Feasibility/Pilot Study of a School-Based Adaptive Intervention for Children with HFASD
The core deficits of students with high-functioning autism spectrum disorder (HFASD) negatively affect social and academic performance (Kasari et al., 2016). Problems with skill generalization from clinic-based interventions have prompted calls for development and testing of social skills interventions within school environments (Kasari et al., 2012; Kretzmann et al., 2015). Adaptive school-based social interventions may be a viable option for students with HFASD, as they can be tailored to the student’s needs, and the intensity can be adjusted based on treatment response (Reichow & Barton, 2014). However, no studies have examined the feasibility of a school-based adaptive social skills intervention for students with HFASD.
This study examined the feasibility and initial efficacy of an adaptive school-based social intervention for 1st through 5th grade students with HFASD.
Participants. Thirteen children, aged 6-11 years with HFASD, were included. Specific inclusion criteria were: (1) short form IQ >70 (one major index score >80); (2) expressive or receptive language score >75; and (3) diagnostic confirmation using an ASD diagnostic interview, screening measure, and/or clinical consensus.
Measures. Skillstreaming Knowledge Assessment (SKA); Adapted Skillstreaming Checklist (ASC); Social Responsiveness Scale, 2nd Ed., (SRS-2); Clinical Global Impression scale (CGI)
Procedures. After baseline testing, all participants received a low intensity social skills intervention (LI-SSI; 1x/30 min per week social skills group [SSG]) for 10 weeks. Following 10 weeks of LI-SSI, responders to the LI-SSI continued to receive the LI-SSI. Non-responders were randomly re-allocated to one of two intensified SSI conditions including a Moderate Intensity SSI (MI-SSI; 2x/30 min per week SSG) or a High Intensity SSI (HI-SSI; 2x/30 min per week SSG plus behavioral reinforcement system) for the remaining eight weeks of intervention. Rating scales, a global impairment rating of clinical progress, and child testing of social skills knowledge were completed pre- and post-treatment.
Feasibility was supported in high levels of treatment fidelity (SSG component >93%) and parent and SSG facilitator satisfaction. Satisfaction ratings averaged 61.5 out of 70 points for parents and 62.3 out of 70 points for SSG facilitators. Pre-post comparisons indicated a significant decrease in parent (SRS-2 p=.041, d=-.58) and teacher (SRS-2 p=.011, d=-.70) rated ASD symptoms, an increase in parent (ASC p=.002, d=1.05) and teacher (ASC p=.041, d=.59) rated social skills, and a decrease in parent (CGI p < .001, d=-1.22) and teacher (CGI p < .001, d =-1.49) global impairment ratings. Child testing showed an overall increase in number of social skills known (SKA p=.001, d=.91) and knowledge of the steps for the skills (SKA p=.002, d =.76)
Results suggest the intervention can be conducted with a high degree of fidelity, parents/school staff find it acceptable, and participation is associated with significant symptom and skills improvements. These findings are especially promising as the effect sizes on some of the parent, teacher, and child measures were large. However, the small sample limits the ability to test the adaptive component of the intervention. Future work using a fully-powered sequential, multiple assignment, randomized trial (SMART) design (Nahum-Shani et al., 2012) is needed.