Objective Measurement of Initiations to Peers Following Behavioral Social Skills Treatment

Background: Studies of children with Autism Spectrum Disorder (ASD) have repeatedly documented low rates of initiations especially to peers, even among children without intellectual disability. Young children typically start peer interactions either 1) by making requests or 2) by initiating to share a social experience. Children with ASD often struggle with both types of initiations. Given that requesting often results in greater tangible reinforcement in natural environments, it is hypothesized that systematic teaching of requesting could motivate children to initiate for social purposes (i.e., sharing social experiences).

Objectives: This presentation reviews data from a randomized controlled trial of a social group intervention aimed at motivating children with ASD to initiate by systematically teaching and reinforcing requesting. Video recorded observations of free play with peers are used to evaluate changes in initiation frequency and type.

Methods: Participants included 44 children with ASD from 4-6 years old. Participants were randomly assigned to the Social Initiation Motivation Intervention (SIMI; n=22) or control group (n=22). Participants in the SIMI condition received 8 weekly 75-minute social group sessions with typically-developing peers, during which therapists arranged cooperative activities to teach and reinforce initiations to request items from peers. Participants in the control group continued stable community-based services. Trained raters blinded to treatment assignment and time point scored video recordings of free play with peers. Frequency of requests to peers were recorded and provided evidence of progress with skills directly targeted in treatment, while frequency of joint attention and social interaction initiations provided evidence of generalization to other initiation types.

Results: Following the 8-week treatment, children in the SIMI intervention showed enhanced motivation to initiate to peers. Not only did they show greater improvement than controls in initiating to make requests during videotaped free play interactions (p = 0.029), they also showed greater generalization to other types of spontaneous social initiations compared to controls (p = 0.007). Results also indicated greater improvement on measures of global social functioning, including the Clinical Global Impressions-Improvement Scale (CGI-I; p=0.026) and Vineland-II Socialization scale (p=0.049).

Conclusions: Findings suggest that behavioral treatment focused on teaching initiations shows promise for enhancing social motivation in children with ASD and improving broader aspects of social functioning. Objective rating of treatment response and generalization can be obtained from review of video recorded interactions with peers. Implications for design of effective inclusive social skills programming and remediation of core social deficits in ASD will be discussed.