Adolescents with Autism Spectrum Disorder and Social Skills Groups at School: A Randomized Trial Comparing Intervention Approach and Peer Composition
Social relationships become increasingly complex during adolescence (Rodkin & Ryan, 2012). Adolescents with autism report having poorer peer relationships, including fewer friends, and less satisfying companionship with their friends compared to typically developing adolescents of the same age (Bauminger & Kasari, 2000). Within general education settings these students report fewer reciprocal friendships (Chamberlain, Kasari & Rotheram-Fuller, 2007), greater loneliness at school (Bauminger & Kasari, 2000), and poorer friendship quality (Bauminger & Kasari, 2000; Chamberlain et al, 2007; Locke et al, 2010) than their classmates. Studies that examine social skills interventions for adolescents with autism generally take place in clinic settings (Laugeson et al., 2014; White, et al., 2013). In the current study, we examined the efficacy of implementing social skills interventions for adolescents with autism at school.
The purpose of this study was to test the effectiveness of two distinct models of social skills group interventions (SKILLS and ENGAGE) with an ethnically and economically diverse group of school age adolescents with autism.
We used a randomized controlled multi-site study to compare two different school-based social skills interventions for adolescents with autism. Sixty-one adolescents (ages 13-17) with autism without cognitive impairment participated in the study. Participants were ethnically diverse (Black = 8%, white = 43%, Hispanic = 9%, Asian = 21%, and other or mixed = 14%), and were educated in secondary school general education classrooms. After meeting eligibility criteria, participants were randomized to either a SKILLS or an ENGAGE condition. All group members in the SKILLS condition had a diagnosis of autism. The ENGAGE condition was peer-mediated, and the group consisted of adolescents with autism and typically developing adolescents. Data were collected prior to the start of the intervention, at the end of the intervention, and at fourteen weeks later. Groups met one time a week for eight weeks during lunch or afterschool. Peer engagement states (Joint Engagement, Parallel, and Solitary) were the primary outcome variables.
We used a linear mixed model with random effects for each participant, and main effects for time, site, treatment, race and a three-way interaction of time-by-treatment-by-race. We found differences approaching significance in Joint Engagement during unstructured times, indicating that the SKILLS intervention increased the Joint Engagement of Caucasian participants, but decreased Joint Engagement in Asian participants (p-value=0.06). There was a significant interaction of treatment by time by race interaction (p-value=0.02, chi-square (4)=12.24). The ENGAGE intervention was effective in raising Parallel for both Caucasian and Asian students, but it seemed to have a negative effect for the other racial groups. Similar effects were identified in Solitary engagement. There was a difference of treatment over time by racial group controlling for site (p-value=0.006). Non-white or Asian decreased their Solitary engagement more than Caucasian or Asian participants.
Results support the efficacy of social skills interventions for adolescents with autism at school. However, findings highlight the heterogeneity existing within populations of students with autism in ethnically diverse schools. More research is needed to examine cultural factors that influence participant responsiveness to intervention.