Last week, while discussing a study that compared medication and psychotherapy for the treatment of teen depression, I mentioned how the current research suggests that the efficacy of Cognitive Behavioral Therapy (CBT) as treatment for depression in adolescents may vary significantly as a function of small variations between the different versions of CBT used by clinicians. That is, not all CBTs are the same and some types appear to be more effective than others. Are other interventions also sensitive to subtle variations?

Last night I read a recent article published in the Journal of Autism and Developmental Disorders that compared two similar social skills intervention groups for children with Autism. Social Skills Group Intervention, or SS-GRIN, is one of the most effective social skills training programs for typically developing children and teens with social difficulties. This intervention uses CBT and social learning techniques to teach social skills and peer relations to “at-risk” kids, such as those experiencing severe peer rejection.

Social skills therapy generally has been found to be of mixed effectiveness when used with children and teens with high functioning autism (HFA). Some studies have suggested that it works while others suggest that it doesn’t. However, the type of social skills programs used in previous studies has varied significantly and some studies included implementation of programs designed to teach social skills to typically developing kids, such as SS-GRIN.

In an effort to design a more appropriate, and hopefully more effective, intervention for kids with HFA, a group of clinicians and researchers developed a version of SS-GRIN especially modified for HFA.  They called it the SS-GRIN-HFA.

The intervention consists of 15 sessions:

Social Skills Training for high functioning autism

They then tested the intervention in 55 children age 8 to 12 with a diagnosis of HFA, Asperger’s disorder, or PDD NOS. The kids were randomly assigned to either SS-GRIN-HFA or the traditional SS-GRIN. Before and after the intervention the parents completed the following measures:

  • Social Responsiveness Scale (SRS), which assesses 5 domains including social awareness, social cognition, social communication, social motivation, and autistic mannerisms.
  • The Achieved Learning Questionnaire (ALQ), which measures social skills learned during the intervention.
  • Social Self-efficacy Scale (SSS), which measures the child’s perceived competence in social skills.

In addition, the child also completed the SSS and the Social Dissatisfaction Questionnaire, which measures the child’s perceived social isolation.

So which therapy was more effective?

Effects of social skill training for children wit autism

In the above table the treatment group is the SS-GRIN-HFA and the control group is the traditional SS-GRIN. The scores below the columns “M” reflect the mean change from before the intervention to after the intervention. In the case of the SRS, negative scores mean improvement after the intervention. For example, when looking at the SRS social awareness difficulties, the SS-GRIN-HFA had a score change of -.33 while the control group had a score change of +.38. That is, those in the SS-GRIN-HFA had a reduction in social awareness difficulties (as reported by parents) while those in the traditional group actually got worse! For all other scores (ALQ, Self-Efficacy, and Social Dissatisfaction) positive numbers mean improvement after the intervention. The last column tells us about the strength of the difference between the SS-GRIN-HFA and the traditional group. Values higher than .50 or lower than -.50 suggest a sizable difference between the groups.

So in the table above  we can see that when compared to the traditional  SS-GRIN intervention, the modified SS-GRIN-HFA resulted in significant improvements in parental reports of:

  • Social Awareness
  • Social Communication
  • Social Motivation
  • Autism Mannerisms
  • Perceived social competence

In contrast, there was no difference between the two interventions in the levels of the child’s report of social competence or perceived social isolation.


The authors concluded:

Overall, the current study provides evidence for the efficacy of the S.S.GRIN-HFA group intervention for enhancing the social skills of children with high functioning ASD. As increasing numbers of children are diagnosed with high functioning ASD, there is an urgent need and demand for efficacious treatment protocols for use with this population (IACC 2009). The S.S.GRIN-HFA treatment program pro- vides a manualized research-based option to aid mental health professionals in their work with children with high functioning ASD. In particular, the S.S.GRIN-HFA intervention offers professionals several advantages compared to more generic SST, including its active engagement of parents, use of community exercises to promote generalization, and focused social skills training. In particular, results of the current study provide clear evidence that when children with high functioning ASD are in a group with more similar peers (i.e., diagnostic, social and developmental profiles), outcomes are enhanced by following a protocol that is designed specifically to meet their social skill needs.

The reference: DeRosier, M., Swick, D., Davis, N., McMillen, J., & Matthews, R. (2010). The Efficacy of a Social Skills Group Intervention for Improving Social Behaviors in Children with High Functioning Autism Spectrum Disorders Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-010-1128-2
ResearchBlogging.org

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7 Responses to Social skills training for children with autism: not all group therapies are the same

  1. EK says:

    I find it interesting that the child self-report is largely dismissed, despite the authors noting that “prior research…has found that children with high functioning ASD were able to reliably report on their own social experience,” etc. (then going on to assume that this must not be relevant or particularly important, from what I can tell). Offhand, it would appear to me that greater parent involvement in the treatment, as noted in the paper, would be likely to inflate perception of efficacy (regardless of actual treatment benefit, or lack thereof). I’m not sure, in this case, that evidence for benefit (aside from parental feelings of self-efficacy, etc.) is as clear as is argued in the paper.

  2. [...] it's interesting. Nestor Lopez-Duran on the Child Psychology Research Blog has a good post up on "Social-skills training for children with autism: not all group therapies are created equal". Bishop Nick Baines gets stuck into those who claim Christians are persecuted in Britain. He [...]

  3. [...] Social skills training for children with autism: not all group therapies are created equal (child-psych.org) [...]

  4. Alex Schulz says:

    Buenops dias Nestor

    From what I can see there is no allocation to the reality that all children with ADS or not will all have ‘light bulb moments’ when all pieces come together. Even as adults we do the same. I would be interested to see if a delayed lesson ‘klanger’ happens when the social situation described in lessons and therapy to a ASD children falls into place.

    Alex

  5. Corinne says:

    Where does medium autism fit in?

  6. Interesting study. Outside of a lab/study environment, variations would be expected as well due to variations in the fidelity of delivery.

    Here’s a paper on a randomized controlled study of FaceSay, social skills computers games, with school aged students with an ASD.

    http://www.springerlink.com/content/k1244308044ml647/

    It was published in Feb 2011 in the same journal. Both the HFA and LFA FaceSay participants improved relative to controls on in-vitro emotion recognition and in-vivo playground social interaction measures.

    The HFA students also improved on Face Recognition tests and the LFA students improved on the parent self reports (SSRS).

    Casey

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