Sustainable Social Gains after Completion of a Group Socialization Program for ASD: Confluence Among Parent Survey, Self-Report Survey, Peer Conversation, Social Impression Rating, and Real-World Social Metric Measures

Background: Social competence is the ability to understand, navigate, and adapt to unfolding social interactions in order to estabilsh and maintain age appropriate relationships. It is a complex, multi-faceted construct that cannot be easily quantified using a single measurement strategy. Therefore, adequately capturing the sometimes nebulous construct of social competence is best accomplished through a combination of complementary evaluative tools, each providing a unique contribution to our understanding of an individual’s interpersonal ability. Parent report measures provide endorsements based on repeated family interactions. Self-report tools offer valuable information about internal thought processes and social self-perceptual accuracy. Live conversations with peers provide data on effective skill use in an uncontrolled, dynamic exchange. Social impression ratings provide insight into peers' perception of one's social desirability. Finally, data on the real world social metrics (number of friendships and frequency of peer contact) provide information on the practical impact of learned competencies.

Objectives: The objective of the current investigation is to examine follow-up data collected 20 weeks after participants had completed the Social Tools And Rules for Teens (START) program for evidence of sustained social competence gains.

Methods: Participants consisted of 35 adolescents with ASD (ages 12-17) who enrolled in an RCT of the START program and were randomly assigned to treatment or waitlist groups. The START program is a 20-week experiential socialization intervention consisting of peer facilitators, free socialization periods, interactive topic discussions, structured social activities, and individual check-in and check-out sessions. At pre, post, and 20-week follow-up time points, participants and their parents completed a comprehensive set of social measures, including parent survey measures (Social Skills Improvement System, Social Responsiveness Scale-2, Social Motivation & Competency Scale), adolescent self-report measures (SSIS, SMCS), two video-recorded 5-minute conversations with untrained peers, and reports of real-world social metrics. Trained research assistants systematically coded all peer conversations for a variety of key social behaviors (i.e. questions asked, speaking/listening ratio, eye contact, facial expressions, engagement). Additionally, multiple peers provided a composite social impression rating after reviewing randomized participant videos.

Results: Repeated measure ANOVA procedures were used to compare pre, post, and follow-up data for all described measures. Participation in the START program was associated with significant increases across social competence measures from pre- to post-intervention time points (p-values < 0.01) with medium to large effect sizes. Across most measures, there were no significant differences between post- and follow-up data, which was reflective of sustainable social gains. Cases of significant post- to follow-up differences were actually due to continued improvements in social functioning even though START participation had ended.

Conclusions: In targeted efforts to improve the social competence of individuals with ASD, the sustainability and social validity of post-intervention gains are arguably the most important metrics of a program’s efficacy. Significant gains in social competence are irrelevant if they do not generalize to everyday peer interactions or persist after a program has concluded. The results of this START efficacy trial are indicative of sustainable, comprehensive social improvements reflected in a confluence of parent, peer, self-report, and observational social gains.