Improving the Social Interactions and Peer Perceptions of Adolescents with ASD: Results from a Randomized Clinical Trial of the START Socialization Program

Background: Social skill programs for adolescents with ASD rarely use live, real-world peer interactions as an outcome measure when these interactions are arguably the most important and socially valid evidence for meaningful socialization improvements. Instead, parent and self-report survey measures and structured social assessments are commonly used instruments to measure social skill gains (Miller et al., 2014). However, these tools may have limited value without converging evidence of real-world social improvements (Cunningham, 2012). Specifically, when these adolescents interact with similarly aged social partners, how are they perceived? Do they use the verbal and non-verbal skills that are generally associated with social competence? To date, no studies have examined if third party, untrained observers perceive social competence improvements in live peer interactions after completing a randomized clinical trial (RCT) of a social skills program.

Objectives: The current study evaluated the efficacy of an RCT of the Social Tools And Rules for Teens (START) program through directly observing and coding social skill use and obtaining peer perceptions of social ability based on brief video-recorded conversations.

Methods: Thirty-five adolescents (ages 12-17) and their parents participated in the RCT of the START program, which is a 20-week experiential social competence and motivation intervention. At pre- and post-intervention, adolescents engaged in 5-minute dyadic conversations with two unfamiliar, typically developing peers (one male and one female). Video-recorded conversations were coded for various social skills (i.e. questions asked, mutual engagement, speaking contributions, eye contact, listening behaviors, and positive facial expressions). Two video coders coded each behavior and reliability was established for 30% of the videos. The video-recorded conversations were also shown to peer observers (unknown to participants and blind to study objectives), who rated participants along several social domains (i.e. social skills, comfort during the interaction, awkwardness during the interaction, and perceived quality of existing relationships). Videos were counterbalanced to ensure that the pre-intervention video was not always viewed before the post-intervention video. Every participant video was rated five times by different raters to ensure consistency of ratings.

Results: Two-way mixed ANOVAs were performed to examine differences between the treatment and waitlist groups on video-coded social skills and peer perceptions of social ability across time. Results revealed significant improvements for adolescents who participated in the START program in the following social skills: questions asked (p = .035; medium-large effect), eye contact (p = .003; large effect), listening behaviors (p = <.001; large effect), and positive facial expressions (p = .009; large effect). Compared to a waitlist control group, adolescents who participated in the START program also demonstrated significant improvements peer perceptions of social ability made by observers unfamiliar with the study (p = <.001; large effect).

Conclusions: The START program resulted in significant gains in the adolescents’ use of specific social skills, which in turn increased peer perceptions of their social competence. This is particularly promising, given that the social strategies one utilizes dictates how favorably one is perceived as a potential conversation partner and sets the foundation for building successful social connections and relationships.