A Longitudinal Look at the Effectiveness of Teaching Social Thinking to Adolescents with Autism Spectrum Disorders

Background:  The recent surge of information about autism in the mainstream and professional literature has prompted new interest in treatments for individuals with Autism Spectrum Disorders (ASD). Unfortunately, research on the usefulness and effectiveness of novel approaches within this population has traditionally lagged behind the basic sciences, especially related to individuals with average to above average language and cognitive abilities. For those with complex language, social cognitive tasks, such as interpreting other’s actions or intentions, understanding social reciprocity, and adjusting verbal/nonverbal behavior according to social cues, prove to be challenging (Koning & Magill-Evans, 2001; Ozonoff & Miller, 1995; Tsatsanis, Foley, & Donehower, 2004; Weiss & Harris, 2001).  Studies addressing the effectiveness of treatments with a social emotional emphasis are key for all children and are most certainly a critical component for te ASD population. In fact, teaching basic social "skills" to those with strong language and cognitive skills only scratches the surface of broader social learning needs.  

Objectives: The purpose of this study was to examine the effectiveness and long term outcomes of a social cognitive intervention (Social Thinking) in four 9-11 year old boys with Autism Spectrum Disorders (diagnosis of AS and HFA).

Methods:  Four boys, aged 9-11 years, were included this treatment study. Multiple baseline measures across behaviors were used to examine generalization of social pragmatic and social problem solving skills immediately after an eight-week pilot intervention and one-year post intervention. All lessons within the treatment model were grounded in the principles of social cognition (Social Thinking). The format of each treatment session included the following components: 1) Gathering (3-5 minutes of open talk time); 2) Group lesson (Specific social cognitive strategies/Social Thinking Lessons); 3) Practice/Unstructured time.Therapists provided verbal/visual feedback during the practice/unstructured time to reinforce the lesson. Weekly meetings and checklists addressed treatment fidelity and consistency. External validity and contextual relevance for families and subjects were highlighted.

Results: Findings indicated gains on dependent measures from baseline to generalization probes during the 8-week intervention as well as an increase or maintenance during a one-year follow-up probe.  All four subjects either maintained or increased “expected” social behaviors or decreased “unexpected” social behaviors with the exception of verbal initiations. However, the change in this skill appeared to be a result of limited verbal demands during the activity included in the measure. Both parents and subjects indicated an increase in social awareness and problem solving strategies.

Conclusions: This study adds to the small pool of clinic-based studies examining the effectiveness social interventions based on social cognition. This model is a shift from traditional social skill approaches in that this cognitive behavioral approach (Social Thinking) promotes understanding of “why” related social skills are relevant in social exchanges and suggests that a meta-cognitive approach may be more relevant for those we currently refer to as AS/HFA or those with ASD who have strong cognitive and language skills.