Social skills training with autism in secondary classroom

Introduction
Individuals with autism spectrum disorders (ASD) usually have a difficulty relating socially to others. The social difficulties they face are among the major symptoms of ASD. Persons with ASD who do not show considerable language or cognitive delays e.g. individuals diagnosed with high functioning autism or Asperger syndrome, usually make significant progress when put through certain interventions. Significant progress to the extent that they improve in terms of communication. However, even with interventions, social difficulties usually remain and may sometimes end up impacting the vocational or academic success of such individuals later in life. Even individuals with autism who have higher or average intelligence usually find it difficult to overcome social difficulties and to communicate in a manner that observes all the unwritten rules of conversation and social interactions (Radley, O’Handley & Sabey, 2017). For example, an individual diagnosed with autism spectrum disorders may not always say the right thing or the most appropriate thing for a specific situation. They may also not know how to observe turn-taking in conversations, how to be brief and clear, and what information to leave out in some instances. Sometimes individuals with ASD also experience difficulties finding what topics to share with whom and how to maintain such topics like other people without the condition normally would.
Background
Social skills educators are at times surprised by how learners can sometimes perfectly show or demonstrate a skill in class or during a practice class and then fail to apply the same skill to a real-life scenario. In education circles, the term generalization is often used. It is usually used to show when a person’s behavior or response is produced in scenarios where it is actually not directly instructed/ or taught. This is a very common experience among social skill educators. It is an experience that also seems to negatively affect social skills instruction (Radley et al., 2017). Addressing this requires a thorough look at how social skills are taught and adjusting the curriculum to make generalization much more likely.
It is usually difficult for young people diagnosed with autism to develop and utilize social skills. According to Shindorf (2016), social skills include all elements of understanding, behavior, and communication that are important for effective social interactions. It is crucial to take cognizance of the complexity of social skills and how they are difficult even for individuals without ASD to master. For individuals with ASD, especially those who have high functioning ASD can master some social skills but usually find it difficult to interact in social situations. They usually also have difficulties with social comprehension. Persons with autism spectrum disorders usually have difficulties interacting in social situations resulting in fewer friends, minimal interactions with others, poor satisfaction with friends, and loneliness (Stichter et. al., 2010). Therefore, it is often quite difficult for them to maintain relationships with their teachers, family members, and peers.
A number of social skills interventions exist that can help to address the social difficulties experienced by persons with ASD. Considering the complexity of social skills, most social skills interventions have specific components that address various social challenges. A good example of a social skill intervention for people with ASD is the SCIP (Social Communication Intervention Project). SCIP has been successfully utilized to improve learning skills, social communication, pragmatic functioning, and conversational competence over the years (Adams et al., 2012). The EBSST (Emotional-Based Social Skills Training) intervention is also a good intervention. It has been shown to boost emotional competence significantly. The SCI (Social Competence Intervention) is also great social skills intervention for people with ASD. It has been proven to boost executive functioning, to improve social abilities, and to enhance problem solving in young people with autism spectrum disorders.
There are also interventions that are framework-based e.g. the SST (Social Skills Training) intervention (Shindorf, 2016). Such framework-based interventions take into account theoretical strategies and perspectives to provide even more effective treatment. Garcia Winner’s Social Thinking intervention is also a good example of a framework-based intervention (Winner & Crooke, 2009), and so is the YETI (Youth Engagement Through Intervention) program.
Study objective
The objective of this present study is to develop a group intervention for social skills training for youths with autism in a high school setting.
Literature review
Social Skills
Social skills include all elements of understanding, behavior, and communication that are important for effective social interactions. Young people with autism spectrum disorders usually face social difficulties because of poor social skills (Shindorf, 2016). However, it is difficult to improve the social skills of persons with autism because of their condition and because of how complex social skills and abilities are. The diversity of social skills also make them difficult to teach and to master for young people with ASD.
Evidenced-Based Practices in Social Skills Interventions
The American Psychological Association (APA) has for many years now been advocating for the use of evidence-based practices. Evidence-based practices are those that require professionals to seek and take into account the latest and most authoritative research and combine it with their special expertise to offer patients quality treatment that also considers the patient’s preferences, culture, characteristic, and circumstances (APA, 2006).
The theoretical basis for utilizing evidence-based practices was initially meant for research in health service (Ubbink, Guyatt & Vermeulen, 2013). Thus, to take into account a theory or evidence to utilize for an evidence-based practice, there must be the consideration of various research evidence to make sure that the theory or evidence or practice is really regarded to be evidence-based. The types of research that are considered include meta-analyses, efficacy research studies, effectiveness research concerning interventions, process-outcome studies, ethnographic studies, public health studies, single-case experimental studies, systematic case studies, qualitative research studies, and clinical observations (APA, 2006).
