Is There Science Behind That? Social Thinking

Catherine L. McHugh, MA, BCBA, LBA, Stacha C. Leslie, MEd, BCBA, LBA, and Thomas Zane, PhD, BCBA-D
Department of Applied Behavioral Science, University of Kansas

Is there science behind that One of the major diagnostic criteria for autism spectrum disorder (ASD) is deficits in social communication (Center for Disease Control and Prevention [CDC], 2022). Research and clinical practice highlight numerous variations of this challenge, manifested by difficulty with back-and-forth conversations, restricted number of topics to discuss with others (e.g., only talking about ceiling fans), failure to respond appropriately to social initiations by others, and atypical approaches towards others (e.g., standing too close to a listener when speaking; American Psychiatric Association, 2013). Individuals with ASD who demonstrate deficits in this area may find it difficult to make friends and maintain a positive, healthy, social life as they grow older (Mendelson, et al., 2016). However, although social communication is a common area of need for individuals with ASD, there are no widely recognized evidence-based curricula for teaching this set of skills (Crooke et al., 2008; National Autism Center, 2015; Wong, et al., 2015).

Social Thinking (Winner, 2005) is a curriculum that includes a packaged intervention aimed at individuals with ASD to try to teach both verbal and nonverbal skills that would commonly fall into the category of social skills. These skills include, but are not limited to, making on-topic remarks, initiating conversations, and looking in the direction of the communicative partner (Crooke, et al., 2018). According to the author, Michelle Garcia Winner, Social Thinking offers strategies for individuals with ASD ages 4 to adulthood. Winner claims the lessons are evidence-based with various studies that offer support (Winner, 2005). The developers of this curriculum assert that this approach is grounded in theories related to social cognition and aimed at teaching these skills. Winner (2005) explained that social thinking works by teaching lessons about social cues and social skills and then, once acquired, helping clients put those skills into practice.

At first glance, this curriculum is appealing because of its positivity and encouragement that social skills are easily taught. However, is there science behind it? The importance of a practice being considered ‘evidenced-based’ is fundamental. Autism treatment has been referred to as a ‘fad magnet’ (Metz et al., 2005) and most human-service organizations have advocated that the practices used with this population be proven effective through the process of sound, methodologically rigorous research (Zane et al., 2016). As can be expected, some practices meet the criteria for being considered evidenced-based, while many others do not (Knight et al., 2019). What about the Social Thinking curriculum?

Review of the literature

On the website for the Social Thinking curriculum, one can find the research-based publications by clicking the tab “Evidence” and then “Peer-Reviewed.” There one finds a total of 20 published articles on the scientific evidence supporting the claim that Social Thinking is proven to be effective in teaching communication-related skills. The majority of these articles on topics such as discussing the importance of social skills and some basic strategies, are conceptual in nature rather than experimental. Two other articles were research-oriented but were labeled ‘pilot’ preliminary investigations. Although interesting, pilot studies do not meet standards for quality research. An additional three studies included interventions in addition to the Social Thinking curriculum, so any positive changes in the participants cannot be attributed solely to Social Thinking. Clinically, when individuals receive Treatments A, B, and C concurrently, it is not possible to know for certain which interventions can be credited for any positive changes that may be observed. This challenge is even more relevant when interpreting results in published research. In other words, when Social Thinking is one component of a multi-element intervention, it is hard to say which elements made the difference.

One study seemed to show positive effects of Social Thinking, but reported its results as pre-post information, even though the authors utilized a multiple baseline within subjects investigation. It was odd that the authors chose to present only the pre-post results, and not the individual behavior change of the participants. In sum, the purported evidence listed on the Social Thinking website is weak as it consists mostly of conceptual papers. Our concern is that many consumers visiting this website may be led to believe that there are 20+ articles that directly study this specific intervention, but instead many of them are conceptual or describe multi-component interventions.

Leaf and colleagues (2016) provided a thorough review of Social Thinking which included an evaluation of its basic conceptualization of behavior and social skills, its methodology, and the quality of empirical evidence presented by its developers to validate supposed claims that the curriculum actually teaches what it claims to teach. Within this review, the authors found two empirical studies on Social Thinking. Leaf and colleagues reported that both studies used a research design (one group pre-post design) that is generally seen as weak in allowing one to claim a causal relationship between the independent variable and changes in dependent measures.

