Journal of Autism and Developmental Disorders

, Volume 40, Issue 2, pp 149–166 | Cite as

Social Skills Interventions for Individuals with Autism: Evaluation for Evidence-Based Practices within a Best Evidence Synthesis Framework

Original Paper

Abstract

This paper presents a best evidence synthesis of interventions to increase social behavior for individuals with autism. Sixty-six studies published in peer-reviewed journals between 2001 and July 2008 with 513 participants were included. The results are presented by the age of the individual receiving intervention and by delivery agent of intervention. The findings suggest there is much empirical evidence supporting many different treatments for the social deficits of individuals with autism. Using the criteria of evidence-based practice proposed by Reichow et al. (Journal of Autism and Developmental Disorders, 38:1311–1318, 2008), social skills groups and video modeling have accumulated the evidence necessary for the classifications of established EBP and promising EBP, respectively. Recommendations for practice and areas of future research are provided.

Keywords

Autism Social skills Evidence-based practice 

Introduction

Since the time of Leo Kanner’s first description of the syndrome of ‘early infantile autism’ (Kanner 1943) major difficulties in social interaction have consistently been identified as a, if not the, central feature of autism (Carter et al. 2005). Various studies have, for example, identified social difficulties/features as being the single most powerful predictors of diagnostic status (Siegel et al. 1989). Social difficulties should differentiate children with autism spectrum disorders (ASD) from those with other developmental disorders (Klin et al. 2007) and are more heavily weighted than other areas in current (DSM-IV and ICD-10) diagnostic approaches (American Psychiatric Association 1994; World Health Organization 1994). Difficulties in the social arena typically remain an area of great vulnerability even for the most cognitively able individuals on the autism spectrum (Howlin 2005; Shea and Mesibov 2005). Somewhat paradoxically, social skills were comparatively much less studied than other aspects of autism. Fortunately, this situation has begun to change dramatically (Volkmar et al. 2004). Figure 1 illustrates a dramatic increase in the amount of research on social skills interventions for individuals with ASD within the current decade, which is a continuation of a trend that began in the previous decade (see Matson et al. 2007).
Fig. 1

Number of studies published by year for studies included in this synthesis

The focus on the social brain in autism has stemmed from several sources (Insel and Fernald 2004). These include a more general focus in neuropsychology and neuroscience on social processes and their neural basis (e.g., Adolphs et al. 2001; Hadjikhani et al. 2007). This work has used a range of technologies to study this issue (Insel and Fernald 2004). Attempts have been made to relate specific social processes to particular brain structures and systems, e.g., the amygdala, prefrontal cortex, and fusiform ‘face’ area (Schultz et al. 2006). Another approach has focused on development of animal models of the disorder (Amaral et al. 2008; Bachevalier and Loveland 2006). Still other approaches have attempted to marry specific psychological theories with studies of both brain and behavior, e.g., the attempt to find neural correlates of ‘theory of mind’ (Campbell et al. 2006; Gregory et al. 2002), deficits in ‘executive functioning’ (Happé et al. 2006), or ‘weak central coherence’ (Rippon et al. 2007). Another line of work has focused on basic differences in specific neuropsychological processes. For example, the observation that individuals with ASD differ in the ways they process faces in the brain (Schultz et al. 2000) and as they view faces and social interaction in real time and more ecologically valid contexts (Klin et al. 2002a, b). The observation of very early development of social difficulties is consistent with Kanner’s original impression and underscores the centrality of basic social information process in multiple aspects of syndrome development (Klin and Jones 2008). As this body of work has grown there has also been a corresponding increasing interest in therapeutic interventions for social difficulties in autism.

To some extent, of course, social skills have always been a target for intervention. Early studies of behavioral treatments entailed a focus on learning to learn techniques and thus an emphasis on joint attention and task engagement, i.e., in helping the child share with adult a focus of interest (Lovass and Smith 1988). Similarly communication based intervention programs intrinsically include some social component given the social nature of communication (Tager-Flusberg et al. 2005). The last decade has witnessed a steady progression the development and implementation of social skills intervention programs. These are widely used with individuals of all ages and fall into three general categories: adult mediated (teacher or clinician instruction/therapy), peer mediated (particularly with preschoolers), and combination approaches (social skills groups with peers and an adult present) (Paul 2003). The focus, theoretical orientation, and developmental framework of these models has, not surprisingly, differed considerably. The volume of supportive, empirical data also has been highly variable with probably the most extensive body of work devoted to evaluation of peer support methods in preschool settings (Goldstein and Cisar 1992; Strain and Fox 1981). Apart from the comparatively much longer tradition of research in this area, evaluations of social skills approaches in other groups and with different methods are much more recent.

The purpose of this review was to examine the empirical evidence of recently studied social skills interventions within the framework of a best evidence synthesis (Slavin 1986). While multiple methods of synthesizing evidence are commonly used (e.g., meta-analysis, systematic reviews, traditional reviews), the framework of a best evidence synthesis was used to help limit bias from studies of poor quality (i.e., only studies with strong methodological rigor were included).

Method

Best Evidence Synthesis

Six criteria were used to select the studies included in this synthesis. First, the majority of the participants in the potential study must have been identified as having an ASD. Second, studies had to evaluate interventions designed to improve one or more social skill(s) of the individuals with ASD. Third, the study must have evaluated at least one social outcome of the participants with ASD. Fourth, the evaluation of the intervention must have been conducted using one of the following research designs: (a) true experimental designs (i.e., randomized clinical trial); (b) quasi-experimental multiple-group comparison, or (c) single subject experimental designs (e.g., multiple-baseline, withdrawal, alternating treatments). Fifth, the study must have been published or accepted for publication with online availability in English in a peer-refereed journal between publication of the National Research Council Report (NRC; Lord et al. 2001) and July 2008. Finally, study reports had to receive acceptable or strong methodological rigor ratings on the rubrics outlined in the Evaluative Method for Determining Evidence-Based Practices in Autism (Reichow et al. 2008). Studies were located using a four-step literature search conducted in the following order: (a) electronic database searches (psycINFO, MEDLINE) using the search terms “autis* and social”, (b) review of references from review articles and eligible reports, (c) hand search of relevant journals, and (d) online search of relevant journal’s in press articles. Seventy-one reports containing 66 studies were located meeting all inclusion criteria.

Study Analysis

Analysis of the studies was completed using a multi-level system. First, the studies were categorized into a two-level organizational scheme. The primary level of organization categorized the studies by the participant’s age, which is a common organizational scheme for reviews of interventions for individuals spanning multiple age groups. When determining the age category of each study, the ages of participants was evaluated with respect to the mean age of the participants and/or the age range of the participants. Although there was some overlap between categories, each study was placed in the best representative category. The category of preschool children contains studies with a majority of participants who had not entered elementary school. Children in the preschool category were typically less than 5-years-old, and no study contained participants over the age of 7-years-old. The category of school-aged children typically contains studies with participants typically between the ages of 6 and 12. Due to the wide age ranges in some studies, there is overlap in ages between the preschool and school-aged categories and the school-aged and adolescent and adult categories. The absolute range of the participant’s ages within the school-age category is 4- to 17-years-old. The category of adolescent and adult participants comprises studies containing participants that were at least 13-years-old.

The secondary level of organization is based on the schema used by Paul (2003), which categorized studies by the delivery agent of the intervention (i.e., who provided the direct therapy or services). Five categories of delivery were used. In studies categorized as having technological delivery, the intervention was provided to the participant through electronic means (e.g., computer, videotape/television, voice output device). The inclusion of an adult solely acting as a device operator (e.g., a teacher turning on the television) did not exclude a study from this category. Studies with parental delivery had direct intervention services provided by the participant’s parent(s). Use of research personnel to train parents how to deliver (provide) the intervention was expected and therefore did not exclude a study from this category. The category of non-parental adult delivery contains studies in which the direct intervention services were provided by an adult other then the child’s parent (e.g., teacher, clinician, therapist). Studies incorporating peer delivery had the direct intervention services provided by a same-aged individual. Use of research personnel to train and/or prompt the same-aged individuals was expected for studies in this category, and their participation did not exclude a study from this category. Studies using same-aged individuals without training to assess generalization were not included in this category. The final category, combined or multiple delivery, is comprised of studies in which multiple types of intervention delivery methods were used. The combinations used in each study are specified in the accompanying tables.

The third step in the analysis entailed extracting information from the included studies pertaining to the characteristics of the research methods, participants, and intervention. Five methodological variables were coded. The results obtained from the Evaluative Method for Determining Evidence-Based Practices in Autism (Reichow et al. 2008) completed during the literature search were examined for specific methodological characteristics, including the overall experimental rigor rating. Second, the study design was categorized (i.e., randomized control trial, quasi-experimental multiple-group comparison, or single-subject research design). Third, the inclusion of generalization and/or maintenance assessments was recorded on a dichotomous scale (present or not present). Procedural fidelity (Billingsley et al. 1980) was analyzed using the three components of treatment integrity proposed by Perepletchikova and Kazdin (2005). Fidelity of treatment adherence was defined as evidence the characteristics of treatment were delivered consistently as planned across and within participants of a sample. Treatment differentiation was defined as evidence the groups of a comparative study received different levels of the treatment package. Therapist competence was defined as evidence of therapist training and/or evaluation of therapist performance. Finally, the dependent measures were recorded for each study. Although the dependent measures are typically considered a methodological variable, the dependent measures of each study will be reported in the ‘Results’ column of the accompanying tables to allow for easier comparison with the success estimates.

Four participant characteristics were coded. The total number of participants quantifies the total number of individuals receiving intervention. For studies using group designs, if the contrasting groups each received a social skills intervention, the totals for each group are presented; participants in control groups were never included. For single subject studies, only participants meeting the inclusion criteria for study selection were included; if a participant was included in a study report but did not have an ASD, the results of their participation were not included in the review. The second participant characteristic was the age range of the participants, which was rounded down to the nearest whole year (i.e., a child who was 5-years-8-months-old was coded as 5-years-old). The gender breakdown of the participants was recorded by coding the number of males and females in the study. Finally, a gross estimation of the typical cognitive functioning level of the participants was determined using a trichotomous scale. Participants categorized as lower functioning had limited or no verbal language skills and had an IQ < 55. Participants categorized as medium functioning typically had an IQ of 55–85 and had rudimentary verbal communication skills. Participants categorized as higher functioning had average to above average intelligence (IQ > 85) and typically had well developed verbal communication.