In short, the APA requires the consideration of rigorous research studies to establish evidence as well as the use of professional knowledge when providing treatment to patients. This is evidence-based practice according to APA. Thus, this paper also regards a similar use of evidence to find research-supported interventions for autistic youth with social difficulties to be the best practice or approach to dealing with the social challenges. Even though there exist many research-supported interventions for youths with social difficulties, the following will be the focus of this project: positive behavior supports, differential reinforcement, social narratives, video modeling, and visual schedules.
Social Skills Interventions
Generally, social skills programs or interventions are those that are specifically design to help young people improve their social abilities and social interactions via the utilization of learning and behavioral strategies. Young people with ASD who have poor social skills usually struggle during conversations and social interactions. This makes it difficult for them to maintain relationships with their family members, peers, and teachers. Social skills interventions are meant to help such young people to improve their cognitive, communication, and behavioral skills (Hutchins et al., 2019). Since social skills are diverse and complex, the interventions are usually designed in such a manner that they include various elements to deal with specific aspects of social skills. Some of the aspects that social interventions may have components that specifically target include social competence, socio-emotional skills, and social communication.
Considering how complex social difficulties are, there is no one way to implement interventions. This means that some interventions are more effective is they are provided to individuals rather than group settings. Because for the individual, they can be adjusted and provided in the manner that they are most effective. Moreover, some professionals prefer taking a framework-based approach to interventions while others prefer following curriculums. That said, most social skills interventions currently in use help improve social communication and its elements including social cognition, social interaction, and language expression (Shindorf, 2016).
A good example of an intervention which helps improve social communication is the SCIP (Social Communication Intervention Project) (Adams et. al., 2011). The Social Communication Intervention Project is an intervention that focuses on helped young people in school to enhance their social interactions, social cue understanding, and their semantics and pragmatics of language (Adams et al., 2012). The intervention has an individual approach in that it includes writing plans for individual young people to help them improve their social communication. It also utilizes various strategies to deal with various needs. Several randomized controlled trials have proven that SCIP is effective particularly in improving social communication, pragmatic functioning, classroom learning skill, and conversational competence (Adams et al., 2012). The Pre-linguistic Milieu Teaching (PMT) is also a very similar intervention to SCIP. It utilizes multiple strategies to improve social communication (Warren et al., 1993).
In addition to social skills interventions that help improve social communication there are many that focus on or help improve social-emotional learning. These interventions usually apply a cognitive behavioral approach. A cognitive behavioral approach is one that is collaborative and involves the setting of goals. The goals are usually achieved through analyzing how a client’s behaviors, feelings, and thoughts relate with each other. The interventions, therefore, usually involve the utilization of goals to help children identify, understand, and regulate their emotions so as to improve their attitudes towards others and themselves (Shah, 2012). Examples of interventions that help improve social emotional learning include Emotional-Based Social Skills Training (EBSST) which is an intervention specifically designed to help children with autism spectrum disorders (Ratcliffe et. al., 2014).
The EBSST intervention is based on emotional intelligence and development theories and it focuses on teaching children to understand emotions. It also focuses on teaching children emotional regulation and emotional problem solving skills (Ratcliffe et. al., 2014). Research has proven that EBSST brings about significant improvement in emotional competence. Improvement which can be maintained over several months (Ratcliffe et. al., 2014). A number of several other interventions that focus on social emotional improvement have also resulted in positive outcomes in the development of social skills for young people with autistic spectrum disorders. The positive outcomes include academic success, less emotional disturbance, less behavioral issues, and positive social behavior (Shah, 2012).
Generalizability and Maintenance of Social Skills
The utilization of research-based practices to enhance social abilities has resulted in positive outcomes for young people with ASD in clinical settings. Unfortunately, the interventions do not reveal that social skills taught can be generalized to school or home settings (Shindorf, 2016). Generalizability refers to a child’s ability to utilize a specific taught skills in settings other than that where the skill was taught. Generally, if a trained behavior or a taught skill can be utilized in different settings without the replication of the settings in training, then it is a generalizable skill. Thus, for the purpose of this paper, generalizability refers to how certain social skills taught in the clinic or class can be utilized to improve social behavior in other school settings and at home.
In the class environment, educators can control, set, or structure the environment for the purposes of making it easy for children to learn the skills they are about to be taught. However, the class environment can only imitate other settings to certain small degree. When the learners face different environments, it will be naturally difficult for them to apply the skills they were taught because the environment is different. This makes it difficult to generalize social skills.