Leaf et al. (2018) reviewed the most recent literature on Social Thinking, which included three articles published since their 2016 review. Leaf and colleagues suggested that all were flawed in some way and could not be considered support for claiming Social Thinking to be evidenced-based. One issue was the experimental design (Crooke et al., 2008; Lee et al., 2016). These researchers did not design their studies in a way that could make the reader confident in the impact of the treatment on the target behaviors in the way they constructed the experiment. For example, Crooke and colleagues (2008) used a pretest-post-test analysis of their data. This type of design does not demonstrate cause-and-effect relations or conclusions (Bailey & Burch, 2002; Campbell & Stanley, 1968). The second major issue was the lack of detail with regard to the implementation of the treatment, in that complete descriptions of the interventions were not described in enough detail to allow replication. A third major issue was the lack of participant information. It is unclear what skill sets these participants had in terms of language and rule governance; therefore, it is unclear if this treatment would work for individuals with varying skill sets. The fourth issue was related to multiple treatment interference. Koning et al. (2013) used a treatment package that included several components, but they did not conduct an analysis of these components to determine which were necessary for behavior change. The obvious implication is the possibility that participants improved due to the added treatments rather than the Social Thinking curriculum. Finally, Lee and colleagues (2016) defined their dependent variables in terms that were somewhat subjective and thus more open to measurement error.

In addition to the studies that were discussed in both Leaf and colleague articles, Nowell and colleagues (2019) conducted a randomized control trial on a treatment that included components of Social Thinking in conjunction with components from other curricula to teach social communication and self-regulation. However, similar to the previous studies, there are several issues with this research. There are several dependent variables listed in this study, but their definitions were unclear. Nowell and colleagues conducted several statistical analyses that were difficult to interpret with regards to the impact of the independent variables on the dependent variables. The results suggest the intervention was effective; however, this treatment consisted of several components that were not clearly defined. Therefore, it is unclear what was responsible for the behavior change.

From this and other research, it is clear that more empirical investigations need to be conducted for this particular curriculum and generally on the concept of Social Thinking. Primarily, research must be conducted using just the Social Thinking curriculum, by itself, using well-established research designs, to answer the first question of whether or not there is a causal relationship between the use of the curriculum and any positive changes in the dependent variables assessed. Secondly, a body of research should be conducted doing a component analysis of the methodology of the Social Thinking curriculum to see what component(s) contribute to its success (if any). Lastly, if the two previous questions are settled, researchers should compare the effectiveness of a Social Thinking approach with alternative strategies designed to teach the same skill sets. If procedures from the curriculum are compatible with other behavioral interventions, are enjoyed by learners, and are methodically assessed for impact at any individual level, it might be possible to include elements of the approach and evaluate its utility for an individual learner. Most importantly, if a Social Thinking approach seems to lead to positive outcomes, research should then assess whether Social Thinking skills are maintained and generalized and how the social thinking curriculum is evaluated by stakeholders, including autistic individuals, parents of children with autism, and professionals involved on interdisciplinary teams.

Conclusions

It is clear that more work needs to be done in the area of teaching social-communicative behavior. This set of behaviors is unique in that social communication is nuanced and dynamic. therefore, it is unsurprising that it is difficult to create packages for a group of individuals with various skill sets on how to engage in these behaviors. With regards to Social Thinking, it does not appear that the accrued data support Social Thinking as evidence-based. There is not yet enough information to suggest that this program will help improve social skills for individuals with ASD. However, given the low risk of the program, future researchers may heed Leaf et al.’s feedback and work to design a more rigorous study that could perhaps add future support. Whether the social communication curriculum by Winner has sufficient experimental research to be considered an evidenced-based practice remains an unanswered question, but current evidence suggests that, at this time, it is not.

If procedures from the curriculum are compatible with other behavioral interventions, are enjoyed by learners, and are methodically assessed for impact at any individual level, it might be possible to include elements of the approach and evaluate its utility for an individual learner. Most importantly, future research could assess issues such as the acquisition, maintenance, and generalization of social thinking skills, and how such a curriculum is evaluated by stakeholders, including individuals diagnosed with autism, parents of such individuals, and professionals who work in the field.

References

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Citation for this article:

McHugh, C. L., Leslie, S. C., & Zane, T. (2023). Social Thinking: Is there science behind that? Science in Autism Treatment, 10(2).

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Social Thinking: Is There Science Behind That?