Online but Live and Interactive Social Skills Intervention

Background:

Addressing core social communication deficits of autism is a universally recommended intervention, but group social skills interventions have not been universally available, particularly in rural or otherwise underserved areas. With increasing availability of Internet service, delivery of telehealth and online services for autism is also increasing. Using an electronic format for social skills instruction has been available in static (learning module) formats, but has not yet been studied in a live, interactive format using a manualized curriculum for in-person group intervention.

Objectives:

This study developed feasible methods for adapting an evidence-based, in-person curriculum to an online, live, interactive format. Once developed, online and in-person delivery of the curriculum were compared in terms of ease, generalization effects, participation rates, and spontaneous conversation generated during sessions.

Methods:

Participants included some typical peers and adolescents (n=17, with n=35 projected), ages 12-16, with existing or pending autism diagnoses. Some parents (n=4) had immigrated to the USA, meaning participants lived in bilingual homes. Inclusionary criteria were language and cognitive abilities consistent with <3 years delay in academics and ability to function independently in group environments. Autism symptoms were verified by Autism Diagnostic Observation Schedule (ADOS-2), Social Communication Questionnaire, and Social Responsiveness Scales (SRS-2). Cognitive and verbal abilities were verified using standardized IQ measures. In-person participants required weekly transportation to the university. Online participants required Internet access and computers with videocameras and microphones. Settings were a large private university (in-person group and generalization probes for both groups) and online (HIPAA-compliant Zoom platform). Protocols for navigating the online environment and rules specific to that environment were developed and distributed. A tech demo teleconference visit was held with families prior to starting online sessions. Curriculum in both delivery models (in-person and online) was the PEERS® Treatment Manual (Laugeson & Frankel, 2010), delivered for 14 weeks, then in-person participants attended 3 generalization probes in age-appropriate activity settings (e.g., going to a museum, out for fast food, and bowling) on campus. Online participants met together on campus on two occasions for generalization probe activities. Parent sessions were held simultaneously for in-person groups, successively for online groups. Measures of effectiveness included direct observation of social engagement during group sessions, pre- and post-intervention parent social skills questionnaires (SRS-2 and Autism Social Skills Profile), and direct observation of social engagement during generalization probes.

Results:

Participants were able to effectively access the online or in-person sessions with only occasional disruption. All elements of the PEERS® curriculum were adapted for online participation, including some games (e.g., Jeopardy!, Battleship, Pictionary, etc.) and token systems for participation were rewarded in both environments. Social engagement in both groups increased over time, with the online group showing increased participation in breakout rooms versus the larger group. Generalization probes showed spontaneous conversation rates maintained in activities outside of group sessions, consistent with parent report of increased conversation skills.

Conclusions:

Online delivery of a manualized social skills intervention may not be ideal, but can be effective for families who cannot otherwise access groups because of geographical isolation or other barriers.