Adolescents with autism spectrum disorder and social skills groups at school

Dean, M., Williams, J., Orlich, F., & Kasari, C. (2020). Adolescents with autism spectrum disorder and social skills groups at school: A randomized trial comparing intervention environment and peer composition. School Psychology Review, 49(1), 60-73. https://doi.org/10.1080/2372966X.2020.1716636

Reviewed by: Daniel Park, MAP and Robert H. LaRue, PhD, BCBA-D
Rutgers, The State University of New Jersey

Why Research This Topic?

Procedures to teach specific skills for individuals with autism In the United States, public schools are required to provide all students with an appropriate education in the least restrictive setting throughout their educational experience. Unfortunately, many adolescents with autism spectrum disorder (ASD) are placed in general education settings with insufficient social skills support (e.g., lack of peer relationship support). As adolescents with ASD often report increased feelings of loneliness, insecurity, vulnerability, and victimization to bullying, it is important to consider effective social interventions in these settings (Humphrey & Symes, 2011). The current investigation sought to be the first to use a randomized controlled trial comparing two school-based group social skills interventions: SKILLS and ENGAGE (Kasari et al., 2015). These two interventions will be detailed below.

What Did the Researchers Do?

The current researchers implemented a multisite randomized controlled trial with students in economically and ethnically diverse public middle/high schools from the Southwestern and Northwestern regions of the United States. After assessing for eligibility, the team chose 62 students who attended either middle school or high school and who met criteria for ASD. The SKILLS and ENGAGE interventions were adapted from Kasari et al. (2015) and students were randomly assigned to either group. All participants in the study had ASD. The SKILLS intervention group only had participants with ASD, while the ENGAGE intervention was peer-mediated with the opportunity to socialize with typically developing peers. The Autism Diagnostic Observation Schedule (ADOS) and Stanford-Binet, Fifth Edition (SB-5) (abbreviated) were used to determine eligibility criteria for a diagnosis of ASD without intellectual disability. Each intervention was implemented once a week for 8 weeks, at the students’ respective schools, for 40 to 60 minutes per session. Sessions were implemented during lunch or after school.

Both interventions followed the same format: welcome, snacks, a mindfulness exercise, homework check-in, lesson/focus skill of the week, activity with group, and expectations for homework. Participants had the opportunity to earn points for both individual and group sessions to earn towards a party at the end of the 8-week session. Points were earned for greeting peers in the hallway, walking together to the bus and practicing new skills outside of the group.

Clinicians were doctoral students studying clinical psychology, education, or were undergraduate student research assistants. Clinicians were trained to facilitate either the SKILLS or ENGAGE intervention.

The SKILLS intervention was designed similarly to that of a social skills intervention in a general education setting. The first half of each meeting was didactic, while the second half involved specific activities intended for participants to practice and learn from the day’s lesson. Homework for the SKILLS intervention focused on social questions and initiation of conversations. For the ENGAGE intervention, group sessions were peer-mediated and peer mentors were selected and trained to deliver a portion of the intervention. Trainees (neurotypical peers) were told they would receive training to learn strategies to socialize with adolescents who had social challenges; trainees were not told they were going to be working with adolescents with ASD. Homework for the ENGAGE intervention focused on creating ideas for social activities outside of the group that both participants and peer-mediators could attend together. As was the case with the SKILLS intervention, the ENGAGE intervention was structured with didactic instruction in the first half of each meeting, while the second half involved specific activities intended for participants to practice and learn from the day’s lesson. All of the sessions were video recorded, and investigators provided feedback to the clinicians. The Social Skills Improvement System was used to measure the effects of social interventions in adolescents with ASD. Data were collected prior to the intervention (baseline), then collected during the phase sessions, and then 4 to 6 weeks following the completion of the intervention.

What Did the Researchers Find?

The investigators found that both the SKILLS and ENGAGE interventions significantly improved joint attention and decreased solitary engagement at follow-up. Despite the observed increases in engagement, neither group self-reported an improvement in their social skills. Interestingly, SKILLS participants reported higher levels of social stress and lower quality interpersonal relationships at the end of the study as compared to the ENGAGE group. In addition, participants reported increased problem behaviors and emotional symptoms at follow-up 4 to 6 weeks later in the SKILLS intervention. The researchers noted that this may not have been observed in the ENGAGE intervention because peer mediators may have buffered any social stressors experienced by the participants with ASD. The ENGAGE intervention may be recommended because it may protect participants from stressors that could affect their mental health.

What Are the Strengths and Limitations?

A primary strength of the current study included the use of a randomized controlled trial to evaluate the effectiveness of the SKILLS and ENGAGE social skills programs. One of the noted limitations was that there were differences in the session duration between the Southwest sessions (30-40 mins) and the Northwest sessions (60 mins) which may have impacted outcomes. There were also differences in homework instruction and delivery model. Furthermore, baseline data were not collected on how often peers/participants socialized outside of the group prior to the interventions taking place which made it difficult to see how much they improved.

What Do the Results Mean?

The results suggest that both the SKILLS and ENGAGE models increased joint attention and decreased solitary engagement. However, participants in the SKILLS group reported levels of social stress and lower quality interpersonal relationships at the end of the study. The findings suggest that using supportive peer mentors (as used in the ENGAGE group) could serve as a buffer for social stressors to help adolescents with ASD build their social repertoire. On the other hand, the results highlight potential harmful effects of the content of social skills curriculum/ homework models that were used. The authors note that school may improve social skills training outcomes by identifying typically developing peers who have prosocial behaviors and who are interested in working with students who have social challenges.

References

Humphrey, N., & Symes, W. (2011). Peer interaction patterns among adolescents with autistic spectrum disorders (ASDs) in mainstream school settings. Autism, 15, 397-419. 1362361310387804 [PubMed: 21454385]

Kasari, C., Dean, M., Orlich, F., Whitney, R., Landa, R., Lord, C., & King, B. (2015). Children with ASD and social skills groups at school: Randomized trial comparing intervention approach and peer composition. Journal of Child Psychology and Psychiatry 57, 171-179. doi: 10.1111/jcpp.12460 [PubMed: 26391889]

Citation for this article:

Park, D., & LaRue, R. (2022). Research Synopsis: Adolescents with autism spectrum disorder and social skills groups at school: A randomized trial comparing intervention environment and peer composition. Science in Autism Treatment, 19(6).

Other Related Research Synopses:

#Adolescents #Adults #School #SchoolAge #SocialSkills #SocialWorkers #Teachers

Adolescents with autism spectrum disorder and social skills groups at school: A randomized trial comparing intervention environment and peer composition