Increasing Social Network Integration for Children with ASD Using the Summer Treatment Program

Background: Forming peer relationships is a key milestone in social development. This is often an area of difficulty for school-age children with autism spectrum disorder (ASD). Peer relationship challenges begin in early childhood and can persist into adolescence and adulthood. The Summer Treatment Program (STP) focuses on developing social and behavioral skills using a manualized curriculum in the context of a naturalistic day camp. It incorporates behavioral principles, sports training, and supported practice with peer relationships in a real-world setting.

Objectives: To examine the integration of children with ASD within social networks over a 5-week day camp using the STP.

Methods: The STP was conducted by the UW Autism Center for 5 weeks, Monday-Friday, 9:00am to 3:00pm. Programmatic elements included a detailed social skills curriculum, sports instruction, a token economy, and extensive training and fidelity procedures. Daily activities included common playground sports, board games, and recess games. The staff of 63 consisted of 5 doctoral level psychologists, 6 masters-level clinicians, and 52 undergraduate and graduate-level counselors. Children were divided into groups of 14 served by a team of 6 counselors, yielding a 1-to-3 staff-to-child ratio. Out of 124 children that participated during the summer of 2018, 48 children had a primary diagnosis of ASD (15 with ASD+ADHD, 45 with ADHD, and 16 with no diagnosis participated but were not included in these analyses). Children nominated a “Buddies List” each week, identifying other children they like to “hang out with” (following Cairns & Cairns, 1994). This information was used to map group social networks. This network data yielded an individual closeness score for each child, indicating the number of steps required to connect one child to each other child in the group, mathematically represented as the inverse of the number of steps required to access each vertex (individual) from a specific vertex within the network, normalized by the total number of vertices within a group. We hypothesized that children’s individual closeness scores within their social network would increase across the 5 weeks of the program.

Results: A model of change in closeness score was fit using a linear mixed effects model (using R package: nlme). The slope parameter was highly significant, finding that individual closeness scores increased by a rate of .003 per week from Week 1 to Week 5 (b = 0.003, SE = 0.0006), t(177) = 5.15, p < .0001). The slope model yielded the following equation for individual closeness: 0.041 + (.003*Week).

Conclusions: The STP focuses explicitly on building social and behavioral skills. This is the first study to examine individual closeness within social networks of children with ASD in the context of the STP program. Children with ASD increased in closeness within their social network over the course of the program, suggesting that the STP may foster social skills with a practical impact on a child’s ability to integrate within their social group. Future studies utilizing a comparison group and randomization are needed to determine the effect of STP on this important domain of child peer relationships.