Four intervention characteristics were coded. The intervention type, provides a gross level description of the techniques and methods used by the practitioner during the intervention sessions. Multiple intervention types could be coded for each study. Eight categories of intervention type were defined for this synthesis. The category of ABA included interventions with a behavioral orientation that were based on the principles and technology of applied behavior analysis (ABA; Baer et al. 1968). Examples of interventions within this category included different prompting paradigms, reinforcement schedules, and imitation and modeling (see also Strain and Schwartz 2001). Naturalistic interventions also typically used behavioral methods, but specified that the delivery of therapy was done in common, every-day settings using naturally occurring antecedents and consequences (see also Cowan and Allen 2007). The distinguishing feature of interventions in the parent training category was researchers training parents to deliver the therapy services to the participants. Peer training (e.g., peer mediation) included studies in which practitioners trained like-aged peers to deliver the direct intervention services to the individuals with ASD (see also Odom and Strain 1984). Interventions categorized as social skills groups contained two or more like-aged individuals (with and/or without disabilities) meeting in a group instructional format (see also White et al. 2007). Social skills group lessons could involve lessons centered on specific social skills (e.g., emotions, peer initiations) and/or general social competence. The category of visual was categorized by the use of visual cues and prompts (e.g., picture cues, scripts, Social Stories) (see also Quill 1997). Interventions utilizing visual techniques were typically (but not necessarily) delivered by an adult. Related to visual presentation, but comprising a specific category was video modeling, which involved the presentation of video vignettes to participants on television or computer screens (see also Bellini and Akullian 2007). The final category of intervention type was other, which subsumes any technique not captured by the first eight categories.

Intervention density provides a quantification of the amount direct services provided during the intervention. Up to three quantifications of density were estimated: (a) the duration of 1 session (in min), (b) the number of sessions per week, and (c) the total length of the intervention (in weeks or sessions). To maintain similar metrics across studies, information provided in the study reports was converted using the following formulae: (a) 1 month = 4.3 weeks, and (b) 1 week = 5 days. The typical setting of the intervention was classified in four categories. The category of home setting was coded when direct intervention services were provided in the participant’s home. Clinical setting was recorded when intervention services were provided by a profession at an off-site office complex or hospital setting. The category of school setting was coded when intervention occurred at the participant’s home school during the school day. The final category, community setting, was coded when the intervention services were provided outside of the home, school, or clinic settings, and included summer camps, before- and after-school care, and other locations within one’s community. The target skills and behaviors of intervention provides a categorization of the outcome(s) (i.e., dependent variables) of each study. Three categories were defined for this review. The first category, general social skills, include outcomes that would enhance an individual’s overall social competence, and included facial affect, theory of mind, and friendship. The second category was social interaction, which includes outcomes related to the ability one needs to interact with other individuals. Examples of outcomes from this category included play skills, proximity, social engagement, social initiations of interactions (non-verbal or unspecified form of delivery), and turn-taking. The final category was social communication, and included outcomes such as verbal social initiations, conversation skills, and joint attention. Like intervention type, multiple categories could be coded for one study.

Analysis of Study Results

Two variables were coded for study results. First, the specific outcome measures or dependent variables used in each study were recorded. Because the lack of a valid and reliable effect size metric for single subject research (Wolery et al. in press) precluded the ability to synthesize the results using statistical techniques (e.g., meta-analysis), a success estimate was created and coded. When studies examined multiple behaviors, an estimate was calculated for each class of social behaviors. Success estimates for study specific results were coded using different coding schemes for group and single subject research. For studies using group research designs, the success estimates are estimates of the magnitude of change or difference (i.e., effect sizes). These estimates should be interpreted with caution since some of the estimates were calculated with small sample sizes and/or were calculated without reference to a control group (e.g., effect sizes for a study comparing two social intervention procedures were calculated using the standardized mean change effect size and are presented across groups).

For single subject research, the success estimate provides an estimate of the success rate across participants and/or behaviors. Specifically, the success rate was estimated using visual analysis and provides a ratio of successful implementations of the independent variable to the total number of implementations attempted. Because one participant might have received intervention across multiple behaviors, the denominator of the ratio does not always equal the number of participants in the study. Thus, the success rate is built on the foundation of replication from which single subject experimental methods are based and provide information about the consistency of replication for the intervention within a study.

Literature Synthesis

Table 1 provides descriptive statistics for the studies included in this review across ages and by age group and rigor rating.
Table 1

Characteristics of studies included in review by age category and rigor rating

Age group

Studies

Research design

Participants

Functioning level

Delivery agent

Rigor Rating

RCT

Q-E

SSED

Total

(M:F)

Low

Med.

High

Tech.

Parent

NPA

Peer

Combo

All age groups

66

3

7

56

513

416:67

26

46

25

10

4

26

10

16

 

4%

11%

85%

 

81%M

39%

67%

38%

15%

6%

39%

14%

24%

    Preschool

35

2

2

31

186

147:29

19

22

9

2

4

15

5

9

53%

6%

6%

89%

36%

79%M

54%

63%

26%

6%

11%

43%

14%

26%

      Strong

 

1

1

6

88

70:18

7

6

2

1

1

3

0

3

      Adequate

 

1

1

25

98

77:11

12

15

7

1

3

12

5

6

    School-age

28

1

4

23

291

239:32

7

21

14

7

0

9

5

7

42%

4%

14%

82%

57%

82%M

25%

75%

50%

25%

0%

32%

18%

25%

      Strong

 

0

2

2

91

86:5

0

2

2

0

0

2

2

0

      Adequate

 

1

2

21

205

133:27

8

20

11

0

0

7

3

7

    Adolescent/Adult

3

0

1

2

36

30:6

0

3

2

1

0

2

0

0

5%

0%

33%

67%

7%

83%M

0%

100%

33%

33%

0%

67%

0%

0%

      Strong

 

0

1

0

32

26:6

0

1

2

1

0

0

0

1

      Adequate

 

0

0

2

4

4:0

0

2

0

0

0

2

0

0

Percentages for all age groups refer to the percentage of all studies (i.e., 73). The percentages for the specific age groups refer to the percentage of studies within that age group

Key: RCT randomized clinical trial, Q-E quasi-experimental group, SSED single subject experimental design, M:F male:female, Med. medium, Tech. technological, NPA non-parental adult, Combo combined or multiple

Sixty-six studies examining 513 individuals with ASD were included in this review. Ten studies were conducted using group designs and 56 studies were conducted using single subject designs; 3 of the 10 group studies were conducted using randomized designs. Of the 66 reports, 13 (20%) reports received a strong rigor rating and 53 studies received an adequate rigor rating. While it is not likely that the studies included in this synthesis form an exhaustive group of studies, the large diversity of studies with respect to the journals in which they were published and authors who conducted the studies should create a representative sample that is sufficient for this synthesis. The possibility of publication bias is discussed further in the limitations section of the discussion.

The literature synthesis is presented on three levels. First, an overview of the participants, research rigor, and research designs across studies are provided. Second, the characteristics of the methods, participants, and interventions will be synthesized by age group. Finally, the findings of the studies will be synthesized across the different types of intervention. Findings specific to the intervention delivery agent will be discussed with reference to the intervention methods.

Age-Specific Findings

Interventions for Preschool Children

The 35 studies with a majority of participants being preschool children are shown by type of intervention provider in Table 2 (see also Table 1). Most of the studies received adequate rigor ratings and used single subject designs. Random clinical trial designs were infrequently used. Generalization and/or maintenance were frequently measured. Although 10 studies measured both generalization and maintenance, 7 studies did not contain measures of either. Finally, procedural fidelity was frequently measured; treatment adherence was evaluated in 26 studies, treatment differentiation was evaluated in 1 study, and therapist competence was evaluated in 18 studies. Sixteen studies contained multiple measures of treatment fidelity.
Table 2

Social skills interventions for preschool-aged-participants by agent of intervention delivery

Reference

Methodological characteristics

Participant characteristics

Intervention characteristics

Study results

Rigor

Design

G/M

Fidelity

n

M, F

Age

Fxn level

Type

Density

Setting

TSB

Success Est.

Outcome measures

Technological delivery

Bellini et al. (2007)

Adequate

Single subject

M

TA

2

2,0

4–5

Medium

Video modeling

30 min 5× per week, 4 weeks total

School

SI

2 of 2

Social engagement

Simpson et al. (2004)

Strong

Single subject

TA

4

2,2

5–6

Lower and medium

Video modeling

30 min 5× per week, ~5 weeks total

School

GSS

SC

4 of 4

4 of 4

Sharing and social greetings

Parental delivery

Aldred et al. (2004)

Adequate

Random clinical trial

M

TC

14

13,1

2–5 \( ({\bar{\text{X}}=4}) \)

Lower and higher

Parent training and ABA

0.25× per week, ~26 weeks total

Clinic and home

SI

d = .43–.56

Shared attention

Ingersoll and Gergans (2007)

Adequate

Single subject

G/M

TC

3

2,1

2–3

Lower

Parent training and naturalistic

30–40 min 2× per week, 10 weeks total

Clinic

SI

3 of 3

Initiations

Schertz and Odom (2007)

Adequate

Single subject

G/M

TA, TC

3

3,0

<3

Lower

Parent training and ABA

~1× per week, 9–26 weeks total

Home

GSS

SC

6 of 6

5 of 6

Attention to faces, turn taking, and joint attention behaviors

Vismara and Lyons (2007)

Strong

Single subject

TA, TC

3

3,0

2–3

Lower

Parent training and ABA

150 min 2× per week, 14 weeks total

Clinic or home

SC

3 of 3

Joint attention behaviors

Non-parental adult delivery

Boyd et al. (2007)

