• Autism Spectrum Disorders: Treatment, Services, Outcomes, and Community Functioning in Adolescents and Adults (ES Brodkin, Section Editor)
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Psychosocial Interventions Targeting Social Functioning in Adults on the Autism Spectrum: a Literature Review

Abstract

Purpose of Review

There is a perceived shortage of evidence-based treatment programs for adults on the autism spectrum. This article reviews the recent research literature on psychosocial/behavioral interventions targeting social functioning in autistic adults without intellectual disability.

Recent Findings

We identified only 41 peer-reviewed studies published from 1980 to 2017 that tested intervention programs focused on one or more of the behavioral components of social functioning (i.e., social motivation, social anxiety, social cognition, and social skills) in more than one adult with autism spectrum disorder (ASD). The studies demonstrated substantial variability in treatment objectives, intervention procedures, assessment methods, and methodologic quality.

Summary

The results indicate a strong need for additional research to develop and rigorously test interventions for autistic adults that target the many behavioral components of social functioning and that include procedures to promote generalization of knowledge and skills to community settings.

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Fig. 1

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

    *Papers included in this review

    1. 1.

      Howlin P, Moss P, Savage S, Rutter M. Social outcomes in mid- to later adulthood among individuals diagnosed with autism and average nonverbal IQ as children. J Am Acad Child Adolesc Psychiatry. 2013;52(6):572–81.

      Article  Google Scholar 

    2. 2.

      Howlin P, Moss P. Adults with autism spectrum disorders. Can J Psychiatry. 2012;57(5):275–83.

      Article  Google Scholar 

    3. 3.

      Shattuck PT, Narendorf SC, Cooper B, Sterzing PR, Wagner M, Taylor JL. Postsecondary education and employment among youth with an autism spectrum disorder. Pediatrics. 2012;129(6):1042–9.

      Article  Google Scholar 

    4. 4.

      Ganz ML. The lifetime distribution of the incremental societal costs of autism. Arch Pediatr Adolesc Med. 2007;161:343–9.

      Article  Google Scholar 

    5. 5.

      Buescher AVS, Cidav Z, Knapp M, Mandell DS. Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatr. 2014;168(8):721–8.

      Article  Google Scholar 

    6. 6.

      Hurlbutt K, Chalmers L. Adults with autism speak out: perceptions of their life experiences. Autism. 2002;17(2):103–11.

      Google Scholar 

    7. 7.

      Muller E, Schuler A, Burton BA, Yates GB. Meeting the vocational support needs of individuals with Asperger syndrome and other autism spectrum disorders. J Vocat Rehab. 2003;18(3):163–75.

      Google Scholar 

    8. 8.

      Shattuck PT, Roux AM, Hudson LE, Taylor JL, Maenner MJ, Trani J-F. Services for adults with an autism spectrum disorder. Can J Psychiatr. 2012;57(5):284–91.

      Article  Google Scholar 

    9. 9.

      Spain D, Blainey SH. Group social skills interventions for adults with high-functioning autism spectrum disorders: a systematic review. Autism. 2015;19(7):874–86.

      Article  Google Scholar 

    10. 10.

      Bishop-Fitzpatrick L, Minshew NJ, Eack SM. A systematic review of psychosocial interventions for adults with autism spectrum disorders. J Autism Dev Disord. 2013;43:687–94.

      Article  Google Scholar 

    11. 11.

      Gates JA, Kang E, Lerner MD. Efficacy of group social skills interventions for youth with autism spectrum disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2017;52:164–81.

      Article  Google Scholar 

    12. 12.

      • *Baker-Ericzen MJ, Fitch MA, Kinnear M, Jenkins MM, Twamley EW, Smith L, et al. Development of the supported employment, comprehensive cognitive enhancement, and social skills program for adults on the autism spectrum: results of initial study. Autism. 2017;22(1):6–19. Even as prevalence estimates for autism in adulthood have continued to increase, vocational outcomes remain particularly poor for this population. This pilot study investigates the feasibility, acceptability, and initial estimates of outcomes for a newly developed intervention entitled Supported Employment, Comprehensive Cognitive Enhancement, and Social Skills (SUCCESS) , a manualized “soft skills” curriculum that targets cognitive and social development in autistic adults.

    13. 13.

      • Pallathra AA, Calkins ME, Parish-Morris J, Maddox BB, Perez LS, Miller J, et al. Defining behavioral components of social functioning in adults with autism spectrum disorder as targets for treatment. Autism Res. 2018;11(3):488–502 Few studies have evaluated the multidimensional nature of social functioning in autistic adults as a means of identifying treatment targets. This study examined social motivation, social cognition, social skills, and social anxiety in adults with autism spectrum disorder and found varying associations between these behavioral components of social functioning, but relatively robust correlations between social motivation and the other components of social skill and social anxiety. The data suggest that treatments should ideally target the many components of social functioning, particularly including social motivation, which has been relatively neglected in most treatment programs.

