Social Skills Deficits in Children with Autism Spectrum Disorders ...

Social Skills Deficits in Children with Autism Spectrum Disorders: Evidence Based Interventions Jennifer Holloway, Olive Healy, Martina Dwyer, and Sinead Lydon

ASD and Social Skills Deficits Broadly speaking, social skills are sets of rules that guide individuals on how to engage and interact with others, to participate in social activities with independence, and to demonstrate emotional reciprocity. Deficits in social skills affect interactions with others and the development of social, emotional, and cognitive development (Bellini et al. 2007). Deficits in social functioning are core features of Autism Spectrum Disorders (ASD), and there exists a myriad of literature documenting the various effects of such deficits on children with ASD. The fundamental diagnostic characteristics of the disorder vary across a spectrum, and social skills deficits can be diverse. In addition, children with ASD present with profound and complex social and language difficulties which necessitate the need for specialized individualized instruction within the area of social skills interventions (Taylor 2001). Social behaviors that are deemed appropriate at one age quickly change as the child ages, and a new set of social skills deficits can be observed. The changing social needs of the child and their environment can make it difficult to design effective social skills interventions. As with the changing skill sets of the child, the interventions also require strategic analysis to select the most appropriate one to meet the child’s individualized needs. Some researchers have reported that certain factors such as age, mental ability, and language ability can impact on outcomes of social skills interventions (e.g., Kasari et al. 2006). In recent years, children with ASD are being provided with more opportunities for inclusion and socialization through access to regular classroom environments. Unfortunately, many children with ASD do not readily or spontaneously interact effectively

J. Holloway • O. Healy (*) • M. Dwyer • S. Lydon School of Psychology, National University of Ireland - Galway, Galway, Ireland e-mail: [email protected]; [email protected]; [email protected]; [email protected] V.B. Patel et al. (eds.), Comprehensive Guide to Autism, DOI 10.1007/978-1-4614-4788-7_62, # Springer Science+Business Media New York 2014

1133

1134

J. Holloway et al.

with their peers (Laushey and Heflin 2000); rather, these children often require very in-depth specialized intervention to promote positive and meaningful integration within such classrooms. There is growing empirical evidence to support the effectiveness of behavioral interventions to teach, maintain, and generalize social skills in children with ASD. These interventions aim to establish the social rules necessary to interact in a meaningful way within the classroom and build social relationships with others (Cappadocia and Weiss 2010). Such interventions include peer-mediated intervention (PMI), video modeling, pivotal response training (PRT), joint attention training, Social Stories™, and script-fading interventions (e.g., Bass and Mullick 2007; Matson et al. 2007; Nikopoulos & Keenan 2004). Although there is a growth in the dissemination of research on evidence-based interventions, there still is no one social skills intervention that “fits” all children with ASD. As already outlined, this is most probably due to the social skills definitions, the complexity of the disorder, and the necessity to design individualized interventions to ensure effective outcomes. However, it is important that parents, clinicians, and policy-makers are aware of the empirical evidence in support of social skills interventions to ensure that data-based decisions are made in the best interest of the individual child in relation to allocation of resources, education provision, and the creation of appropriate social opportunities. This chapter provides an overview of the empirical research on teaching social skills to children with ASD. For the purposes of this chapter, evidence-based interventions that have demonstrated empirical support in peer-reviewed publications will be outlined.

Interventions to Teach Social Skills Social skills interventions can be categorized as demonstrating effective gains (e.g., PMI), modest outcomes (e.g., social skills groups), or mixed results (e.g., Social Stories™). Empirical research encircling all such interventions has grown at a meteoric rate over the years, and fascinating insights have been provided in terms of outcomes, generalization, and maintenance effects. With the rapid growth within this research area, there is still not a consensus on one specific intervention for children with ASD. Rather, outcomes suggest the social skills intervention should be individualized to meet the specific and current skill level, age, and peer group of the child with ASD.

Peer-Mediated Intervention (PMI) Peer-Mediated Intervention (PMI). A treatment approach in which peers (e.g., classmates) are trained to act as intervention agents, implementing instructional programs, behavioral interventions, and “facilitating social interactions” (Chan et al. 2009, p. 877). Behavioral interventions are often designed to include peers as agents of positive change. Interventions can encompass direct training for the child with ASD as well