Adequate

Single subject

TA

3

3,0

3

Medium and higher

ABA

5 min 2–3× per week, 3–4 weeks total

School

SI

3 of 3

Social interactions

Carter (2001)

Adequate

Single subject

G

TA, TC

3

2,1

5–7

Medium

ABA

50 min 2× per week, 10 weeks total

Clinic

SI

3 of 3

Initiating play

Crozier and Tincani (2007)

Adequate

Single subject

M

TA

2

2,0

3–5

Medium and higher

ABA and visual

5 min 3× per week, 9 weeks total

School

SC SI

1 of 1

1 of 1

Talking to peers and appropriate social interactions

DeQuinzio et al. (2007)

Adequate

Single subject

G

3

3,0

3–6

n/p

ABA

5 min 5× per week, 8–9 weeks total

School

GSS

3 of 3

Imitation of facial expressions

Gena (2006)

Adequate

Single subject

G

TA

4

2,2

4

Lower and medium

ABA

40–70 weeks total

School

SI

4 of 4

Social initiations and responses to social initiations

Hancock and Kaiser (2002)

Adequate

Single subject

G/M

TA, TC

4

3,1

3–4

Lower and higher

Naturalistic

15 min 2× per week, 12 weeks total

Clinic

SC

4 of 4

Social communication

Ingersoll et al. (2005)

Adequate

Single subject

G/M

TA, TC

3

3,0

2–3

Lower and medium

Naturalistic

50 min 2× per week, 10 weeks total

Clinic

SC

3 of 3

Social communication

Ingersoll and Schreibman (2006)

Adequate

Single subject

G/M

TA, TC

5

3,2

2–4

Lower and medium

Naturalistic

40–60 min 3× per week, 10 weeks total

Clinic

SC SI

5 of 5

5 of 5

Imitative and spontaneous language, joint attention, object imitation

Kasari et al. (2006)

Strong

Random clinical trial

G

TA, TD, TC

41

15,5

3–4 \( ({\bar{\text{X}}=3}) \)

Lower and medium

ABA and naturalistic

30 min 5× per week, 5–6 weeks total

Clinic

SC

d = .45–1.14

Joint attention measures on Early Social Communication Scales

Kern et al. (2007)

Adequate

Single subject

TA, TC

2

2,0

3

Medium

ABA, visual, and other

2–10 min 5× per week, 9–13 weeks total

School

SI

2 of 2

Social greeting behaviors

Kohler et al. (2001)

Adequate

Single subject

M

TA, TC

4

4,0

4

Lower and medium

Naturalistic

10 min 2–3× per week, up to 29 weeks total

School

SI

4 of 4

Social interactions

Kroeger et al. (2007)

Strong

Multi-group comparison

25

20, 5

4–6 \( ({\bar{\text{X}}=5}) \)

Lower, medium, and higher

Social skill groups

60 min 3× per week, 5 weeks total

Clinic

SI

η2 = .22–.33

Social initiations, responses, and interactions

MacDuff et al. (2007)

Strong

Single subject

G/M

3

3,0

3–5

Lower

Visual and ABA

5 min up to 10× per week

School

SC

3 of 3

Joint attention behaviors

Smith et al. (2004)

Adequate

Multi-group comparison

M

10

n/p

3–5 \( ({\bar{\text{X}}={\text{n}}/{\text{p}}}) \)

n/p

ABA

60 min 5× per week, ~26 weeks

Home

SC

d = 3.05

Social participation

Whalen and Schreibman (2003)

Adequate

Single subject

G/M

TA

5

4,1

4

Medium

ABA and naturalistic

~30 min up to 15× per week, ~5 weeks total

Clinic

SC

4 of 4

Joint attention behaviors

Peer delivery

Garfinkle and Schwartz (2002)

Adequate

Single subject

G/M

TA, TC

4

4,0

3–5

Lower

Peer training and ABA

10 min ~1×per week, 22 weeks total

School

SI

4 of 4

Social interaction

Kohler et al. (2007)

Adequate

Single subject

M

TC

1

1,0

4

Lower

Peer training, visual and ABA

10 min 3× per week, 11 weeks total

School

SI

3 of 3

Social interaction

Nelson et al. (2007)

Adequate

Single subject

M

TA

4

4,0

3–4

Lower and medium

Peer training and visual

30 min 2–4× per week, ~20–40 weeks total

School

SI

4 of 4

Social initiations

Petursdottir et al. (2007)

Adequate

Single subject

TA

1

1,0

5

Higher

Peer training

15 min 4× per week, 4–5 weeks total

School

SI

2 of 3

Social interaction

Zercher et al. (2001)

Adequate

Single subject

M

TA, TC

2

2,0

6

Medium

Peer training

1× per week, 20 weeks total

Community

SC

5 of 5

Joint attention

Combined or multiple delivery

Technological and non-parental adult

    Apple et al. (2005)

Adequate

Single subject

G

TA, TC

5

4,1

4–5

Medium and higher

ABA and video modeling

20 min 3× per week, 7–8 weeks total

School

SI

5 of 5

Social initiations

    Gena et al. (2005)

Strong

Single subject

M

TA

3

2,1

3–5

Medium and higher

ABA and video modeling

15–20 min 2–4× per week, ~15–30 weeks total

Home

GSS

3 of 3

Response to affective behavior

    Maione and Mirenda (2006)

Adequate

Single subject

M

TA

1

1,0

5

Medium

ABA and video modeling

3–30 min 4× per week, ~8–12 weeks total

Home

SC

3 of 3

Social communication

Non-parental adult and peer

    Betz et al. (2008)

Adequate

Single subject

G/M

3

2,1

4–5

n/p

Peer training and visual

40–52 sessions total

Clinic or school

SI

3 of 3

Peer engagement (interaction)

    Ganz and Flores (2008)

Adequate

Single subject

G

TA, TC

3

3,0

4

Medium and higher

Peer training, visual, and ABA

30 min 4–5× per week, 4 weeks total

School

SC

3 of 3

Scripted phrases, context-related comments

    Jones et al. (2006)

Adequate

Single subject

M

TA, TC

5

5,0

<3

Lower

ABA

~3 min 5–20× per week, 7–43 weeks total

Home, community, and school

SC

5 of 5

Joint attention behaviors

    Jung et al. (2008)

Strong

Single subject

G/M

TA, TC

3

3,0

5–6

Lower and medium

Peer training and ABA

10 min 5× per week; ~12–15 weeks total

School

SI

3 of 3

Social interactions

    Kern and Aldridge (2006)

Strong

Single subject

TA, TC

4

4,0

3–5

Lower and medium

Peer training and other

10 min 5× per week, up to 34 weeks

School

SI

4 of 4

Peer interactions

    Sawyer et al. (2005)

Adequate

Single subject

M

TC

1

1,0

4

Medium

Peer training and ABA

30 min 5× per week, 5 weeks total

School

SI

1 of 1

Sharing

Key: G/M generalization and maintenance, G generalization, M maintenance, TA treatment adherence, TD treatment differentiation, TC therapist competence, M male, F female, Fxn level functioning level, TSB target skills or behavior, GSS general social skills, SC social communication, SI social initiations, Success est. success estimate, ABA applied behavior analysis

Across studies, 186 preschool children with autism received intervention. Most of the participants were male, and a majority of the studies contained participants that were at least 4-years-old. The typical cognitive functioning levels of the participants were medium and/or lower. Interventions with preschool children were mostly delivered by non-parental adults acting either as the sole delivery agent or in combination with other delivery methods.

The most frequently used intervention technique were methods based on ABA. Interventions using techniques classified as naturalistic techniques and peer training, were also commonly used. Twenty studies reported session duration of at least 14 min, and 11 studies reported session durations less than 15 min. With respect to the frequency of intervention sessions by the week, 30 studies involved multiple sessions each week and 3 studies involved on average, one or fewer session per week. Less than one-half of the studies reported total intervention durations of at least 12 weeks. Increases in social communication and social interaction were the most commonly targeted skills or behaviors. The most common intervention setting was the school setting, which was the location of therapy in 19 studies. Clinical settings and participant’s homes were also frequently used.

Interventions for School-Aged Children

The 28 studies including a majority of school-aged participants are shown by type of intervention provider in Table 3 (see also Table 1). Most of the studies received adequate rigor ratings and used single subject designs. The random clinical trial design was only used in 1 study. As with the preschool studies, generalization and/or maintenance were frequently measured, however, six studies did not contain either generalization or maintenance. Finally, procedural fidelity was measured in a majority of the studies, including 5 studies that contained multiple assessments of procedural fidelity. Overall, 12 studies contained measures of treatment adherence and 6 studies contained measures of therapist competence.
Table 3

Social skills interventions for school-aged participants by agent of intervention delivery

Reference

Methodological characteristics

Participant characteristics

Intervention characteristics

Results

Rigor

Design

G/M

Fidelity

n

M, F

Age

Fxn Level

Type

Density

Setting

TSB

Success Est.

Outcome measures

Technological delivery

Buggey (2005) (study 1)

Adequate

Single subject

M

2

2,0

9–11

Higher

Video modeling

3 min 5× week, 2 weeks total

School

SI

2 of 2

Social interaction

Charlop-Christy and Daneshvar (2003)

Adequate

Single subject

G/M

3

3,0

6–9

Medium

Video modeling

Up to 43 sessions

Community

GSS

2 of 3

Perspective taking

LeBlanc et al. (2003)

Adequate

Single subject

G/M

3

3,0

7–13

Medium and higher

Video modeling and ABA

4–10 min 2–3× week, ~9–13 weeks total

School or community

GSS

3 of 3

Perspective taking

Nikopoulos and Keenan (2004)

Adequate

Single subject

M

3

3,0

7–9

Medium

Video modeling

~5 min per session, up to 28 sessions total

n/p

SI

3 of 3

Social initiations and interactions

Nikopoulos and Keenan (2007)

Adequate

Single subject

G/M

3

3,0

6–7

Lower, medium, and higher

Video modeling

~30 min 5× per week, ~10 weeks total

School

SI

3 of 3

Social initiations and interactions

Scattone (2008)

Adequate

Single subject

G

TA

1

1,0

9

Higher

Video modeling and visual

5 min 1–2× per week, 15 weeks total

Clinic

SC

2 of 3

Eye contact, smiling, social initiations

Sherer et al. (2001)

Adequate

Single subject

G/M

5

5,0

4–11

Lower and medium

Video modeling

15× per week, ~4–15 weeks total

Clinic or home

SC

5 of 10

Engagement in social conversation

Non-parental adult delivery

Bock (2007)

Adequate

Single subject

M

TA

4

4,0

9–10

Higher

Visual and other

5× per week, 3 weeks total

School

SI

6 of 6

Social participation (interaction)

Fisher and Happé (2005)

Adequate

Randomized clinical trial

M

20

n/p

6–15 \( ({\bar{\text{X}}}=10 )\)

Medium

Other

4–10 25–min sessions, .8–2 weeks total

School

GSS

n. c.

