Fostering Socio-Emotional Competencies in Children with Autism Spectrum Condition: Results of a Randomized Controlled Trial Using the Interactive Training App „Zirkus Empathico“

Saturday, May 13, 2017: 12:00 PM-1:40 PM
Golden Gate Ballroom (Marriott Marquis Hotel)
I. Dziobek1, S. Kirst1, R. Diehm2, S. Wilde-Etzold3, M. A. Noterdaeme4 and L. Poustka5, (1)Berlin School of Mind and Brain, Humboldt University Berlin, Berlin, Germany, (2)Clinic for Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria, (3)Clinic for Child and Adolescent Psychiatry and Psychotherapy, Josefinum, Augsburg, Germany, (4)Child and Adolescent Psychiatry, Augsburg, GERMANY, (5)Clinic for Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria

Given that access to specialist Autism Spectrum Disorder (ASD) service does not meet needs, computer-based interventions offer a cost-effective solution to the problem. Few treatments, especially for socio-emotional competencies, have, however, been rigorously evaluated and could produce improved skills beyond those directly targeted by the intervention.


This study seeks to evaluate the acceptance and effectiveness of „Zirkus Empathico“, a tutor-guided app fostering socio-emotional competencies in pre-school and elementary school children with ASD in a registered, randomized controlled trial (RCT). „Zirkus Empathico“ includes four training modules focusing on i) recognition and verbalization of own emotions, ii) recognition of other’s emotions from facial emotions and iii) context films, iv) emotional empathy and prosocial behavior, and v) generalization into daily life via interactive animations, which aid the communication of own and other’s emotions.


We are conducting a multicenter RCT: Manualized tutor-guided „Zirkus Empathico” (6 weeks with a minimum of 100 min./week) versus an active control group using educational apps not focusing on socio-emotional functions for the same amount of time at three points of assessment (baseline, post training, 3 months follow-up) in children aged 5-10 with high-functioning ASD. N=150 individuals were assessed for eligibility, of which 82 were randomized to participate in the trial. Participants diagnosed with ASD according to ICD-10 criteria, corroborated by ADOS, and have IQ>85. Training takes place at three university centers in Germany and Austria. Parent report Social Responsiveness Scale (SRS) and Griffith Empathy Measure (GEM) ratings serve as outcome measures.


Preliminary analyses of 36 children that completed the trial show high acceptance, as indicated by low drop-out rates of 2%. Results from repeated measures ANOVA for parent SRS and GEM ratings show significant effects of “Zirkus Empathico” compared to the control intervention on SRS total score, and SRS subscales social motivation, social cognition, and social communication at follow-up. In addition, significant effects were shown on GEM total score and GEM subscore affective empathy (all p < .05).


The findings indicate that ”Zirkus Empathico” has high acceptance among children with ASD and leads to improvements in social communication and behavior as well as empathy in affected children. Results of the completed trial as well as moderator analyses for sex, age, ASD symptom severity, and IQ will be reported at the conference.