in the Eyes Test (RMET). We assessed empathy with a multidimensional questionnaire, the Interpersonal Reactivity Index (IRI). We measured anxiety and depression through the self-rating scale Hospital Anxiety and Depression (HAD). We hypothesized that FER would be impaired in AUD patients on admission and improve after detoxification, while being stable in the control group.ResultsRMET scores on admission and at discharge were inferior in AUD patients to those observed in HC (P = 2 × 10⁻⁶ and P = 0.033, respectively). In the patient group, the RMET score improved over the stay (P = 0.034). A time-by-group interaction for RMET score was observed (P = 0.003). IRI scores on admission were superior in AUD patients (P = 0.023) whichwas no longer observed at discharge (P = 0.54). This suggests that RMET might be more accurate in measuring theory of mind evolution in AUD patients after withdrawal. HAD scores on admission and at discharge were inferior in AUD patients compared to controls (P = 3 × 10⁻⁵ and P = 0.007, respectively). After controlling for HAD initial score, a time-by-group interaction was still observed for RMET scores (P = 0.026).ConclusionFER is impaired in patients with Alcohol Use Disorder compared to controls. This alteration improves after alcohol detoxification. We suggest the RMET could be used to follow the improvement of FER during the first month of abstinence, especially as RMET performance has been associated with maintenance of alcohol withdrawal.     

The relationship of motor skills and adaptive behavior skills in young children with autism spectrum disorders

ObjectiveTo determine the relationship of motor skills and adaptive behavior skills in young children with autism.DesignA multiple regression analysis tested the relationship of motor skills on the adaptive behavior composite, daily living, adaptive social and adaptive communicative skills holding constant age, non-verbal problem solving, and calibrated autism severity.SettingMajority of the data collected took place in an autism clinic.ParticipantsA cohort of 233 young children with ASD (n = 172), PDD-NOS (n = 22) and non-ASD (developmental delay, n = 39) between the ages of 14–49 months were recruited from early intervention studies and clinical referrals. Children with non-ASD (developmental delay) were included in this study to provide a range of scores indicted through calibrated autism severity.InterventionsNot applicable.Main outcome measuresThe primary outcome measures in this study were adaptive behavior skills.ResultsFine motor skills significantly predicted all adaptive behavior skills (p < 0.01). Gross motor skills were predictive of daily living skills (p < 0.05). Children with weaker motor skills displayed greater deficits in adaptive behavior skills.ConclusionsThe fine and gross motor skills are significantly related to adaptive behavior skills in young children with autism spectrum disorder. There is more to focus on and new avenues to explore in the realm of discovering how to implement early intervention and rehabilitation for young children with autism and motor skills need to be a part of the discussion.     

Facial emotion recognition in psychiatrists and influences of their therapeutic identification on that ability

ObjectivesAlthough emotional cues like facial emotion expressions seem to be important in social interaction, there is no specific training about emotional cues for psychiatrists. Here, we aimed to investigate psychiatrists' ability of facial emotion recognition and relation with their clinical identification as psychotherapy–psychopharmacology oriented or being adult and childhood-adolescent psychiatrist.MethodsFacial Emotion Recognition Test was performed to 130 psychiatrists that were constructed by a set of photographs (happy, sad, fearful, angry, surprised, disgusted and neutral faces) from Ekman and Friesen's.ResultsPsychotherapy oriented adult psychiatrists were significantly better in recognizing sad facial emotion (p = .003) than psychopharmacologists while no significant differences were detected according to therapeutic orientation among child-adolescent psychiatrists (for each, p > .05). Adult psychiatrists were significantly better in recognizing fearful (p = .012) and disgusted (p = .003) facial emotions than child-adolescent psychiatrists while the latter were better in recognizing angry facial emotion (p = .008).ConclusionFor the first time, we have shown some differences on psychiatrists' facial emotion recognition ability according to therapeutic identification and being adult or child-adolescent psychiatrist. It would be valuable to investigate how these differences or training the ability of facial emotion recognition would affect the quality of patient–clinician interaction and treatment related outcomes.     