Perspective taking

Koegel et al. (2005)

Adequate

Single subject

2

1,1

8–9

Medium

ABA, and naturalistic

1× per week, up to about 52 weeks total

Community

SI

2 of 2

Social interaction

Lee et al. (2002)

Adequate

Single subject

G

 

2

2,0

7

Medium

ABA

2–4× per week, ~20–30 weeks total

School

SC

2 of 2

Responding to social questions

Legoff (2004)

Adequate

Multi-group comparison

47

34,13

6–16 \( ({\bar{\text{X}}}=10) \)

Medium and higher

Social skills group and other

60 min 1× per week and 90 min 1× per week, 12 weeks total

Clinic

GSS

d = .89–2.26

Gilliam Autism Rating Scale—Social Interaction Scale

Legoff and Sherman (2006)

Adequate

Multi-group comparison

60

49,11

Range n/p \( ({\bar{\text{X}}}=9) \)

Medium and higher

Social skills groups other

60 min 1× per week and 90 min 1× per week, 36 weeks total

Clinic

GSS

d = .49–.85

Gilliam Autism Rating Scale—Social Interaction Scale

Lopata et al. (2008)

Strong

Multi-group comparison

TA, TC

54

50,4

6–13

Medium and higher

Social skills groups

360 min 5× per week, 6 weeks total

Community

GSS

d = .51–.54

Behavior Assessment System for Children (parent and teacher scales)

Owens et al. (2008)

Strong

Multi-group comparison

G

TC

31

30,1

6–11

Medium and higher

Social skills groups

60 min 1× per week, 18 weeks total

Clinic

GSS

d = .44–.81

Gilliam Autism Rating Scale—Social Interaction Scale, Vineland Adaptive Behavior Scales—Social Scale

Sarokoff et al. (2001)

Adequate

Single subject

G/M

2

2,0

8–9

Medium

Visual and ABA

3 min per session, 40 sessions total

School

SC

6 of 6

Social communication

Peer delivery

Delano and Snell (2006)

Strong

Single subject

G/M

TA, TC

3

3,0

6–9

Medium

Peer training and visual

45 sessions total

School

SI

3 of 3

Social interaction and interaction skills

Ganz et al. (2008)

Adequate

Single subject

M

TC

3

2,1

7–12

Higher

Peer training and ABA

5 min 2–4× per week, ~5–10 weeks total

School

SC

7 of 9

Social communication

Kuhn et al. (2008)

Adequate

Single subject

TA, TC

2

2,0

7–8

Lower

Peer training and ABA

20 min 8× (peers), ~6–8 sessions total

School

SI

4 of 4

Social interaction

Lee et al. (2007)

Strong

Single subject

G

TA, TC

3

3,0

7–9

Lower

Peer training

20 min 5× (peers); intervention ~4 weeks total

School

SI

3 of 3

Social interaction

Owen-DeSchryver et al. (2008)

Adequate

Single subject

M

TC

3

3,0

7–10

Medium and higher

Peer training

30–45 min 3× (peer training), ~26 weeks total

School

SI

3 of 3

Social initiations and responding

Combined or multiple delivery

Technological and non-parental adult

    Sansosti and Powell-Smith (2008)

Adequate

Single subject

G/M

TA

3

3,0

6–10

Higher

Video modeling, visual, and ABA

5× per week,

School

SC

2 of 3

Social communication

    Shabani et al. (2002)

Adequate

Single subject

TA

3

3,0

6–7

Medium

ABA

18–19 sessions total

School or home

SI

3 of 3

Social initiations

Technological and peer

    Thiemann and Goldstein (2001)

Adequate

Single subject

G/M

TA

4

4,0

6–12

Lower and medium

Visual, social skills groups, peer training, and video modeling

30 min 2× per week, ~6 weeks total

School

SC

12 of 14

Social communication skills

Non-parental adult and peer

    Liber et al. (2008)

Adequate

Single subject

G

TA, TC

3

3,0

6–9

Lower to medium

ABA and peer training

~43–63 sessions total

School

GSS

3 of 3

Social interaction skills

    Loftin et al. (2008)

Adequate

Single subject

M

TA

3

3,0

9–10

Medium

Peer training and ABA

30 min 5× per week, ~7 weeks total

School

SI

3 of 3

Social initiations

    Morrison et al. (2001)

Adequate

Single subject

G/M

4

3,1

10–13

Medium and higher

Visual and peer training

20–30 min 3× per week, ~29–38 weeks total

School

SC

GSS

4 of 4

4 of 4

Social initiations and social communication skills

    Thiemann and Goldstein (2004)

Adequate

Single subject

M

TA

5

5,0

6–9

Lower, medium, and higher

Peer training, ABA, and visual

30 min 5× (peers), 25 min 3–4× per week, ~10–15 total

School

SC

5 of 5

Social communication skills

Key: G/M generalization and maintenance, G generalization, M maintenance, TA treatment adherence, TD treatment differentiation, TC therapist competence, M male, F female, Fxn level functioning level, TSB target skills or behavior, GSS general social skills, SC social communication, SI social initiations, Success est. success estimate, ABA applied behavior analysis, n. c. not calculated, tx treatment

The school-age category had the highest participant total of the three age categories (N = 291). Most of the participants were male, and a majority of the studies contained participants that were at least 10-years-old. In the studies examining interventions with school-aged participants, participants were most likely to have medium or higher cognitive functioning levels. Interventions with school-aged children were mostly delivered by non-parental adults acting either as the sole delivery agent or in combination with other delivery methods.

The most frequently used intervention types were ABA and peer training with visual techniques and video modeling also frequently studied. Twelve studies reported session duration of at least 15 min and 6 studies reported session durations less than 15 min. Eighteen studies reported data on intervention density by the week; 14 studies involved multiple sessions each week and 4 studies involved, on average, one or fewer sessions per week. Eleven studies reported total intervention durations of at least 12 weeks. Increases in general social skills and social interaction were the most frequently targeted behavior and skills. The most common intervention setting was the school setting.

Interventions for Adolescents and Adults

The three studies containing all adolescence and adult participants are shown by type of intervention provider in Table 4 (see also Table 1). A mixture of group and single subject research designs were used, and 1 of 3 studies received a strong rigor rating. A random clinical trial design was not used. A majority of studies did not measure either generalization or maintenance; generalization was measured in 1 study, and maintenance was not measured in any study. Procedural fidelity was also infrequently measured; 1 study evaluated treatment adherence.
Table 4

Social skills interventions for adolescents and adults by agent of intervention delivery

Reference

Methodological characteristics

Participant characteristics

Intervention characteristics

Study results

Rigor

Design

G/M

Fidelity

n

M, F

Age

Fxn level

Type

Density

Setting

TSB

Success Est.

Outcome measures

Technological delivery

Golan and Baron-Cohen (2006)

Strong

Multi-group comparison

G

32

26,6

17–50

Medium and higher

Video modeling (other)

120 min per week (1× per week clinic visit), 10–15 weeks total

Home (and clinic)

GSS

d = .28–1.21

Recognition of emotions

Non-parental adult delivery

Lee and Sturmey (2006)

Adequate

Single subject

3

3,0

17–18

Medium

ABA

4× per week, ~16 weeks total

Community

SC

2 of 3

Social communication

McDonald and Hemmes (2003)

Adequate

Single subject

TA

1

1,0

18

Medium

ABA

15 min 10× per week, ~4 weeks total

Community

SI

3 of 3

Social initiation

Key: G/M generalization and maintenance, G generalization, M maintenance, TA treatment adherence, TD treatment differentiation, TC therapist competence, M male, F female, Fxn level functioning level, TSB target skills or behavior, GSS general social skills, SC social communication, SI social initiations, Success est. success estimate, ABA applied behavior analysis

Across studies, 36 adolescents and adults with autism received intervention. Most of the participants were male. All studies contained participants who were teenagers, and 2 studies contained at least one participant greater than 20-years-old. All of the studies contained participants with medium and/or higher cognitive functioning levels. Interventions for adolescents and adults were delivered by non-parental adults and technological delivery.

Fewer intervention types were used across the studies with adolescents and adults; 1 study examined video modeling and 2 studies examined interventions based on the technology of ABA. The session duration was greater in the studies on adolescent and adults; all studies reported session duration of at least 15 min. Two studies reported data on intervention density by the week, and both studies involved multiple sessions each week. Two of three studies reported total intervention durations of at least 10 weeks. Social initiations, social communication, and general social skills were all targeted in one study apiece. Community settings were used in 2 studies and the home setting was used in one study.

Intervention Specific Findings

Applied Behavior Analysis

The methods and techniques of ABA were the most common intervention type utilized by the studies in this synthesis. Interventions based on ABA were delivered by many intervention agents (i.e., parents, peers, non-parental adults) across ages and levels of cognitive functioning. The largest number of studies came from the preschool group, where ABA has a long history of being used to improve the social skills of young children with autism (Strain and Schwartz 2001). The most common elements of interventions based on ABA included prompting and reinforcement arrangements (e.g., Jung et al. 2008; Owen-Deschryver et al. 2008; Schertz and Odom 2007), imitation and modeling paradigms (e.g., Garfinkle and Schwartz 2002; Jones et al. 2006), and self-monitoring (e.g., Loftin et al. 2008; Morrison et al. 2001). ABA was often used to augment other intervention types (e.g., video modeling, visual, peer training), demonstrating the flexibility and utility of the techniques. In sum, there is much support for the use of interventions based on ABA, and the use of these techniques should continue to be used in practice.

