Social Game Interactivity Levels As Active Ingredients in Performance-Based Intervention for Adolescents with Autism Spectrum Disorder (ASD)

Background: Adolescents with autism spectrum disorder (ASD) have core social deficits that make peer interactions challenging (Picci & Scherf, 2014). Research suggests that non-didactic interventions using intrinsically engaging structured social activities to promote peer interaction (performance-based interventions) may be effective in improving social skills and peer interactions for adolescents with ASD (Corbett, et al., 2017; Lerner et al., 2011). Structured social activities (social games) have also been shown to promote spontaneous in vivo peer interactions (Dolan et al., 2016; LeGoff et al., 2006). Social game structures include various interactive components, such as one-to-one or group formats, verbal and/or non-verbal imitation and communication, and physical activity (Guli et al., 2013). Thus, those containing more components require more interactivity – levels of which are a plausible “active ingredient” in such interventions. However, little research has examined such ingredients in performance-based interventions (Lerner et al., 2012), and none has examined relative levels of interactivity in social games as one that may potentiate spontaneous in vivo peer interaction.

Objectives: This study aimed to assess the differential efficacy of levels of interactivity in three social games for eliciting spontaneous peer interactions. We hypothesized social games with higher interactivity levels would elicit more in vivo spontaneous peer interactions.

Methods: 25 adolescents (M_age= 14.98, SD_age= 1.48, 19 male) with confirmed ASD diagnoses (ADOS-2; Lord et al., 2012) completed a performance-based social skills intervention, Socio-Dramatic Affective-Relational Intervention (SDARI; Lerner et al., 2011). Participants were placed in groups of 5-9 and met for ninety-minute sessions once per week for ten weeks where they engaged in targeted social activities (Lerner & Levine, 2007). Groups were video recorded and multiple blinded raters reliably coded participation in three core SDARI activities (ICC = 0.71; 134 observations): Mirror, Round of Applause, and Walkabout (see Table 1). A separate team of blinded raters reliably coded peer interactions (SIOS; Bauminger, 2002; ICC = 0.79; 440 observations) during a thirty-minute free-time immediately after the activities. Hierarchical linear modeling analysis (Level 1: within-person between-session; Level 2: between person) were used to examine session-level relations between activity participation and peer interaction.

Results: Increased participation in Walkabout (i.e., high interactivity) significantly predicted increased observer-rated peer interaction (β = 5.23; p = 0.001). However, increased participation in Mirror (i.e., low interactivity) significantly attenuated peer interaction (β = -4.29; p = 0.032). Round of Applause (i.e., medium interactivity) had no effect on peer interactions (p = 0.29; see Figure 1).

Conclusions: These results suggest participation in social games with different levels of interactivity elicit varied amounts of spontaneous in vivo peer interactions. These results suggest a linear, bimodal relation between social game activity level and immediately subsequent peer interactions, such that low levels of interactivity may actually exert an iatrogenic effect. This likewise suggests the possibility of an interactivity threshold effect, wherein a certain level of interactivity may be required to elicit spontaneous peer interactions. These findings may help explain the heterogeneity in outcomes of social interventions (Gates et al., 2017), and provide guidance to increase their efficacy.