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Learning without Teaching: Social Performance-Based Intervention Promotes Gains in Social Knowledge in the Absence of Explicit Training for Youth with Autism Spectrum Disorder
Children with autism spectrum disorder (ASD) display deficits in social knowledge, including formal social knowledge, facial emotion recognition (FER) and theory of mind (ToM; Mendelson, Gates, & Lerner, 2016). Traditionally, it was presumed that individuals with ASD could not acquire such knowledge without explicit teaching. Subsequently, most social skills interventions (SSIs) have employed a didactic approach (White et al., 2007). Recent literature shows improvements in overall social functioning using so-called “performance-based SSIs” (e.g., Lerner & White, 2015), where skills are taught implicitly via activities designed to potentiate prosocial engagement. However, it is unknown whether youth with ASD learn explicit social knowledge through these non-didactic, performance-based approaches.
Objectives:
To determine if performance-based SSIs can impact social knowledge in youth with ASD without explicit instructions.
Methods:
Youth with ASD participated in a randomized controlled trial of two performance-based social skills interventions (see Table 1). Both interventions aimed to provide enriched environments for reinforcing peer interaction and targeted specific social skills goals with minimal didactic instruction or instrumental reinforcement of skills (Lerner & Levine, 2007). The modified Children’s Assertiveness Behavior Scale (CABS; Michelson & Wood, 1982; Wojnilower & Gross, 1988), and Test of Adolescent Social Skills Knowledge (TASSK; Laugeson & Frankel, 2006) assessed formal social knowledge. The Theory of Mind Inventory (ToMI; Hutchins, Prelock, & Bonazinga, 2012) assessed ToM and the Diagnostic Analysis of Nonverbal Accuracy (DANVA-2; Nowicki, 2004) assessed FER. All areas were assessed at baseline, endpoint, and 10-week follow up.
Results:
Generalized estimating equations (GEE; Hanley et al., 2003) were used to estimate effects of timepoints on change in dependent variables while accounting for nesting within groups (Table 1). There was a significant main effect of timepoint in CABS scores (Wald’s χ2= 6.56,p =.038) indicating that at endpoint youth had lower CABS scores than at baseline (Figure 1). There was a significant main effect of timepoint on TASSK scores (Wald’s χ2=10.31, p =.006) from endpoint to follow up. There was a significant main effect of timepoint on ToMI scores (Wald’s χ2=12.15, p<.001), evincing a linear increase over time. There was no effect of timepoint on DANVA-2 Faces (Wald’s χ2=1.69, p=.43).
Conclusions: This is the first study to examine the effects of performance-based SSIs on social knowledge in youth with ASD. Findings indicate that such SSIs may improve aspects of social knowledge (formal social knowledge and ToM) without explicit, didactic teaching of social knowledge content. This was seen in both conditions, despite the absence of explicit teaching, contrary to extant theory suggesting that this should not occur. In contrast to previous reports on intensive performance-based community-administered SSIs (Lerner et al., 2011), we did not see results for FER. Factors such as dosage or the specific approaches used may be essential for acquiring a less explicit, formal aspect of social knowledge such as FER. Overall, these findings support the principle that youth with ASD are able to acquire aspects of social knowledge without direct teaching, provided there is sufficient scaffolding of the social context and activities are properly matched to outcomes.