Naturalistic

Although naturalistic techniques were the third most common intervention type for preschool children, their methods were only employed in one study involving older children. When used, naturalistic techniques were often combined with other approaches, the most frequent being parent training. For the studies in this synthesis, naturalistic techniques were often used to provide structure to parent child interactions (e.g., Ingersoll and Gergans 2007) or to teach imitation and/or joint attention behaviors (e.g., Ingersoll et al. 2005; Whalen and Schreibman 2003). The popularity of naturalistic techniques in the preschool aged children is not surprising given the practice is consistent with recommended practices for early childhood education. While there is enough evidence supporting the recommendation of naturalistic techniques for young children with autism, the evidence for older individuals is insufficient to make recommendations. While the heuristic value of naturalistic techniques is high, i.e., intervening in the natural environment with natural reinforcers during interactions guided by the child, the use of these methods for older children and adults is not known. It is likely that modifications would need to be made to the typical paradigms used to accommodate the unique needs of older learners. Given the positive findings using these techniques with young children, future research should explore their application to older individuals.

Parent Training

Parental and family involvement is considered an essential element of intervention programs for children with autism (Lord et al. 2001). With respect to the studies included in this review, parent training was not examined extensively, only being measured as the main intervention type in 4 studies for preschool children. The accumulating evidence with young children for the support of parent training permits the recommendation of parent training as an effective method for increasing the social skills of young children. However, the scarcity of research involving older participants does not permit the same.

Peer Training

The use of peers to help teach children with autism has been a commonly used method that has much research support (Chan et al. in press; Goldstein et al. 2007; Lord et al. 2001; Rogers 2000). In this synthesis, peer training was a commonly used method of intervention for both preschool and school-aged children. The characteristics of the peers used by the studies reviewed included like-aged individuals with (e.g., Ganz et al. 2008; Kuhn et al. 2008) and without disabilities (e.g., Thiemann and Goldstein 2004). In the studies included in this review, peers were taught to provide pivotal response treatment (Kuhn et al. 2008), visual supports (e.g., Delano and Snell 2006; Nelson et al. 2007; Thiemann and Goldstein 2001), and prompting (e.g., Garfinkle and Schwartz 2002; Liber et al. 2008). In sum, interventions that train peers to deliver treatment has much support and should be considered a recommended practice for all individuals with autism.

Social Skills Groups

The results of the studies contained in this synthesis confirm the tentative support of social skills groups in a recent review by White et al. (2007). While the findings of social skills groups were generally positive, some studies did not show strong effects, had inconsistent results, and/or reported poor maintenance of skills. Although some studies examined social skills groups as the sole intervention (e.g., Kroeger et al. 2007; Owens et al. 2008), many studies included in this review evaluated social skills groups as a component of a treatment package (e.g., Golan and Baron-Cohen 2006; Legoff and Sherman 2006). Thus, the effects of social skills groups in isolation remain widely unknown and warrant future study. Additionally, all but one study focused on evaluating social skills groups for individuals with medium to higher cognitive functioning levels. More needs to be known about the effectiveness of this type of intervention on individuals with lower functioning levels. Although these weaknesses could be a limitation of the measurement techniques, more research is needed to provide guidance on best practices for social skills groups. The feasibility and social validity of social skills groups delivered in school settings by special education teachers, guidance counselors, or speech-language pathologists is also needed.

Visual

Visual supports were frequently used in social skill interventions for preschool and school-aged individuals. The most commonly employed visual supports were Social Stories (e.g., Sansosti and Powell-Smith 2008; Scattone 2008; Thiemann and Goldstein 2001), scripts (e.g., Ganz and Flores 2008; MacDuff et al. 2007), and visual activity schedules (e.g., Betz et al. 2008). Visual supports were also used in tandem with other intervention types, including ABA (e.g., Crozier and Tincani 2007), peer training (e.g., Ganz and Flores 2008; Kohler et al. 2007), and video modeling (e.g., Sansosti and Powell-Smith 2008; Scattone 2008). Overall, the studies using visual supports had positive findings, suggesting they can be an effective method for enhancing social understanding and structuring social interactions or communication for preschool and school-aged children with autism. Although the use of visual supports to structure and teach social skills for adolescents and adults with autism is probably occurring, no study meeting the criteria of this review evaluated this technique. More research on the use of visual techniques for older individuals with autism is needed.

Video Modeling

An additional intervention type that is hypothesized to tap into the visual learning style of individuals with autism is video modeling. Consistent with the results of recent reviews of video modeling (Ayres and Langone 2005; Bellini and Akullian 2007; Delano 2007; McCoy and Hermansen 2007), video modeling appears to typically be an effective intervention for teaching social skills to individuals with autism. Although there is a growing body of supporting evidence for these techniques, much remains to be learned concerning the boundaries of the intervention’s effectiveness (Rayner et al. 2009). Many studies reviewed in this synthesis suggest that video modeling by itself might not be a powerful enough intervention to elicit the desired changes in behavior (e.g., Apple et al. 2005; Maione and Mirenda 2006). Future research should continue to examine what behaviors change for whom and under what conditions as a results of video modeling interventions. Greater specificity is also needed concerning the type of model (e.g., peer, adult, point-of-view, self) that provides the greatest probability of a successful outcome.

Discussion

As interest in autism has grown, so too have the number of studies examining social skills interventions (see Fig. 1). Within the last 8 years, 66 studies with strong or acceptable methodological rigor have been conducted and published. These studies have been conducted using over 500 participants, and have evaluated interventions with different delivery agents, methods, target skills, and settings. Collectively, the results of this synthesis show there is much supporting evidence for the treatment of social deficits in autism. However, the methods and results of this synthesis do not permit conclusions about the superiority of one treatment over another to be made.

As shown in Fig. 1, the annual publication of the studies included in this review, which are a good representative of published peer-reviewed studies examining social skills interventions for individuals with autism, is increasing. Additionally, nine studies were published or accessible in an in press format during the first half of 2008 (not shown in Fig. 1), which is greater than or equal to the total number of studies published in all years except 2007. Thus, the trend appears to be continuing. While the influx of research on social skills interventions is good, and more research is needed, care must be taken when conducting and interpreting the results of the studies. Research demonstrating the effectiveness of social skills interventions will be most valuable when carefully executed using rigorous research designs.

A second noteworthy trend from Fig. 1 is the increase in studies utilizing group research designs over the last 5 years. Because results from studies utilizing multiple research methods can broaden the knowledge of the boarders and boundaries of an intervention’s effects, a need for studies on using group research designs, especially true experimental designs, remains.

The results of this synthesis were used to determine which interventions could be considered EBP for specific age groups of individuals with ASD using the criteria proposed by Reichow et al. (2008). These criteria delineate two levels of EBP—established EBP (the more stringent level) and promising EBP. No interventions for preschool-aged children or adolescents and/or adults had enough support to be considered and EBP based on the results of this review. Social skills groups for school-aged children with ASD demonstrated the evidence necessary to be considered an established EBP. The most common characteristics of the studies examining social skills groups for school-aged children included (a) participants with a mean age of approximately 10-years-old with medium and higher levels of cognitive functioning, (b) density of 1 session per week for at least 12 weeks, and (c) location in a clinical setting.

The only other intervention meeting the criteria of Reichow et al. for classification of an EBP was video modeling for school-aged children with ASD, which amassed the necessary criteria to be considered a promising EBP. The studies examining video modeling for school-aged children with ASD had much variability between studies, which precludes the ability to make recommendations based on the studies included in this review.

The evaluation of the status of interventions as EBP in this review must be considered in context. The inclusion criteria of recent publication (i.e., 2001–2008) greatly narrowed the scope of the review. Many social skills interventions have been studied for many years, and it is likely that some interventions might meet a higher level of EBP if an exhaustive review was conducted. Additionally, the EBP criteria were not applied to three of the most commonly used intervention categories (i.e., ABA, parent training, peer training) due to the variability in intervention procedures within the techniques classified. It is likely that a more exhaustive review of each intervention technique might demonstrate these methods as meeting criteria for being classified as an EBP. Finally, the EBP criteria were not applied to many interventions (i.e., Social Stories, scripts, prompt/reinforcement techniques, and video modeling for preschool-aged children) because the studies included in this review used the techniques in combination with other intervention methods. Again, it is likely that some of these interventions would meet the criteria needed for classification as an EBP in a more exhaustive review. The results of the evaluation of EBP should be used as a starting point for further evaluation of practices close to meeting EBP criteria.

Because studies obtaining a weak rating on the evaluative method (Reichow et al. 2008) were excluded from this review, statements concerning the state of the science with respect to the rigor of methods cannot be made. However, an examination of the results of the methodological rigor ratings for the included studies revealed four areas consistently underperforming expectations. First, participant characteristics need to be more descriptive, and when possible, should use the results of standard diagnostic measures to characterize the participants. Second, procedural fidelity needs to be measured more frequently. Given the frequent drop of fidelity when implementing treatments in natural settings, not knowing the precision with which an intervention must be implemented to be effective make recommending the treatment to practitioners and consumers difficult. Third, few studies evaluated for this synthesis used blind raters. Using blind raters reduces the likelihood of observer bias and should be employed whenever possible. Finally, many studies did not meet the inclusion criteria for this review because they did not have an adequate sample size (i.e., group studies with less than 10 participants per group). Because small sample sizes increases the probability of type I error, studies using group research designs should aim to include larger sample sizes with adequate power to detect meaningful changes in behavior. For the overall rigor of intervention studies examining individuals with ASD to improve, these four methodological aspects need to receive greater attention in future research.

