Interventions Addressing Social Impairment in Autism
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Children with an autism spectrum disorder have significant impairment in social skills. This area of development has also been the focus of many intervention studies. In this article we review intervention studies published over the past two years. Three topical areas were addressed in current interventions: social skills knowledge, peer relationships, and joint attention/joint engagement. Younger children most often received interventions on joint attention/joint engagement and older, higher functioning children received interventions on social knowledge and peer relationship development. Both single subject research designs and group designs were reviewed. One advancement was that more randomized controlled trials were reported, as well as effectiveness trials in the community. Study quality was also rated. More group than single subject designs were rated as adequate or strong in quality. Overall, moderate to large effects were found for interventions targeting joint attention/joint engagement and peer relationships with mixed effects on interventions targeting social skills knowledge. Future studies should focus on isolating the active ingredients of interventions and include broader participant representation.
KeywordsInterventions Social impairment Autism Autism spectrum disorder Social skills Randomized controlled trials Single subject research designs Joint attention Joint engagement Peer relationships Social knowledge Psychiatry
The preparation of this paper was supported by HRSA AIR-B UA3MC11055. SP was supported by the Canadian Institutes for Health Research - Doctoral Foreign Study Award and an Autism Speaks Weatherstone Fellowship, #7036.
C. Kasari: grants from Autism Speaks and National Institutes of Health; S. Patterson: royalties from Jessica Kingsley Publishers and compensation for travel/accommodations from Canadian Institutes for Health Research.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Kasari C, Rotheram-Fuller E. Peer relationships of children with autism: Challenges and Interventions. In: Hollander E, Anagnostou E, editors. Clinical manual for the treatment of autism. Washington DC: American Psychiatric Publishing; 2007. p. 235–57.Google Scholar
- 3.National Institute of Mental Health. Congressional appropriations report on the state of autism research. Bethesda, MD: Author; 2004.Google Scholar
- 4.Interagency Autism Coordinating Committee: Autism spectrum disorder research: Portfolio analysis report. Available at http://iacc.hhs.gov/portfolioanalysis/2010/2010_portfolio_analysis.pdf. Accessed August 2012.
- 13.Parker RI, Vannest KJ, Brown L. The improvement rate difference for single-case research. Except Child. 2009;75:135–50.Google Scholar
- 15.Banda DR, Hart SL. Increasing peer-to-peer social skills through direct instruction of two elementary school girls with autism. JORSEN. 2010;10:124–32.Google Scholar
- 19.• Charlop MH, Carpenter MH, Greenberg AL. Teaching socially expressive behaviors to children with autism through video modeling. Education and Treatment of Children. 2010;33:371–393. Received ‘adequate’ rating on quality indicators for single subject research designs. Taught 3 children to use more socially expressive vocalizations and gestures through video-modeling intervention. CrossRefGoogle Scholar
- 21.• Jull S, Mirenda P: Parents as play date facilitators for preschoolers with autism. J Posit Behav Interv 2011;13:17–30. Received ‘adequate’ rating on quality indicators for single subject research designs. Taught parents of 2 children to facilitate play dates between their child with ASD and a typical peer. Parents learned strategies and children engaged in more synchronous interactions and children spent more time interacting with peers. Parents maintained strategies over one year follow up.CrossRefGoogle Scholar
- 23.• Koegel RL, Fredeen R, Kim S, et al.: Using perseverative interests to improve interactions between adolescents with autism and their typical peers in school settings. J Posit Behav Interv 2012;14:133–141. Received ‘adequate’ rating on quality indicators for single subject research designs. Used the perseverative interests of 3 adolescents to design lunch clubs at school as context for increasing social engagement and initiations. Engagement increased immediately with variable increases in initiations among the participants. CrossRefGoogle Scholar
- 26.Reichow B, Sabornie EJ. Brief report: Increasing verbal greeting initiations for a student with autism via a Social Story intervention. Journal on Developmental Disabilities. 2009;39:1740–3.Google Scholar
