Group Social Skills Interventions for Youth with Autism

Introduction

Individuals with autism spectrum disorder (ASD) typically experience significant difficulty relating socially to others. These social difficulties are among the major defining symptoms of ASD. Persons with ASD who do not show considerable language or cognitive delays — for example, individuals diagnosed with high-functioning autism or Asperger syndrome — usually make significant progress when put through certain interventions, improving notably 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 challenges and to communicate in a manner that observes all the unwritten rules of conversation and social interaction (Radley, O'Handley & Sabey, 2017). For example, an individual diagnosed with ASD may not always say the most appropriate thing for a specific situation. They may also struggle to observe turn-taking in conversations, to be brief and clear, and to know what information to leave out in certain contexts. Sometimes individuals with ASD also experience difficulties knowing which topics to share with whom and how to sustain those topics the way others without the condition normally would.

Background and Social Skills Foundations

Social skills educators are at times surprised by how learners can sometimes perfectly demonstrate a skill in class or during a practice session and then fail to apply the same skill to a real-life scenario. In education circles, the term generalization is often used to describe when a person's behavior or response is produced in scenarios where it was not directly instructed or taught. This is a very common experience among social skills educators, and one that seems to negatively affect social skills instruction (Radley et al., 2017). Addressing this requires a thorough examination of how social skills are taught and an adjustment of the curriculum to make generalization far more likely.

It is generally 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 interaction. It is crucial to appreciate the complexity of social skills and the fact that they are difficult even for individuals without ASD to master. For individuals with ASD — especially those with high-functioning ASD — some social skills can be learned, but interacting successfully in social situations remains consistently challenging. Difficulties with social comprehension are also common. Persons with autism spectrum disorders typically have difficulties interacting socially, resulting in fewer friendships, minimal interactions with others, poor satisfaction with relationships, and loneliness (Stichter et al., 2010). As a result, maintaining relationships with teachers, family members, and peers is often quite difficult for them.

A number of social skills interventions exist that can help address the social difficulties experienced by persons with ASD. Considering the complexity of social skills, most such interventions include specific components that target various social challenges. A good example is the Social Communication Intervention Project (SCIP), which has been successfully utilized to improve learning skills, social communication, pragmatic functioning, and conversational competence (Adams et al., 2012). The Emotional-Based Social Skills Training (EBSST) intervention has also been shown to boost emotional competence significantly. The Social Competence Intervention (SCI) has been proven to improve executive functioning, social abilities, and problem-solving in young people with ASD.

There are also framework-based interventions, such as Social Skills Training (SST) (Shindorf, 2016). These take into account theoretical strategies and perspectives to provide more effective treatment. Garcia Winner's Social Thinking intervention is a well-known example of a framework-based approach (Winner & Crooke, 2009), as is the Youth Engagement Through Intervention (YETI) program. 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.

Evidence-Based Social Skills Interventions

Social skills include all elements of understanding, behavior, and communication that are important for effective social interaction. Young people with ASD usually face social difficulties because of poor social skills (Shindorf, 2016). However, improving the social skills of persons with autism is challenging both because of the nature of the condition and because of how complex social skills and abilities are. The diversity of social skills also makes them difficult to teach and to master.

The American Psychological Association (APA) has for many years advocated for the use of evidence-based practices — those that require professionals to seek and integrate the latest authoritative research with their own expertise in order to offer patients quality treatment that also considers the patient's preferences, culture, characteristics, and circumstances (APA, 2006).

The theoretical basis for evidence-based practice was initially developed for research in health services (Ubbink, Guyatt & Vermeulen, 2013). To establish that a theory, evidence, or practice qualifies as evidence-based, various forms of research must be considered, including 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 both rigorous research and professional knowledge when providing treatment. This paper likewise regards evidence-supported interventions for autistic youth with social difficulties as the best practice for addressing social challenges. While many such interventions exist, this project focuses on positive behavior supports, differential reinforcement, social narratives, video modeling, and visual schedules.

Generally, social skills programs or interventions are those specifically designed to help young people improve their social abilities and interactions through learning and behavioral strategies. Young people with ASD who have poor social skills usually struggle during conversations and social interactions, making it difficult to maintain relationships with family members, peers, and teachers. Social skills interventions are meant to help such young people improve their cognitive, communication, and behavioral skills (Hutchins et al., 2019). Because social skills are diverse and complex, interventions are typically designed to include various elements targeting specific aspects such as social competence, socio-emotional skills, and social communication.

Considering the complexity of social difficulties, there is no single way to implement interventions. Some interventions are more effective when provided individually rather than in group settings, because individual delivery allows adjustment to the person's specific needs. Moreover, some professionals prefer a framework-based approach while others prefer following structured curricula. 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 focused on social communication is SCIP (Adams et al., 2011). SCIP focuses on helping young people in school to enhance their social interactions, social cue understanding, and their semantics and pragmatics of language (Adams et al., 2012). It includes individualized writing plans to help young people improve their social communication and utilizes various strategies to address varying needs. Several randomized controlled trials have confirmed that SCIP is effective, particularly in improving social communication, pragmatic functioning, classroom learning skills, and conversational competence (Adams et al., 2012). The Pre-linguistic Milieu Teaching (PMT) method is also similar to SCIP in that it utilizes multiple strategies to improve social communication (Warren et al., 1993).

In addition to interventions targeting social communication, many focus on improving social-emotional learning. These typically apply a cognitive behavioral approach — one that is collaborative and involves goal-setting, achieved through analyzing how a client's behaviors, feelings, and thoughts relate to one another. Such interventions involve using goals to help children identify, understand, and regulate their emotions in order to improve their attitudes toward others and themselves (Shah, 2012). The Emotional-Based Social Skills Training (EBSST) intervention is a key example, specifically designed for children with ASD (Ratcliffe et al., 2014). EBSST is based on emotional intelligence and development theories and focuses on teaching children to understand emotions, regulate them, and apply emotional problem-solving skills. Research has confirmed that EBSST brings about significant improvement in emotional competence that can be maintained over several months (Ratcliffe et al., 2014). Several other social-emotional interventions have also produced positive outcomes for young people with ASD, including academic success, reduced emotional disturbance, fewer behavioral issues, and more positive social behavior (Shah, 2012).