Group Social Skills Intervention for High-Functioning Children with Autism Spectrum Disorder: Process and Outcomes

Background:   Given that social impairment is a key feature of autism spectrum disorder (ASD), social skills training remains paramount. The present eight-session intervention, led by two Masters level clinicians, was designed to address a variety of deficits reported by parents: friendship management, staying on topic, taking turns and other conversational skills, recognizing feelings, keeping calm, and hygiene. After completing an initial assessment, adolescents with ASD and an estimated IQ in the average range or above were admitted. Group participants were Caucasian males aged 12 to 17 (M = 14) with Gilliam Asperger’s Disorder Scale (GADS) quotients ranging from 100 to 127 (M = 111.8, SD = 10.57) and Autism Spectrum Symptom Questionnaire (ASSQ) scores ranging from 24 to 42 (M = 33.6, SD = 7.16) Five typically-developing peers from local high schools also attended the group as social models. 

Objectives:  The current study aimed to describe and examine an outpatient clinic-based social skills group intervention with five high-functioning adolescents with ASD.

Methods:   Each session included 5 general components: a warm-up activity to promote group interaction; an instructional component to teach new skills; snack time to promote unstructured practice of new skills; guided role-play and active practice of new skills; a review of skills discussed and conclusion; and the assignment of homework to facilitate practice of skills outside of the group. Parents were provided a review of each session, including the skills covered and the assigned homework. During each two hour session, adolescents received approximately 1.5 hours of direct skills training and active structured practice; the remaining 30 minutes (e.g., snack, assessment) allowed opportunities for spontaneous practice of skills. Each week’s session focused on a new social skill, including getting to know others and starting a conversation, turn-taking in conversation and activities, self-monitoring of appropriate and inappropriate comments, perspective-taking, nonverbal communication and intentions behind comments, understanding emotions in self and others, and social problem solving. Adolescents with  ASD were assessed before the group and at the last meeting using self- and parent-report measures, including the Behavioral Assessment Schedule for Children (BASC-2), Autism Spectrum Screening Questionnaire (ASSQ), Gilliam Asperger’s Disorder Scale (GADS), and the Social Skills Rating System (SSRS). Adolescents and group leaders completed the Therapeutic Alliance Scale for Children (TASC-R). 

Results:   Mean scores on BASC-2 subscales at pre- and post-group showed a slight trend in improvement in many areas across time. Though modest, these changes were observed after only 8 weeks of treatment despite the test-retest reliability of the BASC-2. a strong negative correlation, although only a statistical trend, was observed between group leader ratings on the TASC-R and ASSQ scores (r = -.92, p = .08). 

Conclusions:  Overall, these results suggest improvements following group inclusion, and with extended treatment, effects may be even stronger.  Though clinicians should be cognizant of their own viewpoints and biases with this population, even with treatment gains.