Phase IV-Community Effectiveness Trial of a Psychosocial Treatment for Children with HFASDs

Background: Children with high-functioning ASDs (HFASDs) require comprehensive treatments, yet few have been validated in rigorous studies. A NIMH working-group (Smith et al., 2007) proposed a 4-phase model for conducting ASD intervention studies: Phase I–development/testing of new techniques; Phase II–development/testing of a manualized protocol; Phase III–randomized clinical trials (RCT); and Phase IV–community effectiveness studies (implementation by a community agency). Lopata and colleagues developed and evaluated the efficacy of a summer psychosocial intervention in a series of studies (2006; 2008; 2010) that followed NIMH guidelines including a Phase III-RCT (2010) that established the treatment program’s efficacy.  

Objectives: This Phase IV-community effectiveness trial evaluated the (1) effectiveness of the summer intervention on the ASD-symptoms and social performance of children with HFASDs; and (2) feasibility (satisfaction and fidelity) when administered by a community agency.  

Methods:

Participants. Twenty-eight children, ages 7-10 with HFASDs; inclusion criteria – short-form IQ factor score >80; receptive or expressive language score >80; and score meeting ASD criteria on the ADI-R/ADOS/or SCQ.

Outcome measures. Parent and staff ratings – Social Responsiveness Scale (SRS; assesses ASD features); Behavior Assessment System for Children-2 (BASC2; Adaptive Skills and Social Skills subtests). Child testing – Comprehensive Assessment of Spoken Language (Idiomatic Language subtest); Diagnostic Analysis of Nonverbal Accuracy2 (Child Faces subtest). Satisfaction measured using parent, child, and staff Satisfaction Surveys.

Procedures. Groups included 7 children with HFASDs and 3 staff. The manualized program was implemented 5 days/week, 7.5 hours/day over 5-weeks during the summer. Treatment included (1) social skills instruction, (2) face-emotion instruction, (3) interest expansion activities, and (4) non-literal language instruction, along with weekly parent training. A response-cost system was used to strengthen new skills and reduce problem behaviors. The daily schedule included five 70-minute treatment cycles; each consisting of a 20-minute structured skills group and a 50-minute therapeutic activity. Fidelity was assessed throughout treatment. Efficacy measures were administered pre-post treatment (one-tailed) and satisfaction post-treatment. 

 Results: Results indicated significant decreases in ratings of ASD-symptoms (SRS parent t(26)=4.592, p<.001; staff t(27)=4.178, p<.001) and significant increases in social skills (BASC2 parent t(26)=-2.505, p<.009, staff t(27)=-3.890, p<.001) and adaptive skills (BASC2 parent t(26)=-2.522, p=.009, staff t(27)=-4.626, p<.001). Child testing indicated a significant increase in understanding of non-literal language (CASL Idioms t(27)=-8.081, p<.001) and non-significant increase in decoding of facial emotions (DANVA2 Child Faces t(27)=-1.506, p=.072). Fidelity was 92.3% for skills groups and 93.5% for therapeutic activities. Satisfaction ratings were positive from parents, children, and staff.  

Conclusions: Results of this Phase IV-community effectiveness trial suggest that the comprehensive summer program was feasible when conducted by a community agency (high levels of fidelity and satisfaction). Participation in the program was associated with a significant reduction in ratings of ASD symptoms and significant increases in social and adaptive skills. Children with HFASDs demonstrated a significant increase in understanding of non-literal language (idioms). Decoding of emotions in child faces also improved however this was not statistically significant. A large-scale Phase IV-community-effectiveness controlled trial appears warranted.