Areas for Future Research

The results of this synthesis also highlight the need for studies examining interventions for adolescents and adults with ASD. Only three studies had a majority of participants at least 13-years-old met the inclusion criteria of this review. Additionally, no study in the adolescent and adult category examined parental delivered social skills training and no study examined a parent training intervention for adults with autism. This is unfortunate since many parents and family members often remain involved with the individuals with ASD throughout their lives (Howlin 2005; Shea and Mesibov 2005). More research is needed examining methods of educating parents about how to increase social skills in their children with ASD.

The most studied individuals with respect to cognitive functioning were individuals with medium and higher functioning skills. This trend was especially apparent for interventions with older individuals (i.e., adolescent and adult aged participants), which contained zero studies examining interventions for individuals with lower functioning levels. Because social abilities are hindered in all individuals with ASD regardless of functioning level, more research needs to be conducted on how to increase appropriate social behavior for individuals with lower functioning ASD. Researchers should also examine which interventions are effective across cognitive functioning ranges and which interventions require an individual to have a minimal level of cognitive skills for an intervention to be effective.

Important considerations with respect to the choice of peers when utilizing peer training is essential (DiSalvo and Oswald 2002), and more research providing a priori recommendations of the peer selection process is needed. One group of peers that has received limited empirical study is siblings. Although the research on siblings as peer agents is limited, the research has suggested promising results and should be explored in future research (Bass and Mulick 2007).

Finally, the results of this review document the abundant dependent measures being used to evaluate social skills interventions (see Tables 2, 3, and 4). The measures include standardized measures of social behavior on a global level (e.g., Vineland, ADOS) and observational measures of behaviors operationalized and measured for specific studies (e.g., frequency of initiations, duration of social engagement). Although observation of specific behaviors was more common in the studies of this review, both levels of measurement are important and future research should continue to utilize measures that examine the ability of individuals with ASD to function within their social milieu. Demonstration of the utility of this type of measure to document meaningful (i.e., clinically significant, socially valid) changes due to intervention is greatly needed.

Limitations

Publication bias (Borenstein et al. 2009; Gilbody et al. 2000) is a potential confound in most literature syntheses, and suggest systematic differences between the selected and excluded studies. An extensive literature search using multiple methods and sources was conducted to limit the effects of publication bias. However, the narrow inclusion criteria that involved methodological rigor and peer-reviewed status likely create a situation in which the existence of publication bias in cannot be dismissed. Unfortunately, there are no methods of calculating or estimating the effect of publication bias given the constraints and methods of this synthesis (i.e., there are no methods of estimating publication bias for single subject research). Thus, we to acknowledge the possibility of study selection bias and alert the readers to its possibility.

Caution must be taken when interpreting the results of the evaluation with respect to evidence-based practices. The inclusion criteria of recent publication (i.e., 2001–2008) greatly narrowed the scope of the review. Many interventions (e.g., peer-mediated interventions) have been studied for many years, which would not be reflected in the current review. The results of the evaluation of EBP should be used as a starting point for further evaluation of practices close to meeting EBP criteria. It is likely that future systematic reviews or meta-analyses of interventions with a more focused scope involving broader inclusion criteria is likely to produce additional interventions that can be considered evidence-based.

References

References preceded by an asterisk (*) indicate the studies included in the synthesis

