Latest research on socials skills interventions

Michelle Garcia Winner

While I have continued to review research since delving into what I ended up naming Social Thinking® in 1995, the last time I did a comprehensive research review, as it related to my ILAUGH model of Social Cognition, was in the year 2000. Ten years later it is exciting to see the trends in research as they are very much validating the clinical theories put forward in my early books (Inside Out: What Makes Persons with Social Cognitive Deficits Tick, 2000; Thinking About You Thinking About Me, 1st edition, 2002). One example of this is in 2002 I postulated that while the researchers are exploring the meaning and arguing to some degree the relevance of each of the core theories related to ASD, Theory of Mind, executive functioning and central coherence theory, I was observing my students had learning issues related to all three of these issues. It was not one problem, but many problems working in tandem. The research now shows that to be quite evident (Sodian & Frith, 2008; Pelicano, 2010)

As I finish writing a major new project that hopefully will be published in about a year, I’m doing an extensive review of the research. Three articles that have caught my attention relate to meta-analysis of social skills intervention research. A “meta-analysis” is an analysis of the published research to draw conclusions more holistically from the trends being discovered from studying the research results in mass, rather than focusing on the results of a singular study.

As I review the research I take bulleted quotes or summarize ideas from the research to help navigate my own summary for my writing project. This project will be, in part, steeped in exploring evidence based thinking and our development of related treatment practices.

There are three interesting articles that have been published on this topic in the last few years (White, Keonig &Scahill, 2007; Rao, Beidel & Murray, 2008; Reichow & Volkmar, 2010).

Some of the findings in Rao and Murray, 2008, are summarized by my description of the main points of the article as I reviewed it (some of the below are direct quotes and others are my interpretation of the text):

* Social skills in childhood linked to positive outcomes.
* Children who are deficient in social skills lack the behavioral repertoire necessary to interact with others according to social conventions; a deficit affects both academic and social development.
* Neurotypical preschool children can observe the social challenges of their peers who have social learning disabilities.
* Some of our students can have a strong awareness of their own social skills deficits.
* Our students don’t outgrow their challenges; they have them throughout adulthood.
* Most social skill programs are designed for a broader application to different types of students; few are specifically designed for students with ASD.
* Now that more children are fully included in regular education classrooms, they are more consistently exposed to social pressures and demands than their lower functioning counterparts (those who have ASD, but are lower functioning according to cognitive and language development). Thus, despite the small literature base on this topic, a thoughtful examination of the efficacy of social skills trainings is warranted at this juncture, particularly for this higher functioning population.
* Studies don’t control for poor motivation… there is not a common definition of social skills. While certain skills appear to be universally included in social skills curriculum (greeting, initiation of conversations...), others appear to be more idiosyncratic and often represent complex behavior patterns (problem solving, self-control/self-regulation). The lack of agreed upon group of behaviors considered within the domain of social skills teachings represents challenges for the scientific literature.
* Few groups use design to control for maturational development over time. Most data (behavioral) doesn’t show strong ability for our students to generalize what they are learning.
* Most social skills studies don’t look at follow up to see stabilization of skills learned over time, if they do explore generalization. The only way to study this is through exploring treatment efficacy through single subject design..

Similarly, I reviewed and summarized in bullet points the findings of the meta-analysis by White, Keonig and Scahill, 2007 (some of the below are direct quotes and others are my interpretation of the text):

* For students with ASD, impairment and distress may increase as children approach adolescence because the social milieu becomes more complex and the child becomes more aware of their social disability.
* Our students with ASD’s social skill deficits are not due to lack of social interest.
* With the increased recognition of ASD (as including those who are brighter and have reasonable language skills), there is a greater emphasis on inclusion in regular classroom. Clinicians are increasingly called upon to enhance working with students to decrease social deficits of school age children and adolescents with ASD.
* Lack of carryover / generalization is noted in the studies they reviewed.
* The SSRS (Social Skills Rating System) was not designed for ASD, but instead for neurotypicals. The SSRS measures broad-based behaviors associated with developing social skills but does not assess the nuances of behavior associated with social reciprocity that are lacking in children with autism. Hence, using the SSRS as a pre and post measure is not sensitive enough to measure some of our students with ASD social learning/changes.
* There are no clinician rating scales for kids with ASD.
* Discrepancies between private practice clinician diagnosis of ASD and school eligibility are common.
* In studying and researching social skills teachings, given the variability in expression of ASD across children, investigators need to consider other variables (e.g., level of cognitive functioning) in case ascertainment and group assignment to ensure the group assignment is well balanced and random for research.

The most recent study by Reichow and Volkmar, 2010, did a deeper analysis of a select group of studies to explore the effectiveness of different social skills teaching methods between the years of 2001 and 2008. This article specifically explored social skill treatments for preschool, school aged and adolescent/adult students with ASA. They also explored different treatment techniques (ABA and teaching social competencies, video modeling, peer mentoring, parent training and visuals [e.g. social stories, scripts, written plans]).

