Measuring the Efficacy of Social Skills Interventions for Children with Autism

Background:  Impairments in social functioning are a hallmark of autism spectrum disorders, and represent an area of great need within this population. Currently there are many interventions available to improve the social skills of children with autism. However, these interventions are paired with an equally diverse number of outcomes used to measure social gains. Because of this diversity, it is difficult to compare outcomes across studies to determine the best interventions for specific children.

Objectives:  The range of outcome measures used to evaluate the efficacy of social skills interventions for children with autism will be explored.  Recommendations for systematic measurement of intervention gains will also be discussed.

Methods:  Literature on social skills interventions was reviewed from 1992 to 2010.  Studies were included in the review if they utilized a school-based, social skills focused intervention for children with autism. A total of 48 studies were evaluated.  Each study was assessed to determine the type of intervention, as well as the specific outcome measures used to investigate social progress or success. Outcomes were grouped into three discrete categories, including observations, standardized reporting measures, and non-validated surveys. The range of outcomes included in each of these categories was analyzed to get an overall estimate of the variety of measures being used to calculate social success. The number of studies that employed probes to assess generalization and maintenance of skills was also examined.

Results:  Preliminary results suggest that over 171 discrete outcomes were used across the 48 studies reviewed. These outcomes varied from informal self-report measures to standardized test scores, with 73% of the studies focusing on observational data, 25% using standardized measures, and 2% using non-validated rating scales. There were 35 unique categories of skills measured using observational data, ranging from specific verbal social interaction skills to nonverbal behaviors. There were 3 categories of non-validated rating scales, and 33 standardized measures used. The standardized measures appeared most frequently in the studies that included larger sample sizes.  Only 17 of the 48 studies assessed generalization of skills across settings, and just 4 studies measured maintenance of skills up to 2 months after the end of treatment.

Conclusions:  Although there is a considerable need for social skills interventions for children with autism, the variety of outcomes used across studies means that we are unable to compare interventions conducted by independent researchers. Given the heterogeneity within the population of children with autism, there is a critical need to be able to identify which interventions will be the most successful with specific children. The current review suggests that broader social skills outcomes may be needed in order to systematically compare outcomes across studies.