  1. Adolphs, R., Sears, L., & Piven, J. (2001). Abnormal processing of social information from faces in autism. Journal of Cognitive Neuroscience, 13, 232–240.PubMedGoogle Scholar
  2. *Aldred, C., Green, J., & Adams, C. (2004). A new social communication intervention for children with autism: Pilot randomised controlled treatment study suggesting effectiveness. Journal of Child Psychology and Psychiatry, 45, 1420–1430.PubMedGoogle Scholar
  3. Amaral, D. G., Schumann, C. M., & Nordahl, C. W. (2008). Neuroanatomy of autism. Trends in Neurosciences, 31, 137–145.PubMedGoogle Scholar
  4. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  5. *Apple, A. L., Billingsley, F., & Schwartz, I. S. (2005). Effects of video modeling alone and with self-management on compliment-giving behaviors of children with high-functioning ASD. Journal of Positive Behavior Interventions, 7, 33–46.Google Scholar
  6. Ayres, K. M., & Langone, J. (2005). Intervention and instruction with video for students with autism: A review of the literature. Education and Training in Developmental Disabilities, 40, 183–196.Google Scholar
  7. Bachevalier, J., & Loveland, K. A. (2006). The orbitofrontal-amygdala circuit and self-regulation of social-emotional behavior in autism. Neuroscience and Biobehavioral Reviews, 30, 97–117.PubMedGoogle Scholar
  8. Baer, D. M., Wolf, M. M., & Risely, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91–97.PubMedGoogle Scholar
  9. Bass, J. D., & Mulick, J. A. (2007). Social play skill enhancement of children with autism using peers and siblings as therapists. Psychology in the Schools, 44, 727–735.Google Scholar
  10. Bellini, S., & Akullian, J. (2007). A meta-analysis of video modeling and video self-modeling interventions for children and adolescents with autism spectrum disorder. Exceptional Children, 73, 264–287.Google Scholar
  11. *Bellini, S., Akullian, J., & Hopf, A. (2007). Increasing social engagement in young children with autism spectrum disorders using video self-modeling. School Psychology Review, 16, 80–90.Google Scholar
  12. *Betz, A., Higbee, T. S., & Reagon, K. A. (2008). Using joint activity schedules to promote peer engagement in preschoolers with autism. Journal of Applied Behavior Analysis, 41, 237–241.PubMedGoogle Scholar
  13. Billingsley, F. F., White, O. R., & Munson, R. (1980). Procedural reliability: A rationale and an example. Behavioral Assessment, 2, 229–241.Google Scholar
  14. *Bock, M. A. (2007). The impact of social-behavioral learning strategy training on the social interaction skills of four students with Asperger syndrome. Focus on Autism and Other Developmental Disorders, 22, 88–95.Google Scholar
  15. Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009). Introduction to meta-analysis. West Sussex, United Kingdom: Wiley.Google Scholar
  16. *Boyd, B. A., Conroy, M. A., Mancil, G. R., Nakao, T., & Alter, P. J. (2007). Effects of circumscribed interests on the social behaviors of children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37, 1550–1561.PubMedGoogle Scholar
  17. *Buggey, T. (2005). Video self-modeling applications with students with autism spectrum disorder in a small private school setting. Focus on Autism and Other Developmental Disabilities, 20, 52–63.Google Scholar
  18. Campbell, R., Lawrence, K., Mandy, W., Mitra, C., Jeyakuma, L., & Skuse, D. (2006). Meanings in motion and faces: Developmental associations between the processing of intention from geometrical animations and gaze detection accuracy. Development and Psychopathology, 18, 99–118.PubMedGoogle Scholar
  19. *Carter, C. M. (2001). Using choice with game play to increase language skills and interactive behaviors in children with autism. Journal of Positive Behavior Interventions, 3, 131–151.Google Scholar
  20. Carter, A. S., Davis, N. O., Klin, A., & Volkmar, F. R. (2005). Social development in autism. In F. R. Volkmar, A. Klin, R. Paul, & D. J. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (3rd ed., pp. 312–334). Hoboken, NJ: Wiley.Google Scholar
  21. Chan, J. M., Lang, R., Rispoli, M., O’Reilly, M., Sigafoos, J., & Cole, H. (in press). Use of peer-mediated interventions in the treatment of autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders.Google Scholar
  22. *Charlop-Christy, M. H., & Daneshvar, S. (2003). Using video modeling to teach perspective taking to children with autism. Journal of Positive Behavior Interventions, 5, 12–21.Google Scholar
  23. Cowan, R. J., & Allen, K. D. (2007). Using naturalistic procedures to enhance learning in individuals with autism: A focus on generalized teaching within the school setting. Psychology in the Schools, 44, 701–715.Google Scholar
  24. *Crozier, S., & Tincani, M. (2007). Effects of social stories on prosocial behavior of preschool children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37, 1803–1814.PubMedGoogle Scholar
  25. Delano, M. E. (2007). Video modeling interventions for individuals with autism. Remedial and Special Education, 28, 33–42.Google Scholar
  26. *Delano, M., & Snell, M. E. (2006). The effects of social stories on the social engagement of children with autism. Journal of Positive Behavior Interventions, 8, 29–42.Google Scholar
  27. *DeQuinzio, J. A., Townsend, D. B., Sturmey, P., & Poulson, C. L. (2007). Generalized imitation of facial models by children with autism. Journal of Applied Behavior Analysis, 40, 755–759.PubMedGoogle Scholar
  28. DiSalvo, C. A., & Oswald, D. P. (2002). Peer-mediated interventions to increase the social interaction of children with autism: Consideration of peer expectancies. Focus on Autism and Other Developmental Disabilities, 17, 198–207.Google Scholar
  29. *Fisher, N., & Happé, F. (2005). A training study of theory of mind and executive function in children with autistic spectrum disorders. Journal of Autism and Developmental Disorders, 35, 757–771.PubMedGoogle Scholar
  30. *Ganz, J. B., & Flores, M. M. (2008). Effects of the use of visual strategies in play groups for children with autism spectrum disorders and their peers. Journal of Autism and Developmental Disorders, 38, 926–940.PubMedGoogle Scholar
  31. *Ganz, J. B., Kaylor, M., Bourgeois, B., & Hadden, K. (2008). The impact of social scripts and visual cues on verbal communication in three children with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 23, 79–94.Google Scholar
  32. *Garfinkle, A. N., & Schwartz, I. S. (2002). Peer imitation: Increasing social interactions in children with autism and other developmental disabilities in inclusive preschool classrooms. Topics in Early Childhood Special Education, 22, 26–38.Google Scholar
  33. *Gena, A. (2006). The effects of prompting and social reinforcement on establishing social interactions with peers during the inclusion of four children with autism in preschool. International Journal of Psychology, 41, 541–554.Google Scholar
  34. *Gena, A., Couloura, S., & Kymissis, E. (2005). Modifying the affective behavior of preschoolers with autism using in vivo or video modeling and reinforcement contingencies. Journal of Autism and Developmental Disorders, 35, 545–556.PubMedGoogle Scholar
  35. Gilbody, S. M., Song, F., Eastwood, A. J., & Sutton, A. (2000). The causes, consequences and detection of publication bias in psychiatry. Acta Psychiatrica Scandinavica, 102, 241–249.PubMedGoogle Scholar
  36. *Golan, O., & Baron-Cohen, S. (2006). Systemizing empathy: Teaching adults with Asperger syndrome or high-functioning autism to recognize complex emotions using interactive multimedia. Development and Psychopathology, 18, 591–617.PubMedGoogle Scholar
  37. Goldstein, H., & Cisar, C. L. (1992). Promoting interaction during sociodramatic play: Teaching scripts to typical preschoolers and classmates with disabilities. Journal of Applied Behavior Analysis, 25, 265–280.PubMedGoogle Scholar
  38. Goldstein, H., Schneider, N., & Theimann, K. (2007). Peer-mediated social communication intervention: When clinical expertise informs treatment development and evaluation. Topics in Language Disorders, 27, 182–199.CrossRefGoogle Scholar
  39. Gregory, C., Lough, S., Stone, V., Erzinclioglu, S., Martin, L., Baron-Cohen, S., et al. (2002). Theory of mind in patients with frontal variant frontotemporal dementia and Alzheimer’s disease: Theoretical and practical implications. Brain, 125, 752–764.PubMedGoogle Scholar
  40. Hadjikhani, N., Joseph, R. M., Snyder, J., & Tager-Flusberg, H. (2007). Abnormal activation of the social brain during face perception in autism. Human Brain Mapping, 28, 441–449.PubMedGoogle Scholar
  41. *Hancock, T. B., & Kaiser, A. P. (2002). The effects of trainer-implemented enhanced milieu teaching on the social communication of children with autism. Topics in Early Childhood Special Education, 22, 39–54.Google Scholar
  42. Happé, F., Booth, R., Charlton, R., & Hughes, C. (2006). Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder: Examining profiles across domains and ages. Brain and Cognition, 61, 25–39.PubMedGoogle Scholar
  43. Howlin, P. (2005). Outcomes in autism spectrum disorders. In F. R. Volkmar, A. Klin, R. Paul, & D. J. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (3rd ed., pp. 201–222). Hoboken, NJ: Wiley.Google Scholar
  44. *Ingersoll, B., Dvortcsak, A., Whalen, C., & Sikora, D. (2005). The effects of a developmental, social-pragmatic language intervention on rate of expressive language production in young children with autistic spectrum disorders. Focus on Autism and Other Developmental Disabilities, 20, 213–222.Google Scholar
  45. *Ingersoll, B., & Gergans, S. (2007). The effect of a parent-implemented imitation intervention on spontaneous imitation skills in young children with autism. Research in Developmental Disabilities, 28, 163–175.PubMedGoogle Scholar
  46. *Ingersoll, B., & Schreibman, L. (2006). Teaching reciprocal imitation skills to young children with autism using a naturalistic behavioral approach: Effects on language, pretend play, and joint attention. Journal of Autism and Developmental Disorders, 36, 487–505.PubMedGoogle Scholar
  47. Insel, T. R., & Fernald, R. D. (2004). How the brain processes social information: Searching for the social brain. Annual Review of Neuroscience, 27, 697–722.PubMedGoogle Scholar
  48. *Jones, E. A., Carr, E. G., & Feeley, K. M. (2006). Multiple effects of joint attention intervention for children with autism. Behavior Modification, 30, 782–834.PubMedGoogle Scholar
  49. *Jung, S., Sainato, D. M., & Davis, C. A. (2008). Using high-probability request sequences to increase social interactions in young children with autism. Journal of Early Intervention, 30, 163–187.Google Scholar
  50. Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250.Google Scholar
  51. *Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young children with autism: A randomized controlled intervention study. Journal of Child Psychology and Psychiatry, 47, 611–620.PubMedGoogle Scholar
  52. *Kern, P., & Aldridge, D. (2006). Using embedded music therapy interventions to support outdoor play of young children with autism in an inclusive community-based child care program. Journal of Music Therapy, 43, 270–294.PubMedGoogle Scholar
  53. *Kern, P., Wolery, M., & Aldridge, D. (2007). Use of songs to promote independence in morning greeting routines for young children with autism. Journal of Autism and Developmental Disorders, 37, 1264–1271.PubMedGoogle Scholar
  54. Klin, A., & Jones, W. (2008). Altered face scanning and impaired recognition of biological motion in a 15-month-old infant with autism. Developmental Science, 11, 40–46.PubMedGoogle Scholar
  55. Klin, A., Jones, W., Schultz, R., Volkmar, F., & Cohen, D. (2002a). Defining and quantifying the social phenotype in autism. American Journal of Psychiatry, 159, 895–908.PubMedGoogle Scholar
  56. Klin, A., Jones, W., Schultz, R., Volkmar, F., & Cohen, D. (2002b). Visual fixation patterns during viewing of naturalistic social situations as predictors of social competence in individuals with autism. Archives of General Psychiatry, 59, 809–816.PubMedGoogle Scholar
  57. Klin, A., Saulnier, C. A., Sparrow, S. S., Cicchetti, D. V., Volkmar, F. R., & Lord, C. (2007). Social and communication abilities and disabilities in higher functioning individuals with autism spectrum disorders: The Vineland and the ADOS. Journal of Autism and Developmental Disorders, 37, 748–759.PubMedGoogle Scholar
  58. *Koegel, R. L., Werner, G. A., Vismara, L. A., & Koegel, L. K. (2005). The effectiveness of contextually supported play date interactions between children with autism and typically developing peers. Research and Practice for Persons with Severe Disabilities, 30, 93–102.Google Scholar
  59. *Kohler, F. W., Anthony, L. J., Steighner, S. A., & Hoyson, M. (2001). Teaching social interaction skills in the integrated preschool: An examination of naturalistic tactics. Topics in Early Childhood Special Education, 21, 93–103.Google Scholar
  60. *Kohler, F. W., Greteman, C., Raschke, D., & Highnam, C. (2007). Using a buddy skills package to increase the social interactions between a preschooler with autism and her peers. Topics in Early Childhood Special Education, 27, 155–163.Google Scholar
  61. *Kroeger, K. A., Schultz, J. R., & Newsome, C. (2007). A comparison of two group-delivered social skills programs for young children with autism. Journal of Autism and Developmental Disorders, 37, 808–817.PubMedGoogle Scholar