      Article  Google Scholar 

    14. 14.

      Chevallier C, Kohls G, Troiani V, Brodkin ES, Schultz RT. The social motivation theory of autism. Trends Cogn Sci. 2012;16:231–9.

      Article  Google Scholar 

    15. 15.

      • Clements CC, Zoltowski AR, Yankowitz LD, Yerys BE, Schultz RT, Herrington JD. Evaluation of the social motivation hypothesis of autism: a systematic review and meta-analysis. JAMA Psychiat. 2018;in press. The social motivation hypothesis suggests that individuals with autism spectrum disorder (ASD) find social stimuli less rewarding than typically developing individuals, which leads to downstream effects on the development of social cognition, social skills, and overall functioning in the community. This study evaluated the literature on fMRI studies to examine whether individuals with ASD process rewarding stimuli differently than typically developing individuals and whether previous contradictory findings in the literature might be due to sample characteristics. Results supported the broader hypothesis that individuals with ASD show atypical processing of social and nonsocial rewards.

    16. 16.

      • Maddox BB, White SW. Comorbid social anxiety disorder in adults with autism spectrum disorder. J Autism Dev Disord. 2015;45(12):3949–60 Social anxiety symptoms commonly co-occur among youth with autism spectrum disorder and without intellectual disability. This study evaluated the co-occurrence of social anxiety disorder in adults with and without ASD, and results illustrated how adults with ASD plus SAD differ from those with ASD without SAD in several key characteristics. This paper suggests that treatments targeting social functioning should include elements to address social anxiety, particularly in those participants with co-occurring SAD.

      Article  Google Scholar 

    17. 17.

      Gotham K, Brunwasser SM, Lord C. Depressive and anxiety symptom trajectories from school age through young adulthood in samples with autism spectrum disorder and developmental delay. J Am Acad Child Adolesc Psychiatry. 2015;54(5):369–76.

      Article  Google Scholar 

    18. 18.

      Bishop-Fitzpatrick L, Mazefsky CA, Minshew NJ, Eack SM. The relationship between stress and social functioning in adults with autism spectrum disorder and without intellectual disability. Autism Res. 2015;8(2):164–73.

      Article  Google Scholar 

    19. 19.

      Kennedy DP, Adolphs R. Perception of emotions from facial expressions in high-functioning adults with autism. Neuropsychologia. 2012;50(14):3313–9.

      Article  Google Scholar 

    20. 20.

      Volkmar F. Understanding the social brain in autism. Dev Psychobiol. 2011;53:428–34.

      Article  Google Scholar 

    21. 21.

      Baron-Cohen S, Leslie AM, Frith U. Does the autistic child have a “theory of mind”? Cognition. 1985;21:37–46.

      CAS  Article  Google Scholar 

    22. 22.

      Reichow B, Steiner AM, Volkmar F. Cochrane review: social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD). Evidence-Based Child Health. 2013;8(2):266–315.

      Article  Google Scholar 

    23. 23.

      Kasari C, Shire S, Factor R, McCracken C. Psychosocial treatments for individuals with autism spectrum disorder across the lifespan: new developments and underlying mechanisms. Curr Psychiatry Rep. 2014;16(11):512.

      Article  Google Scholar 

    24. 24.

      Gersten R, Fuchs LS, Compton D, Coyne M, Greenwood C, Innocenti MS. Quality indicators for group experimental and quasi-experimental research in special education. Except Child. 2005;71(2):149–64.

      Article  Google Scholar 

    25. 25.

      Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest. 1989;95(2):2S–4S.

      CAS  Article  Google Scholar 

    26. 26.

      *Gantman A, Kapp SK, Orenski K, Laugeson EA. Social skills training for young adults with high-functioning autism spectrum disorders: a randomized controlled pilot study. J Autism Dev Disord 2012;42:1094–103.

    27. 27.

      *Laugeson EA, Gantman A, Kapp SK, Orenski K, Ellingsen R. A randomized controlled trial to improve social skills in young adults with autism spectrum disorder: the UCLA PEERS program. J Autism Dev Disord. 2015;45:3978–89.

    28. 28.

      *Saban-Bezalel R, Mashal N. The effects of intervention in the comprehension or irony and on hemispheric processing of irony in adults with ASD. Neuropsychologia. 2015;77:233–41.

    29. 29.

      *McVey AJ, Dolan BK, Willar KS, Pleiss S, Karst JS, Casnar CL, et al. A replication and extension of the PEERS for young adults social skills intervention: examining effects on social skills and social anxiety in young adults with autism spectrum disorder. J Autism Dev Disord. 2016;46(12):3739–54.

    30. 30.