Autism spectrum disorder and the student teacher relationship: A comparison study with peers with intellectual disability and typical development

This study examined relations among behavior problems, social skills, and student–teacher relationships within a sample of children (mean age 8) with autism spectrum disorders or ASD (n = 36) and comparison samples of children with typical development (n = 91) or with intellectual disability (n = 38.) Student–teacher relationships (STRs) for children with ASD appeared to be qualitatively different from those of similarly aged children with ID or typical development. The STRs for children with ASD were considerably poorer, with less closeness and more conflict, than in the two comparison groups. Within the group with ASD, teacher-reported child externalizing behavior and social skills accounted for significant variance in the total score on the Student Teacher Relationship Scale. Conflict was predicted only by externalizing behavior, whereas closeness was predicted by social skills; level of autistic mannerisms negatively related to the teacher's perception of closeness. Findings address the implications for transition to early schooling for children with ASD.     

Improvement in social dysfunction of children with autism spectrum disorder following long term Kata techniques training

The purpose of the present study was to investigate the effects of long term Kata techniques training on social interaction of children with autism spectrum disorders (ASD). We assigned 30 school aged children with ASD to an exercise (n = 15) or a no-exercise group (n = 15). We required participants of the exercise group to exercise Kata techniques for 14 weeks, while participants of the control group received no exercise. We evaluated the social interaction of the participants at baseline, post-intervention (week 14), and at one month follow up. Results revealed that Kata techniques training significantly improved social dysfunction in the exercise group. Interestingly, at one month follow up improvement in social deficiency in the exercise group remained unchanged compared to post-intervention time. The social deficiency of participants of the control group was not changed across the experimental period. We concluded that teaching martial arts techniques to children with ASD leads to significant improvement in their social interaction.     

Efficacy of cognitive behavior therapy-based social skills intervention for school-aged boys with autism spectrum disorders

School-aged children with Autism Spectrum Disorders (ASD) experience significant difficulty with peer interaction. Research to identify the most effective strategies to address this difficulty has increased but more evidence is needed. Cognitive behavior therapy (CBT), which focuses on changing how a person thinks about social situations as well as how he behaves, is a promising approach. This study evaluated the efficacy of a 15 week CBT-based social skills intervention for boys aged 10–12 years diagnosed with an ASD. Boys with average or better IQ and receptive language skills were randomly assigned to either a control (n = 8) or intervention condition (n = 7). During intervention, boys attended weekly 2 h long group sessions focusing on self-monitoring skills, social perception and affective knowledge, conversation skills, social problem-solving, and friendship management skills. Comparison of the outcomes using repeated measures analyses indicated that boys receiving the intervention scored significantly better on measures of social perception, peer interaction, and social knowledge than boys who had not received intervention. There were no differences on general measures of socialization. The manualized intervention used in this study shows promise but replication with larger samples is needed.     

Social skills: Differences among adults with intellectual disabilities,co-morbid autism spectrum disorders and epilepsy

Assessing social skills is one of the most complex and challenging areas to study because behavioral repertoires vary depending on an individual's culture and context. However, researchers have conclusively demonstrated that individuals with intellectual disabilities (ID) have impaired social skills as well as those with co-morbid autism spectrum disorders (ASD) and epilepsy. However, it is unknown how these groups differ. Assessment of social skills was made with the Matson Evaluation of Social Skills for Individuals with Severe Retardation. One hundred participants with ID were matched and compared across four equal groups comprising 25 participants with ID, 25 participants with epilepsy, 25 participants with ASD, and 25 participants with combined ASD and epilepsy. When controlling for age, gender, race, level of ID, and hearing and visual impairments, significant differences were found among the four groups on the MESSIER, Wilks's Λ = .58, F(18, 257) = 3.05, p < .01. The multivariate η² based on Wilks's Λ was .17. Significant differences were found on the Positive Verbal subscale, F(3, 96) = 3.70, p < .01, η² = .10, Positive Non-verbal subscale, F(3, 96) = 8.95, p < .01, η² = .22, General Positive subscale, F(3, 96) = 7.30, p < .01, η² = .19, Negative Non-verbal subscale, F(3, 96) = 5.30, p < .01, η² = .14, and General Negative subscale, F(3, 96) = 3.16, p < .05, η² = .09. Based on these results, individuals with ID expressing combined co-morbid ASD and epilepsy had significantly more impaired social skills than the ID only or groups containing only a single co-morbid factor with ID (ASD or epilepsy only). Implications of these findings are discussed.     