  62. *Kuhn, L. R., Bodkin, A. E., Devlin, S. D., & Doggett, R. A. (2008). Using pivotal response training with peers in special education to facilitate play in two children with autism. Education and Training in Developmental Disabilities, 43, 37–45.Google Scholar
  63. *LeBlanc, L. A., Coates, A. M., Daneshvar, S., Charlop-Christy, M. H., & Morris, C. (2003). Using video modeling and reinforcement to teach perspective-taking skills to children with autism. Journal of Applied Behavior Analysis, 36, 253–257.PubMedGoogle Scholar
  64. *Lee, R., McComas, J. J., & Jawor, J. (2002). The effects of differential and lag reinforcement schedules on varied verbal responding by individuals with autism. Journal of Applied Behavior Analysis, 35, 391–402.PubMedGoogle Scholar
  65. *Lee, S., Odom, S. L., & Loftin, R. (2007). Social engagement with peers and stereotypic behavior of children with autism. Journal of Positive Behavior Interventions, 9, 67–79.Google Scholar
  66. *Lee, R., & Sturmey, P. (2006). The effects of lag schedules and preferred materials on variable responding in students with autism. Journal of Autism and Developmental Disorders, 36, 421–428.PubMedGoogle Scholar
  67. *LeGoff, D. B. (2004). Use of LEGO as a therapeutic medium for improving social competence. Journal of Autism and Developmental Disorders, 34, 557–571.PubMedGoogle Scholar
  68. *LeGoff, D. B., & Sherman, M. (2006). Long-term outcome of social skills intervention based on interactive LEGO play. Autism, 10, 317–329.PubMedGoogle Scholar
  69. *Liber, D. B., Frea, W. D., & Symon, J. B. G. (2008). Using time-delay to improve social play skills with peers for children with autism. Journal of Autism and Developmental Disorders, 38, 312–323.PubMedGoogle Scholar
  70. *Loftin, R. L., Odom, S. L., & Lantz, J. F. (2008). Social interaction and repetitive motor behaviors. Journal of Autism and Developmental Disorders, 38, 1124–1135.PubMedGoogle Scholar
  71. *Lopata, C., Thomeer, M. L., Volker, M. A., Nida, R. E., & Lee, G. K. (2008). Effectiveness of a manualized summer social treatment program for high-functioning children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38, 890–904.PubMedGoogle Scholar
  72. Lord, C., Bristol-Power, M., Cafiero, J. M., Filipek, P. A., Gallagher, J. J., Harris, S. L., et al. (2001). Educating children with autism. Washington, DC: National Academy Press.Google Scholar
  73. Lovass, O., & Smith, T. (1988). Intensive behavioral treatment for young autistic children. In B. B. Lahey & A. E. Kazdin (Eds.), Advances in clinical child psychology (Vol. 11, pp. 285–324). New York: Plenum.Google Scholar
  74. *MacDuff, J. L., Ledo, R., McClannahan, L. E., & Krantz, P. J. (2007). Using scripts and script-fading procedures to promote bids for joint attention by young children with autism. Research in Autism Spectrum Disorders, 1, 281–290.Google Scholar
  75. *Maione, L., & Mirenda, P. (2006). Effects of video modeling and video feedback on peer-directed social language skills of a child with autism. Journal of Positive Behavior Interventions, 8, 106–118.Google Scholar
  76. Matson, J. L., Matson, M. L., & Rivet, T. T. (2007). Social-skills treatments for children with autism spectrum disorders. Behavior Modification, 31, 682–707.PubMedGoogle Scholar
  77. McCoy, K., & Hermansen, E. (2007). Video modeling for individuals with autism. A review of model types and effects. Education and Treatment of Children, 30, 183–213.Google Scholar
  78. *McDonald, M. E., & Hemmes, N. S. (2003). Increases in social initiation toward an adolescent with autism: Reciprocity effects. Research in Developmental Disabilities, 24, 453–465.PubMedGoogle Scholar
  79. *Morrison, L., Kamps, D., Garcia, J., & Parker, D. (2001). Peer mediation and monitoring strategies to improve initiations and social skills for students with autism. Journal of Positive Behavior Interventions, 3, 237–250.Google Scholar
  80. *Nelson, C., McDonnell, A. P., Johnston, S. S., Crompton, A., & Nelson, A. (2007). Keys to play: A strategy to increase the social interactions of young children with autism and their typically developing peers. Education and Training in Developmental Disabilities, 42, 165–181.Google Scholar
  81. *Nikopoulos, C. K., & Keenan, M. (2004). Effects of video modeling on social initiations by children with autism. Journal of Applied Behavior Analysis, 37, 93–96.PubMedGoogle Scholar
  82. *Nikopoulos, C. K., & Keenan, M. (2007). Using video modeling to teach complex social sequences to children with autism. Journal of Autism and Developmental Disorders, 37, 678–693.PubMedGoogle Scholar
  83. Odom, S. L., & Strain, P. S. (1984). Peer-mediated approaches to promoting children’s social interaction: A review. American Journal of Orthopsychiatry, 54, 544–557.PubMedGoogle Scholar
  84. *Owen-DeSchryver, J. S., Carr, E. G., Cale, S. I., & Blakeley-Smith, A. (2008). Promoting social interactions between students with autism spectrum disorders and their peers in inclusive school settings. Focus on Autism and Other Developmental Disabilities, 23, 15–28.Google Scholar
  85. *Owens, G., Granader, Y., Humphrey, A., & Baron-Cohen, S. (2008). LEGO therapy and the social use of language programme: An evaluation of two social skills interventions for children with high functioning autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 38, 1944–1957.PubMedGoogle Scholar
  86. Paul, R. (2003). Promoting social communication in high functioning individuals with autistic spectrum disorders. Child and Adolescent Psychiatric Clinics of North America, 12, 87–106. vi-vii.PubMedGoogle Scholar
  87. Perepletchikova, R., & Kazdin, A. E. (2005). Treatment integrity and therapeutic change: Issues and research recommendations. Clinical Psychology: Science and Practice, 12, 365–383.Google Scholar
  88. *Petursdottir, A. L., McComas, J., McMaster, K., & Horner, K. (2007). The effects of scripted peer tutoring and programming common stimuli on social interactions of a student with autism spectrum disorder. Journal of Applied Behavior Analysis, 40, 353–357.PubMedGoogle Scholar
  89. Quill, K. A. (1997). Instructional considerations for young children with autism: The rationale for visually cued instruction. Journal of Autism and Developmental Disorders, 27, 697–714.PubMedGoogle Scholar
  90. Rayner, C., Denholm, C., & Sigafoos, J. (2009). Video-based intervention for individuals with autism: Key questions that remain unanswered. Research in Autism Spectrum Disorders, 3, 291–303.Google Scholar
  91. Reichow, B., Volkmar, F. R., & Cicchetti, D. V. (2008). Development of an evaluative method for determining the strength of research evidence in autism. Journal of Autism and Developmental Disorders, 38, 1311–1318.PubMedGoogle Scholar
  92. Rippon, G., Brock, J., Brown, C., & Boucher, J. (2007). Disordered connectivity in the autistic brain: Challenges for the “new psychophysiology”. International Journal of Psychophysiology, 63, 164–172.PubMedGoogle Scholar
  93. Rogers, S. J. (2000). Interventions that facilitate socialization in children with autism. Journal of Autism and Developmental Disorders, 30, 399–409.PubMedGoogle Scholar
  94. *Sansosti, F. J., & Powell-Smith, K. A. (2008). Using computer-presented social stories and video models to increase the social communication skills of children with high-functioning autism spectrum disorders. Journal of Positive Behavior Interventions, 10, 162–178.Google Scholar
  95. *Sarokoff, R. A., Taylor, B. A., & Poulson, C. L. (2001). Teaching children with autism to engage in conversational exchanges: Script fading with embedded textual stimuli. Journal of Applied Behavior Analysis, 34, 81–84.PubMedGoogle Scholar
  96. *Sawyer, L. M., Luiselli, J. K., Ricciardi, J. N., & Gower, J. L. (2005). Teaching a child with autism to share among peers in an integrated preschool classroom: Acquisition, maintenance, and social validation. Education and Treatment of Children, 28, 1–10.Google Scholar
  97. *Scattone, D. (2008). Enhancing the conversation skills of a boy with Asperger’s disorder through Social Stories and video modeling. Journal of Autism and Developmental Disorders, 38, 395–400.PubMedGoogle Scholar
  98. *Schertz, H. H., & Odom, S. L. (2007). Promoting joint attention in toddlers with autism: A parent-mediated developmental model. Journal of Autism and Developmental Disorders, 37, 1562–1575.PubMedGoogle Scholar
  99. Schultz, R., Chawarska, K., & Volkmar, F. R. (2006). The social brain in autism: Perspectives from neuropsychology and neuroimaging. In S. O. Moldin & J. L. Rubenstein (Eds.), Understanding autism: From basic neuroscience to treatment (pp. 323–348). New York: CRC Press.Google Scholar
  100. Schultz, R. T., Gauthier, I., Klin, A., Fulbright, R. K., Anderson, A. W., Volkmar, F., et al. (2000). Abnormal ventral temporal cortical activity during face discrimination among individuals with autism and Asperger syndrome. Archives of General Psychiatry, 57, 331–340.PubMedGoogle Scholar
  101. *Shabani, D. B., Katz, R. C., Wilder, D. A., Beauchamp, K., Taylor, C. R., & Fischer, K. J. (2002). Increasing social initiations in children with autism: Effects of a tactile prompt. Journal of Applied Behavior Analysis, 35, 79–83.PubMedGoogle Scholar
  102. Shea, V., & Mesibov, G. B. (2005). Adolescents and adults with autism. In F. R. Volkmar, A. Klin, R. Paul, & D. J. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (3rd ed., pp. 288–311). Hoboken, NJ: Wiley.Google Scholar
  103. *Sherer, M., Pierce, K. L., Pardes, S., Kisacky, K. L., Ingersoll, B., & Schreibman, L. (2001). Enhancing conversation skills in children with autism via video technology: Which is better, “self” or “other” as a model? Behavior Modification, 25, 140–158.PubMedGoogle Scholar
  104. Siegel, B., Vukicevic, J., Elliot, G. R., & Kraemer, H. C. (1989). The use of signal detection theory to assess DSM-III-R criteria for autistic disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 542–548.PubMedGoogle Scholar
  105. *Simpson, A., Langone, J., & Ayres, K. M. (2004). Embedded video and computer based instruction to improve social skills for students with autism. Education and Training in Developmental Disabilities, 39, 240–252.Google Scholar
  106. Slavin, R. E. (1986). Best evidence synthesis: An alternative to meta-analytic and traditional reviews. Educational Researcher, 15, 5–11.Google Scholar
  107. *Smith, C., Goddard, S., & Fluck, M. (2004). A scheme to promote social attention and functional language in young children with communication difficulties and autistic spectrum disorder. Educational Psychology in Practice, 20, 319–333.Google Scholar
  108. Strain, P. S., & Fox, J. J. (1981). Peer social initiations and the modification of social withdrawal: A review and future perspective. Journal of Pediatric Psychology, 6, 417–433.PubMedGoogle Scholar
  109. Strain, P. S., & Schwartz, I. (2001). ABA and the development of meaningful social relations for young children with autism. Focus on Autism and Other Developmental Disabilities, 16, 120–128.Google Scholar
  110. Tager-Flusberg, H., Paul, P., & Lord, C. (2005). Language and communication in autism. In F. R. Volkmar, A. Klin, R. Paul, & D. J. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (3rd ed., pp. 335–364). Hoboken, NJ: Wiley.Google Scholar
  111. *Thiemann, K. S., & Goldstein, H. (2001). Social stories, written text cues, and video feedback: Effects on social communication of children with autism. Journal of Applied Behavior Analysis, 34, 425–446.PubMedGoogle Scholar
  112. *Thiemann, K. S., & Goldstein, H. (2004). Effects of peer tutoring and written text cueing on social communication of school-age children with pervasive developmental disorder. Journal of Speech, Language, and Hearing Research, 47, 126–144.PubMedGoogle Scholar
  113. *Vismara, L. A., & Lyons, G. L. (2007). Using perseverative interests to elicit joint attention behaviors in young children with autism: Theoretical and clinical implications for understanding motivation. Journal of Positive Behavior Interventions, 9, 214–228.Google Scholar
  114. Volkmar, F. R., Lord, C., Bailey, A., Schultz, R. T., & Klin, A. (2004). Autism and pervasive developmental disorders. Journal of Child Psychology and Psychiatry and Allied Disciplines, 45, 135–170.Google Scholar
  115. *Whalen, C., & Schreibman, L. (2003). Joint attention training for children with autism using behavior modification procedures. Journal of Child Psychology and Psychiatry, 44, 456–468.PubMedGoogle Scholar
  116. White, S. W., Keonig, K., & Schaill, L. (2007). Social skills development in children with autism spectrum disorders: A review of the intervention research. Journal of Autism and Developmental Disorders, 37, 1858–1868.Google Scholar
  117. Wolery, M., Busick, M., Reichow, B., & Barton, E. E. (in press). Comparison of overlap methods for quantitatively synthesizing single subject data. Journal of Special Education.Google Scholar
  118. World Health Organization. (1994). Diagnostic criteria for research. ICD-10. Geneva: World Health Organization.Google Scholar
  119. *Zercher, C., Hunt, P., Schuler, A., & Webster, J. (2001). Increasing joint attention, play and language through peer supported play. Autism, 5, 374–398.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Yale University Child Study CenterNew HavenUSA

Personalised recommendations