Fifteen Years of Social Skills Group Training "Kontakt"© - Heading for Precision Support, Dosage Optimization and Long-Term Follow-up

Background: KONTAKT^(c) is a manualized social skills group program for children and adolescents with ASD aged 8-17 years in the normative IQ range. It uses principles of cognitive behavior therapy, psychoeducation, behavioral activation, cognitive training, and observational learning to increase social communication skills, conflict management and prevention, coping strategies, self-confidence, and daily functional skills. The teaching formats include individual goal identification, group discussions and activities, social and role-play, emotion-processing training, and homework assignments based on functional analysis.

Objectives: To summarize quantitative and qualitative research on KONTAKT from the last 15 years across three countries (Germany, Sweden, Australia), current analyses on genetic and psychiatric comorbidity moderators of the effects of training, and planned register-based long-term follow-up of study participants.

Methods: Two pilot studies in Sweden and Germany were conducted, followed by largest (pragmatic) randomized controlled trial (RCT) in ASD ever on 12 and 24 sessions of KONTAKT against standard care across 13 centers [NCT01854346] (n=296 [12 sessions], n=50 [24 sessions]) in Sweden. Saliva samples were collected from the RCT participants for Copy Number Variations (CNV) analyses . A qualitative responder analysis was also carried-out. Subgroup analyses were conducted for KONTAKTs efficacy in children, adolescents, girls and boys. Further, the potential effects of other mediators and moderators were examined, such as IQ, language level, medication, and psychiatric comorbidity.

Results: The RCT showed that effect sizes for social communication and adaptive functioning improvement were large for participants in the 24-session program (d=0.76-0.82) and moderate for female and adolescent participants in the 12-session program (d =0.33-0.40). Aside of age and sex, participant characteristics that were associated with KONTAKT's efficacy were psychiatric comorbidity and the size of CNVs: Clients with additional anxious-depressed symptoms responded better to KONTAKT, while those carrying large CNVs responded poorer. Extensive qualitative studies of KONTAKT showed a multitude of individual progress not covered by the outcome measures used in the RCT, indicating benefits even in quantitative “non-responders”.

Conclusions: These results indicate, for the first time, a substantial dose-response effect for social skills group training in autism, which implies that service providers can reach better results by optimizing the length of intervention. Importantly, we found that age, sex, psychiatric comorbidity, and genomic variation impact on KONTAKT effects, endorsing that personalized training decisions might be meaningful.