Social skills group training in children with autism spectrum disorder: a randomized controlled trial

Abstract

In 122 high-functioning children with autism spectrum disorder (ASD; 9-13 years; 19 girls), we investigated the effectiveness of a 15-session social skills group training (SST) with and without parent and teacher involvement (PTI) in a randomized controlled trial with three conditions: SST (n = 47), SST-PTI (n = 51), and care-as-usual (CAU, n = 24). Hierarchical linear modeling was used for immediate and 6-month follow-up analyses. Measures were administered before randomization (blind), post-treatment and at follow-up (not blind). Trial registration: Dutch Trial Register; http://www.trialregister.nl ; NTR2405. At post-treatment, children in both SSTs had improved significantly more than CAU on the primary outcome, Vineland Socialization (SST: Cohen's d = 0.39; 95% CI - 2.23 to 3.11 and SST-PTI: d = 0.43; 95% CI - 2.19 to 3.15) and on the secondary outcome parent-SSRS "Cooperation" (SST: d = 0.43; 95% CI - 0.23 to 1.15 and SST-PTI: d = 0.45; 95% CI - 0.21 to 1.17), with no difference between post-treatment and follow-up. Additionally, children in SST-PTI improved significantly more on the teacher-SSRS than in CAU ["Cooperation" d =0.42 (95% CI - 0.33 to 1.13); "Assertion" d =0.34 (95% CI - 0.39 to 1.11); "Self-Control" d =0.61 (95% CI - 0.08 to 1.34)] and in SST ["Cooperation" d =0.34 (95% CI - 0.37 to 1.05); "Self-Control" d =0.59 (95% CI - 0.13 to 1.32)]. The current study corroborates earlier findings in smaller samples and wider age ranges, with small but statistically significant effects of SST for high-functioning pre-adolescent children with ASD. Parental and teacher involvement intensified treatment, yet did not yield an additional effect relative to SST for children only, as reported by parents. 6 months after training, no further improvement or decline was found.

Keywords: Autism spectrum disorder; Effectiveness; Randomized controlled trial; Social skills training.

Fig. 1

CONSORT diagram of study recruitment, treatment allocation, and assessment. ^aTwo children participated in less than half of the child sessions; ^btwo children participated in less than half of the child sessions, two parents participated in less than half of the parent sessions (one from the same family as one of the children who participated in less than half of the child sessions), one teacher did not participate

Fig. 2

Expected mean per time point and per condition, as based on the fixed part of the multilevel models of the measurements for parents and teachers. Parents: effect sizes in the figures represent significant changes in the specified condition (by symbol), compared to CAU. Significant effect sizes were only present for the comparison between T1 and T2. Teachers: effect sizes in the figures represent significant changes in the social skills training with parent and teacher involvement, compared to CAU (diamond) or compared to SST (square). Each measure is presented in a separate panel. For parent measures: a Vineland Socialization; b ESTIATS; c SSRS-P Cooperation; d SSRS-P Assertion; e SSRS-P Self-Control; f SSRS-P Responsibility. For teacher measures: g SSRS-T Cooperation; h SSRS-T Assertion; i SSRS-T Self-Control