      *Morgan L, Leatzow A, Clark S, Siller M. Interivew skills for adults with autism spectrum disorder: a pilot randomized controlled trial. J Autism Dev Disord. 2014;44:2290–300.

    31. 31.

      *Spek AA, van Ham NC, Nyklicek I. Mindfulness-based therapy in adults with an autism spectrum disorder: a randomized controlled trial. Res Dev Disabil. 2013;34(1):246–53.

    32. 32.

      *White SW, Richey JA, Gracanin D, Coffman M, Elias R, LaConte S, Ollendick TH. Psychosocial and computer-assisted intervention for college students with autism spectrum disorder: preliminary support for feasibility. Educ Train Autism Dev Disabil. 2016;51(3):307–317.

    33. 33.

      *Cunningham A, Sperry L, Brady MP, Peluso PR, Pauletti RE. The effects of a romantic relationship treatment option for adults with autism spectrum disorder. Counsel Outcome Res Eval 2017;7(2):99–110.

    34. 34.

      *Eack SM, Hogarty SS, Greenwald DP, Litschge MY, Porton SA, Mazefsky CA, Minshew NJ. Cognitive enhancement therapy for adult autism spectrum disorder: results of an 18-month randomized clinical trial. Autism Res. 2018;11(3):519–30.

    35. 35.

      *Smith MJ, Ginger EJ, Wright K, Wright MA, Taylor JL, Humm LB, et al. Virtual reality job interview training in adults with autism spectrum disorder. J Autism Dev Disord. 2014;44(2450–2463).

    36. 36.

      *Hesselmark E, Plenty S, Bejerot S. Group cognitive behavioural therapy and group recreational activity for adults with autism spectrum disorders: a preliminary randomized controlled trial. Autism. 2014;18(6):672–83.

    37. 37.

      *Golan O, Baron-Cohen S. Systemizing empathy: teaching adults with asperger syndrome or high-functioning autism to regonize complex emotions using interactive multimedia. Dev Psychopathol. 2006;18(591–617).

    38. 38.

      *Bolte S, Feineis-Matthews S, Leber S, Dierks T, Hubl D, Poustka F. The development and evaluation of a computer-based program to test and to teach the recognition of facial affect. Int J Circumpolar Health. 2002;61:61–8.

    39. 39.

      *Turner-Brown LM, Perry TD, Dichter GS, Bodfish JW, Penn DL. Brief report: feasibility of social cognition and interaction training for adults with high functioning autism. J Autism Dev Disord. 2008;38:1777–84.

    40. 40.

      *Strickland DC, Coles CD, Southern LB. JobTIPS: a transition to employment program for individuals with autism spectrum disorders. J Autism Dev Disord. 2013;43:2472–83.

    41. 41.

      *Sizoo BB, Kuiper E. Cognitive behavioural therapy and mindfulness based stress reduction may be equally effective in reducing anxiety and depression in adults with autism spectrum disorders. Res Dev Disabil. 2017;64:47–55.

    42. 42.

      *Faja S, Aylward E, Bernier R, Dawson G. Becoming a face expert: a computerized face-training program for high-functioning individuals with autism spectrum disorders. Dev Neuropsychol. 2008;33(1):1–24.

    43. 43.

      *Koehne S, Behrends A, Fairhurst MT, Dziobek I. Fostering social cognition through an imitation and synchronization-based dance/movement intervention in adults with autism spectrum disorder: a controlled proof-of-concept study. Psychother Psychosom. 2016;85:27–35.

    44. 44.

      *McGillivray JA, Evert HT. Group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people with ASD. J Autism Dev Disord. 2014;44(8):2041–51.

    45. 45.

      *Koch SC, Mehl L, Sobanski E, Sieber M, Fuchs T. Fixing the mirrors: a feasibility study of the effects of dance movement therapy on young adults with autism spectrum disorder. Autism. 2015;19(3):338–50.

    46. 46.

      *Howlin P, Yates P. The potential effectiveness of social skills groups for adults with autism. Autism 1999;3(3):299–307.

    47. 47.

      *Bonete S, Calero MD, Fernández-Parra A. Group training in interpersonal problem-solving skills for workplace adaptation of adolescents and adults with Asperger syndrome: a preliminary study. Autism. 2015;19(4):409–20.

    48. 48.

      *Eack SM, Greenwald DP, Hogarty SS, Bahorik AL, Litschge MY, Mazefsky CA, Minshew NJ. Cognitive enhancement therapy for adults with autism spectrum disorder: results of an 18-month feasibility study. J Autism Dev Disord 2013;43:2866–77.

    49. 49.

      *Faja S, Webb SJ, Jones E, Merkle K, Kamara D, Bavaro J, Aylward E, Dawson G. The effects of face expertise training on the behavioral performance and brain activity of adults with high functioning autism spectrum disorders. J Autism Dev Disord. 2012;42(2):278–93.

    50. 50.

