Beyond intervention into daily life: A systematic review of generalisation following social communication interventions for young children with autism

Abstract

Researchers have generally considered autistic individuals to have difficulties generalising learned skills across novel contexts. Successful generalisation is necessary for an intervention to have benefits in everyday life beyond the original learning environment. We conducted a systematic review of randomised controlled trials of early social communication interventions for children with autism in order to explore generalisation and its measurement. We identified nine RCTs that provided evidence of initial target learning and measured generalisation, of which eight demonstrated at least some successful generalisation across people, settings, and/or activities. The findings did not support the widely reported generalisation 'difficulties' associated with autism. However, generalisation was not consistent across all skills within studies, and one study found no generalisation despite evidence for initial target learning within the intervention context. In general, there are few methodologically sound social communication intervention studies exploring generalisation in autism and no consensus on how it should be measured. In particular, failure to demonstrate initial learning of target skills within the intervention setting and an absence of formal mediation analyses of the hypothesised mechanisms limit current research. We outline a framework within which measurement of generalisation can be considered for use in future trials. To maximise the effectiveness of interventions, the field needs to gain a better understanding of the nature of generalisation among autistic individuals and what additional strategies may further enhance learning. Autism Res 2020, 13: 506-522. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: It is generally considered that autistic individuals experience difficulties applying things they have learned in one context into different settings (e.g. from school to home). This is important to consider for intervention studies. Our review does not support a complete lack of generalisation but instead suggests that after early social communication intervention, autistic children can transfer some skills to new contexts. Overall, there is limited research in this area and further work is needed.

Keywords: autism; generalization; intervention research; learning; skill learning; social communication.

Figure 1

Schematics representing potential scenarios regarding initial learning and generalisation in interventions: the implied route of generalisation in interventions (A); problems with generalisation given successful initial target learning (B); poor initial learning of the target skill within the original intervention setting and therefore a knock on absence of generalisation (C); and presence of target skills in the generalised context despite no improvement of the target skills within the original intervention context (D).

Figure 2

The PRISMA flow chart of study selection. *Inclusion of measures of initial target learning was assessed first and was excluded if they did not include one. These studies may or may not have included generalisation measures.