Overall, they found in the last decade we have actively begun to study social skill interventions, but we still have far to go. While social skill deficits are the hallmark of autism spectrum disorders, the diagnostic traits of autism are better studied than social skills and related treatments that underpin this diagnosis. With regards to preschool and the adolescent group, they found there is not enough research to support determining effective treatments for this group. They also found there are no studies to distinguish or support which treatments should, or could be used for those with higher functioning cognition versus those with lower cognitive skills. Peer mentoring and all of the treatment types listed above appear to have some positive impact. ABA and social competency teaching have strong evidence for school age students. Video modeling, using visual cues, peer mentoring and parent training also have positive impact, but are not well studied and most of these may be used as supplements but do not serve as the entire teaching process. Overall, when reviewing this analysis, the final word is, what is actually to be taught related to social skills, and how exactly to teach it for different age groups and cognitive levels, has yet to be well defined.

My own thoughts on all these studies of studies…

As we strive to determine what teaching strategies work most effectively for the very heterogeneous group we are now calling ASD (Autism Spectrum Disorders) and like disabilities (ADHD, NVLD, etc.), a student’s language and cognition matter!

It is also important to recognize that each of us who are born to somewhat “neurotypical social skills” are also masterful judges of social behavior as young as preschool aged children. This means that we define social expectations for how those behave around us. However, I also contend, when we can determine that a person is born to less than strong social skills (i.e., they are obviously impaired socially), the peer group is more forgiving of their awkward and odd social presence all the way through adulthood. However, socially neurotypical folks are not so forgiving of folks social missteps when they can’t easily determine that their brain’s weak social processing is leading to these missteps. Hence, those who appear to be pretty “neurotypical looking” (i.e., look pretty normal) but make a significant number of social errors, will not be as forgiven by their peers. Instead, they will be held accountable to each social mistake. This means not only does language and cognition matter, but the level of social nuance matters! We need to teach more nuance based social skills to those who are expected to function with more socially nuanced based expectations. In conclusion, I believe we do need different types of social teachings for those with different types of social skill related challenges, and related peer expectations. In my world, there is no such thing as having “mild social skill problems”; if someone has determined you have any level of social skill problems, this can cause rejection, unemployment and related mental health challenges.

As we also look at the above social skills studies, I found they are limited in what they describe as their definitions of “social skills”. Not a single study or meta-analysis has included in their definition the subtle shifts in physical presence as relating to our social skills. When you look at those with good social skills in contrast to those with weak social skill development, you are likely to observe a distinct difference in how they relate from a communicative perspective through their physical stance, posture, etc.

Finally, while this research is revealing of some of the many challenges in teaching and measuring social skills as we think of them broadly in our community, they don’t account for the fact that social skills (or lack of) for our students with higher levels of social awareness, but still have weak social skill performance end up with significantly greater mental health challenges. Hence, when we study social skill teachings we have to account for how one’s mental health is at risk for becoming even more challenged as they study their own weaknesses to help them eventually improve in this area. From my experience, highly depressed or anxious students present with even less social competencies, given that depression/anxiety throws up a big stop sign as they try to access their social knowledge and related social skills. Remember, the only reason we produce our social skills is to impact how others think and feel about us. Our social skills lead to emotional reactions; it is difficult to study one without studying the other for our highest functioning/highest challenged clients/students.

This means, in summary, we have to keep exploring how to teach social skills by exploring how to decide which types of social skills/social learning challenges demand different levels of social teachings… and how do we measure social skill progress when mental health problems may become temporary or lifelong barriers to social success? It may be impossible to study one without studying the other in tandem!

Pelicano, E. (2010) Individual Differences in Executive Function and Central Coherence Predict Developmental Changes in Theory of Mind in Autism. Developmental Psychology. Vol. 46, No. 2, 530-544.

Rao, P., Beidel, D. and Murray, M. (2008) Social Skills Interventions for Children with Asperger Syndrome or High Functioning Autism: A review and recommendations. Journal of Autism and Developmental Disorders, 38, 353-361.

Reichow, B. and Volkmar, F. (2010) Social Skill Interventions for Individuals with Autism: Evaluation for Evidence-Based Practices within a Best Evidence Synthesis Framework. Journal of Autism and Developmental Disorders. 40: 149-166.

Sodian, B. & Frith, U. (2008) Metacognition, Theory of Mind, and Self-Control: The Relevance of High-Level Cognitive Processes in Development, Neuroscience, and Education. Journal Compilation, International Mind, Brain and Education Society and Wiley Periodicals. Volume 2-Number 3.

White, S., Keonig, K. and Scahill, L. (2007) Social Skill Development in Children with Autism Spectrum Disorder: A review of intervention research. Journal of Autism and Developmental Disorders. 37: 1858-1868.

Courtesy of Social Thinking

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