- 33.• Castorina LL, Negri LM: The inclusion of siblings in social skills training groups for boys with Asperger syndrome. J Autism Dev Disord 2011;41:73–81. Received ‘adequate’ rating on quality indicators for group designs. Small pilot RCT demonstrating increases in emotion identification and non-verbal social cues for children with direct training on social skills with and without siblings present in groups. Compared to wait list control, both treatment groups improved and maintained skills over 3 month follow up. Increased identification of cues did not translate to social skills as rated by parent and teacher. PubMedCrossRefGoogle Scholar
- 35.• DeRosier ME, Swick DC, Davis NO, et al.: The efficacy of a social skills group intervention for improving social behaviors in children with high functioning autism spectrum disorders. J Autism Dev Disord 2011;41:1033–1043. Received ‘adequate’ rating on quality indicators for group designs. Adapted social skills program for high functioning children with ASD with group instruction involving parents in some sessions. Parents in treatment group reported increased social skills compared to control parents. Children did not report differences by group. PubMedCrossRefGoogle Scholar
- 36.• Frankel F, Myatt R, Sugar C, et al.: A randomized controlled study of parent-assisted children’s friendship training with children having autism spectrum disorders. J Autism Dev Disord 2010;40:827–842. Received ‘adequate’ rating on quality indicators for group designs. Focus on high functioning children with ASD in 2nd to 5th grade. Group child and parent intervention addressing social skills, play dates, and friendships. Parents in treatment group reported improved social skills and increased play dates. Children reported less loneliness and more popularity. At 3 month follow up, results for treatment group still improved from baseline. PubMedCrossRefGoogle Scholar
- 39.•• Kaale A, Smith L, Sponheim, E: A randomized controlled trial of a preschool-based joint attention intervention for children with autism. J Child Psychol Psychiatr 2012;53:97–105. Received a’ strong’ rating on quality indicators. An effectiveness trial of joint attention and play intervention delivered by nursery school teachers yielded effects on joint attention initiations with teachers and joint engagement with parents. CrossRefGoogle Scholar
- 40.•• Kasari C, Gulsrud AC, Wong C, et al.: Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. J Autism Dev Disord 2010;40: 1045–1056. Received a ‘strong’ rating on quality indicators. Small randomized controlled trial of parent mediated joint attention and play intervention improved joint engagement between parents and toddlers, and child joint attention responses and functional play acts. PubMedCrossRefGoogle Scholar
- 41.•• Kasari C, Rotheram-Fuller E, Locke J, et al.: Making the connection: Randomized controlled trial of social skills at school for children with autism spectrum disorders. J Child Psychol Psychiatr 2012;53:431–439. Received a ‘strong’ rating on quality indicators. Partial effectiveness trial in the schools (researchers delivered the intervention) with significant effects of intervention conditions involving typical peers from the child with ASD’s class. Multi-informant outcome measures including peers (social connections), teacher report, and playground observations. CrossRefGoogle Scholar
- 44.• Laugeson EA, Frankel F, Gantman A, et al.: Evidence-based social skills training for adolescents with autism spectrum disorders: The UCLA PEERS program. J Autism Dev Disord 2012;42:1025–1036. Received ‘adequate’ rating on quality indicators. Randomized trial of group based and parent mediated social skills program for teens with significant effects on parent reported social skills, and more get-togethers at home between teens. Teens tested significantly better on social knowledge post intervention. PubMedCrossRefGoogle Scholar
- 45.• Lawton K, Kasari C: Brief report: Longitudinal improvements in the quality of joint attention in preschool children with autism. J Autism Dev Disord 2012a;42:307–312. Received ‘adequate’ rating on quality indicators. Longitudinal assessment of children involved in a randomized trial of joint attention and play interventions with concomitant improvements in shared positive affect with the joint attention intervention. PubMedCrossRefGoogle Scholar
- 50.Frankel F, Myatt R. Children’s friendship training. New York: Brunner-Routledge; 2003.Google Scholar
- 52.Kasari C, Paparella T, Freeman S, et al. Language outcome in autism: Randomized comparison of joint attention and play. J Child Psychol Psychiatr. 2008;76:125–37.Google Scholar