However, with maintenance, many social skills can be generalized. Maintenance is the degree to which a specific new behavior continues after the end of an intervention (Shindorf, 2016). It requires the use and reinforcement of newly learned skills both in class settings and in other settings to make sure they become a habit and like second nature to the learners. So maintenance can help with the generalization of social skills.
Method
Literature Search
Electronic databases including CINAHL, PsycINFOR, Medline, and EMBASE will be searched between January and February 2020 to find relevant works. Only the works with the following keywords in the subject heading will be eligible for the literature review “group interventions” and “social skills”. Another eligibility criteria will be to check the language (must be English language) and the age range of the participants (must be between 14 and 21 years old). Reference lists of the chosen works will also be scoured to find additional relevant works for the literature review.
Inclusion and Exclusion Criteria
Systematic Review
Two independent reviewers will help rate the abstracts of the selected works against the established eligibility criteria. Whenever the two disagree, solutions will be found via a discussion. A third reviewer will be at hand to step consult in case disagreements are not resolved (Wolstencroft et al., 2018). Works will only be eligible for this present study if they meet the following eligibility criteria: (1) they are randomized control trials that make use of a delayed treatment control group (2) they involve a social skill intervention by professionals for a multi-modal group with at least two children (3) they include participants who are between 14 and 21 years old (4) they entail the examination of social skills utilizing SSRS and/ or SRS. To improve internal validity and reduce heterogeneity, only the randomized control trials that make use of a delayed treatment control group are going to be retained.
Published works will not be eligible for this study if they: (1) are conducted another language which is not English (2) include young people with other intellectual disabilities (3) are protocols, theses, abstracts, conference proceedings, or reviews. Studies not in English will be excluded to reduce possible translation errors or lost cultural meanings, while studies including children with intellectual disabilities will be excluded to ensure low sample heterogeneity.
Quality Assessment: Risk of Bias
Two independent reviewers will separately conduct the quality assessment of the selected studies utilizing the Cochrane Collaboration Risk of Bias (RoB) v2 tool (Higgins & Green, 2011). The two reviewers will assess for bias in selective reporting, incomplete outcomes, blinding of outcome assessments, blinding of personnel and participants, baseline measurements, allocation concealment, and sequence generation (Higgins & Green, 2011). Solutions to disagreements between the two independent reviewers will be arrived at via discussions.
Data Extraction
Two independent reviewers will separately help with the data extraction using a customized data extraction spreadsheet. The data that will be extracted will include the characteristics of the interventions, the characteristics of the patients, the outcome measures utilized, and the outcome scores. In case any additional information is required, the authors of the published works will be contacted. They authors will also be contacted to provide sub-scale and total scores of SSRS and SRS in cases where they have not published them. The co-variates will include the type of intervention, the duration of the intervention, the intensity, the teaching strategy utilized, and whether there is direct parental involvement.
Data Analysis
Meta-analysis
A statistical analysis utilizing STATA 14 will be done. The standardized mean difference and 95 percent CI (confidence interval) for every outcome will be utilized as the summary statistic. Post treatment outcomes for the treatment and for the delayed groups shall be compared for every study. The standardized mean difference shall be interpreted as small, moderate, and large for the following values respectively, 0.20-0.50, 0.50-0.80, and 0.80-1.30 (Cohen, 2013). They shall be interpreted as very large for the values more than 1.30 (Cohen, 2013). If heterogeneity is suspected, the random-effects model shall be employed. And heterogeneity shall be examined utilizing the Higgins heterogeneity I2 statistic. The extent of heterogeneity shall be interpreted as low, moderate, and high for the following values respectively 25-49 percent, 50-74 percent, and 75 percent or more (Higgins & Green, 2011). Only when p < 0.05 will heterogeneity be considered to be statistically significant.
Sensitivity Analyses
The trim and fill approach plus funnel plots with Egger’s test will be utilized to assess publication bias (Egger et al., 1997).
References
Adams, C., Lockton, E., Freed, J., Gaile, J., Earl, G., McBean, K., ... & Law, J. (2012). The Social Communication Intervention Project: a randomized controlled trial of the effectiveness of speech and language therapy for school?age children who have pragmatic and social communication problems with or without autism spectrum disorder. International Journal of Language & Communication Disorders, 47(3), 233-244.
Adams, C., Lockton, E., Freed, J., Gaile, J., Earl, G., McBean, K., Nash, M., Green, J., Vail, A., and Law, J. (2011). An evidence-based program for school, & aged children: Social communication intervention project. Research report. Uppsala: Inst.
American Psychological Association (APA) (2006). Evidence-Based Practice in Psychology. American Psychologist, 61(4), 271–285. doi: 10.1037/0003-066X.61.4.271
Cohen, J. (2013). Statistical power analysis for the behavioral sciences. Routledge.
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