Social Skills Group Training in High-Functioning Autism Spectrum Disorder: A Pragmatic Multicenter RCT

Background: Despite the continuous need for evidence based interventions for individuals with higher functioning autism spectrum disorder (HFASD) few treatments have been comprehensively evaluated. Social skills group training (SSGT) is a widely applied method for school aged children and adolescents with HFASD. Reviews conclude that there is some evidence for the efficacy of SSGT, but that more rigorous research is needed to draw robust conclusions, and that more focus on external validity is required.

Objectives: This study sought to overcome several of the methodological shortcomings of previous randomized controlled trials of SSGT in HFASD, by examining the by far largest sample ever, using manual-based method, well-defined inclusion and exclusions criteria, psychometrically sound outcome measures, multiple informants including blinded raters, computerized randomization, monitoring of the standard care control treatment as well as personalized medicine and therapy genetics.

Methods: We conducted a pragmatic randomized controlled multicenter trial: Manualized SSGT “KONTAKT” (12 sessions) plus treatment as usual [TAU] versus waiting list TAU only at three points of assessment (baseline, post training, 3 months follow-up) in children and adolescents with HFASD. N=366 individuals aged 7 to 18 years were assessed for eligibility, of which 304 were randomized to SSGT treatment plus TAU (n=153) or TAU only (n=151). Participants have clinical ICD-10 diagnoses of ASD, corroborated by ADOS, and IQ>70. They were trained at 14 regular health care units by 50 clinicians, in the majority certified in the manualized training. Parent and blind teacher report Social Responsiveness Scale ratings served as primary outcome measures. 

Results: Preliminary analyses for parent SRS ratings show significant effects of SSGT “KONTAKT” on SRS social cognition scores at follow-up. Blind teacher SRS ratings show significant post treatment effects for social cognition and autistic mannerisms. Further analyses for age group yield that adolescents show significant symptom improvement for the SRS total score post training and at follow-up on the parent but not the teacher report form.

Conclusions: Findings indicate that SSGT ”KONTAKT” (i) is feasible in naturalistic clinical settings, (ii) leads to various social communication symptoms improvements, (iii) and has higher effects in adolescents than in children. Furthermore, (iv) results indicate that parents report more improvements than teachers. Ongoing moderator analyses for sex, age, comorbidity, medication, severity, language, IQ and other variables, as well as genome-wide methods such as SNP microarrays and next generation sequencing will identify sets of predictors of individual SSGT response.