A Behavioral Summer Treatment Program Improves Social Functioning for Children with High-Functioning Autism Spectrum Disorder

Background:  Targeting reciprocal social interaction deficits is extremely important for children with high-functioning ASD (HFASD), as they initiate fewer interactions and are typically less engaged with peers.  A case report by Mrug and Hodgens (2008) described how the Summer Treatment Program (STP), a comprehensive behavioral intervention developed for children with Attention-Deficit/Hyperactivity Disorder, produced substantial changes in social functioning in four boys with Asperger’s Disorder.  The STP offers a unique opportunity to target peer relationships and social skills of children with HFASD within the context of a naturalistic, summer camp setting.  Moreover, the STP holds promise as an efficacious intervention for children with HFASD in that the program aims to foster social competence in an individualized manner.

Objectives:  The present study examined individualized daily goals targeting the initiation of a conversation with a peer for children with HFASD during the STP.

Methods:  The participants were seven boys with HFASD who attended the STP between 2004 and 2010. All participants were between 7 and 11 years (M = 8.9 years, SD = 1.4) and were diagnosed with a HFASD by a licensed psychologist. Throughout the intensive, 6-week-long daily behavioral treatment program, extensive data were recorded for all target behaviors, including initiating a conversation with a peer.  Conversation was operationally defined as a child asking a peer a question, the peer responding, and the child making a contingent utterance (i.e., saying something related to the peer’s response). Participants received immediate verbal praise, daily rewards from their parents and weekly rewards at the STP contingent upon attaining their goals. The frequency of initiating a conversation was monitored and calculated each day.  This behavior was analyzed across each week of the program both visually as a series of single cases and quantitatively using polynomial contrasts in repeated measures ANOVA.   

Results:  The number of initiations of a conversation significantly changed over time, F (1.8, 10.8) = 7.3, p < .01.  Additionally, a significant linear trend, F (1, 6) = 13.83, p < .01, η_p² = .70, indicated that conversation initiations increased linearly over time.  Post hoc mean comparisons revealed that the number of conversations initiated during Week 6 (M = 3.5 conversations/day) was significantly higher than the number initiated during Week 1 (M = 0.2 conversations/day) of the program.

Conclusions:  These results suggest that children with HFASD are responsive to the structure of the STP and add to the mounting evidence of the effectiveness of the STP in improving the social functioning of these children.  Consistent with the STP focus on targeting individual areas of greatest functional impairment for each child and social deficits common in children with HFASD, individualized goals targeting social interaction deficits and aiming to improve interactions with peers were very common for children with HFASD in the STP. Overall, these children made significant improvements in their ability to initiate and maintain reciprocal social conversations with peers during the course of the STP.