Performance-Based Social Skills Intervention Improves Explicit Social Cognition in Children with Autism Spectrum Disorder

Background:

Individuals with autism spectrum disorder (ASD) exhibit deficits in theory of mind (ToM; Frith & Frith, 2003), emotion recognition (Lozier et al., 2014), and social knowledge (Attwood, 2007), all of which are social cognition processes fundamental to social interactions (Kennedy & Adolphs, 2012). These involve explicit understanding of the correct information about a social situation and overt indication of such understanding is required for applying these skills to everyday life. Therefore, most social skills interventions (SSI) for ASD utilize didactic approach to directly and explicitly teach these target skills (e.g., Goldstein & McGinnis, 1997; Laugeson et al., 2009). These SSI have shown positive yet limited effects in social cognitive skills (White et al., 2007).

There is a growing empirical support for performance-based approaches in SSI that provide enriched, in vivo social learning and practice opportunities without explicit instruction (Lerner et al., 2011; Lerner & White, 2015). It is unknown, however, which (if any) explicit social cognitive processes may be affected directly by these interventions – that is, can explicit social understanding be learned via non-didactic, performance-based approaches?

Objectives:

This study examined the impact of a non-didactic SSI on social cognition processes not explicitly taught. We hypothesized that participating in a performance-based intervention would yield improvements in ToM, emotion recognition, and social knowledge.

Methods:

Children with ASD (N=13; M_age=13.25, SD_age=2.14) participated in a 6-week social performance-based summer intervention program. They completed measures of explicit social knowledge (Maedgen & Carlson, 2000) and facial emotion identification (Nowicki, 2004). Their parent completed a measure of explicit ToM (Hutchins, Prelock, & Bonazinga, 2012), assessing early, basic, advanced, and total ToM. 

Results:  

Bivariate correlations revealed negative association between early ToM and deficits in social knowledge, driven by the subscale indicating a tendency to believe passive responses to social situations as correct, and positive association between the subscale indicating a tendency to believe aggressive responses to social situations as correct and errors in emotion recognition (Table 1). Paired samples t-tests between pretest and posttest scores evinced improvement in total ToM (t=2.920, p=.014), which was driven by gains in advanced ToM (t=2.695, p=.021); improvement in explicit social knowledge regarding assertive behavior (t=-2.185, p=.051); and improvement in emotion recognition (t=-2.462, p=.015), which was driven by subtler faces (t=-3.154, p<.001). 

Conclusions:  

As measured by parent-reported, self-reported, and behavioral indexes, we found relations among social knowledge, ToM, and facial emotion recognition in children with ASD. More importantly, we found that participating in an SSI that does not teach via didactic instruction led to improvements in ToM, identification of emotion in faces, and explicit social knowledge. Our results suggest that even with minimal didactic instruction or instrumental reinforcement of target skills (e.g., explicit training and feedback on face-emotion recognition or ToM activities), these social cognitive skills can be implicitly and experientially acquired in children with ASD via engaging in targeted activities. This provides additional support for intact implicit learning in ASD (Foti et al., 2014), and for social performance-based approaches to SSI that provide an enriched environment for children with ASD.