      *Fullerton A, Coyne P. Developing skills and concepts for self-determination in young adults with autism. Focus Autism Dev Disabil 1999;14(1):42–52.

    51. 51.

      *Hillier A, Fish T, Cloppert P, Beversdorf DQ. Outcomes of a social and vocational skills support group for adolescents and young adults on the autism spectrum. Focus Autism Dev Disabil. 2007;22(2):107–15.

    52. 52.

      *Hillier A, Fish T, Siegel JH, Beversdorf DQ. Social and vocational skills training reduces self-reported anxiety and depression among young adults on the autism spectrum. J Dev Phys Disabil. 2011;23:267–76.

    53. 53.

      *Kandalaft MR, Didehbani N, Krawczyk DC, Allen TT, Chapman SB. Virtual reality social cognition training for young adults with high-functioning autism. J Autism Dev Disord. 2013;43(34–44).

    54. 54.

      *Koegel LK, Ashbaugh K, Koegel RL, Detar WJ. Increasing socialization in adults with Asperger’s syndrome. Psychol Sch. 2013;50(9):899–909.

    55. 55.

      *Koegel LK, Ashbaugh K, Navab A, Koegel RL. Improving empathic communication skills in adults with autism spectrum disorder. J Autism Dev Disord. 2016;46(3):921–33.

    56. 56.

      *Koegel LK, Navab A, Ashbaugh K, Koegel RL. Using reframing to reduce negative statements in social conversation for adults with autism spectrum disorder. J Posit Behav Interv. 2015;18(3):133–44.

    57. 57.

      *Lovett S, Rehfeldt RA. An evaluation of multiple exemplar instruction to teach perspective-taking skills to adolescents with Asperger syndrome. Behavior Dev Bull. 2014;19(2):22–36.

    58. 58.

      *Palmen A, Didden R, Arts M. Improving question asking in high-functioning adolescents with autism spectrum disorder: effectiveness of small-group training. Autism. 2008;12(1):83–98.

    59. 59.

      *Retherford KS, Schreiber LR. Camp campus: college preperation for adolescents and young adults with high-functioing autism, Asperger syndrome, and other social communication disorders. Top Lang Disord. 2015;35(4):362–85.

    60. 60.

      *Trepagnier CY, Olsen DE, Boteler L, Bell CA. Virtual conversation partner for adults with autism. Cyberpsychol Behav Soc Netw. 2011;14(1–2):21–7.

    61. 61.

      *Kiep M, Spek AA, Hoeben L. Mindfulness-based therapy in adults with an autism spectrum disorder: do treatment effects last? Mindfulness. 2014;6(3):637–44.

    62. 62.

      *Mason RA, Rispoli M, Ganz JB, Boles MB, Orr K. Effects of video modeling on communicative social skills of college students with Asperger syndrome. Dev Neurorehabil. 2012;15(6):425–34.

    63. 63.

      *Pugliese CE, White SW. Brief report: problem solving therapy in college students with autism spectrum disorders: feasibility and preliminary efficacy. J Autism Dev Disord. 2014;44:719–29.

    64. 64.

      *Spain D, Blainey SH, Vaillancourt K. Group cognitive behaviour therapy (CBT) for social interaction anxiety in adults with autism spectrum disorders (ASD). Res Autism Spectr Disord. 2017;41–42:20–30.

    65. 65.

      *Ekman E, Hiltunen AJ. Modified CBT using visualization for autism spectrum disorder (ASD), anxiety and avoidance behavior—a quasi-experimental open pilot study. Scand J Psychol. 2015;56(6):641–8.

    66. 66.

      Baron-Cohen S, Golan O, Wheelwright S, Hill JJ. Mind reading: the interactive guide to emotions. London: Jessica Kingsley; 2004.

      Google Scholar 

    67. 67.

      Baron-Cohen S, Wheelwright S. The empathy quotient: an investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences. J Autism Dev Disord. 2004;34:163–75.

      Article  Google Scholar 

    68. 68.

      Kasari C, Rotheram-Fuller E, Locke J, Gulsrud A. Making the connection: randomized controlled trial of social skills at school for children with autism spectrum disorders. J Child Psychol Psychiatry. 2012;53:431–9.

      Article  Google Scholar 

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    Acknowledgments

    The editors would like to thank Dr. Anthony Rostain for taking the time to review this manuscript

    Funding

    This study was funded by the NIMH (R34MH104407).

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    Correspondence to Edward S. Brodkin.

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    Pallathra, A.A., Cordero, L., Wong, K. et al. Psychosocial Interventions Targeting Social Functioning in Adults on the Autism Spectrum: a Literature Review. Curr Psychiatry Rep 21, 5 (2019). https://doi.org/10.1007/s11920-019-0989-0

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    Keywords

    • Autism
    • Adult
    • Social behavior
    • Interventions
    • Review