Assessment of joint attention in school-age children and adolescents

Joint attention (JA), the ability to share attention to an object or event with another person, is one of the earliest identified deficits in autism spectrum disorders (ASD) and directly influences language and social development. There are several effective assessments of JA for young children (e.g., Mundy et al., 2003), but none are appropriate for school-age or adolescence. We developed a measure of response to JA and assessed individuals with ASD (n = 18) and typical development (n = 24), ages 7 to 17. Six naturalistic prompts were interleaved throughout a testing session. Discriminative validity was high: there was a broad range for both groups, though scores were lower for children with ASD. Scores in the ASD group were associated with receptive language, symptomatology, and theory of mind. Reliability across examiners was high (κ = .875). This measure, which requires no special equipment and minimal training, was useful in capturing JA skills in older individuals with and without ASD. Further, scores were associated with theoretically related skills, indicating high external validity. Given the powerful developmental sequelae and numerous interventions for JA, this measure offers a longitudinal assessment opportunity.     

Autistic characteristics in adults with epilepsy

IntroductionThe reported prevalence of autism spectrum disorders in people with epilepsy ranges from 15% to 47%. Despite the high comorbidity, there has been a lack of systematic studies of autistic characteristics in epilepsy. Little is known about the relationship of epilepsy to the core characteristics of autism. The aim of this research was to measure autistic traits and characteristics in adults with epilepsy who do not have a diagnosis of any autism disorder.MethodWe investigated autistic characteristics in adults with epilepsy and those without epilepsy employing the Autism Spectrum Quotient (group with epilepsy, n = 40; control group, n = 38) and systemizing and empathizing abilities employing the Intuitive Physics test and the Adult Eyes Task—Revised (group with epilepsy, n = 19; control group, n = 23).ResultsSignificantly more autistic behavioral traits, as measured by the AQ, were related to having epilepsy, but intact systemizing and empathizing abilities in these adults suggest that, in adults with epilepsy, autism-like symptoms may be present in the absence of wider cognitive profiles characteristic of autism.ConclusionIncreased autistic characteristics found in adults with epilepsy without an ASD diagnosis suggest that epilepsy syndromes may incorporate behavioral aspects of autism in the absence of some of its core cognitive features.     

The effect of peer- and sibling-assisted aquatic program on interaction behaviors and aquatic skills of children with autism spectrum disorders and their peers/siblings

The purpose of this study was to assess the effect of peer- and sibling-assisted learning on interaction behaviors and aquatic skills in children with autism spectrum disorders (ASD). Outcome measures were also examined in their typically developing (TD) peers/siblings. Twenty-one children with ASD and 21 TD children were assigned in three groups: peer-assisted (PG), sibling-assisted (SG), and control (CG). All participated in 16-week aquatic settings under three instructional conditions (teacher-directed, peer/sibling-assisted, and voluntary support). The main findings were that (a) PG and SG of children with ASD showed significantly more improvement on physical and social interactions with their TD peers/siblings during peer/sibling-assisted condition as compared to CG (p < 0.01), (b) PG and SG of children with ASD showed significantly more improvement on physical interactions with their TD peers/siblings (p < 0.01) and social interactions with their teachers and other children with ASD (p < 0.01) during voluntary support condition as compared to CG, and (c) all children with ASD and their TD peers/siblings significantly increased their aquatic skills after the program. The benefit for children with ASD as well as TD peers/siblings makes the use of TD peer/sibling assisted learning an even more desirable instructional strategy.