Social Skills Deficits in Children with Autism Spectrum Disorders

1135

as the typically developing peer. Creating a peer-mediated instructional context can present multiple challenges. Children with ASD often require highly specialized instruction to overcome profound language and social deficits and to ensure learning readiness to benefit from peer interactions. Oftentimes, highly intensive work must be undertaken with the child with ASD to provide them with the necessary prerequisite skills to learn from a peer. Contrary to common belief, proximity alone is not sufficient to promote positive social interactions for children with ASD, and a more structured approach is necessary to teach social skills (e.g., Elliot and Gresham 1993). Many researchers have documented the significant positive empirical support for PMI to teach social skills for children with ASD (e.g., Apple et al. 2005; Bass and Mullick 2007). Social skills interventions involving peers must be designed to target ageappropriate social skills and be cognizant of the ever-changing social expectations of the wider community. For example, typically developing young children are not required to sustain attention with peers for long periods of time during play and games with simple nonverbal rules. Conversely, changes occur quite dramatically as children get older and the peer interactions become more complex and require more of the social interaction between children. This becomes evident in the intricate games involving multiple players and rules observed in the playground (Taylor 2001). In addition, expectations of typically developing peers must also be age matched for children with ASD to ensure they have the social skills necessary to participate successfully in social skills interventions. The overall objective of teaching social interactions with typically developing peers is to establish a mutually reinforcing relationship between the children (Baker et al. 1998). Taylor (2001) reviewed the literature on teaching peers to interact with children with ASD. The author highlighted a number of general conclusions which are of note. Summary Findings of Empirical Research on Peer Social Skills Training (Taylor 2001): 1. The peer, child with ASD, or both children should undergo direct training in procedures being implemented to maximize the outcomes of the intervention. 2. Teaching typically developing children key skills for interacting with children with ASD can promote better outcomes. The amount of training required of the peer will vary in line with the skills of the child with ASD. 3. Specific reinforcement procedure and schedules are required to implement the intervention and maintain the relationship. 4. Generalization and maintenance strategies must be programmed as part of the intervention to ensure these outcomes are demonstrated. 5. Specific procedures should be programmed to fade and remove additional prompts. 6. Interactions between the typically developing peer and child with ASD must be taught in most cases, as many children with ASD often ignore their peer. 7. Teaching strategies must be matched to the child’s ability. More specifically, structured teaching environments may be required if the child with ASD presents

1136

J. Holloway et al.

with multiple challenges, and alternatively children who have more advanced skills can often learn from more naturalistic environments. This requires further empirical research. Peer-mediated interventions have been empirically supported across multiple research studies. Although all of the research reports positive outcomes in relation to teaching social skills, few of the articles have documented generalization and maintenance effects in their outcome measures (e.g., Trembath et al. 2009; Kasari et al. 2012). A recent study, and one which demonstrates maintenance effects, was conducted by Kasari, Rotheram-Fuller, Locke, and Gulsrud’s (2012). The researchers compared the effects of a peer-mediated approach to social skills intervention with a child-assisted approach. The results reported significant improvements across several measures for those children who received a peer-mediated intervention; these measures included social network salience, number of friendship nominations, teacher report of social skills in the classroom, and decreased isolation on the playground. In addition, such increases persisted at a 3-month follow-up. Modest effects for generalization and maintenance were demonstrated in Trembath, Balandin, Togher, and Stancliffe’s (2009) study. The authors examined the effects of training six typically developing peers in the implementation of peermediated naturalistic teaching on communicative behaviors emitted by three classmates with autism. Trembath et al.’s intervention resulted in modest increases in communicative behavior, and while data showed that these increases generalized to mealtime interactions with peers, only one participant maintained such increases in communication. Further studies in PMI demonstrate positive outcomes using multiple baseline designs across participants. Trottier, Kamp, and Mirenda (2011) showed that a peer-mediated intervention resulted in an increase in communicative interactions among children with ASD using a speech-generating device in social game routines. Owen-DeSchryver, Carr, Cale, and Blakely-Smith (2008) assessed the effectiveness of a peer training intervention on social initiations and responses among three students with ASD and their typical peers. Increases in initiations among trained peers and increases in initiations and responses among children with ASD were observed. Interestingly, an increase in initiations emitted by untrained peers was also observed. Some PMIs also include other behavior change procedures as part of the treatment package. The impact of Chung et al.’s (2007) peer-mediated social skills training program which was combined with video feedback, positive reinforcement, and a token system was measured by way of an observational coding system in an AB design. Marked increases of contingent responses, behaviors securing attention, and initiated comments and requests were observed in three out of four participants as a result of the program. The work on PMI has been extended to demonstrate siblings as agents of positive change in children with ASD. Recent research articles have focused on sibling-mediated social skills intervention for those with ASD. In Castorina and


1137

Negri’s (2011) pilot investigation, the effectiveness of siblings as generalization agents in social skills training for boys with Asperger syndrome was explored. Training resulted in significant improvements in participants’ identification of nonverbal social cues which were also maintained at 3-month follow-up, and was not directly related to sibling involvement. Moreover, when compared with controls, similar trends were observed relating to participants’ ability to interpret emotions. However, such improvements did not extend to parent and teacher ratings on standardized social skills measures, which may suggest poor generalization effects. Table 1 provides a summary of the evidence base for PMI. This table describes studies evaluating PMI in terms of age of participants, the type of assessment or measure used to evaluate effectiveness, outcomes, generalized effects, and the maintenance of such outcomes over time.

Pivotal Response Training (PRT) Pivotal Response Training (PRT). Utilizes natural learning opportunities to target and change key social skills. PRT provides a set of procedures designed to increase motivation for social interaction and to encourage generalization (Koegel and Koegel 2006; Pierce and Schreibman 1995). PRT is another effective social skills intervention for individuals with ASD which has been explored in recent years and is comparable to PMI as it is conducted within the child’s naturalistic setting (Flynn and Healy 2012). According to Koegel and Koegel (2006), the primary objectives of PRT are to move children with ASD towards a typical developmental trajectory and promote opportunities within natural inclusive settings. The founding authors highlight that PRT concentrates on teaching a core set of skills, namely, motivation for social interaction, self-management, self-initiation, empathy, and responsivity to multiple cues. Table 2 provides a summary of the evidence base for PRT. This table describes studies evaluating PRT in terms of age of participants, the type of assessment or measure used to evaluate effectiveness, outcomes, generalized effects, and the maintenance of such outcomes over time. Kuhn, Bodkin, Devlin, and Doggett (2008) conducted a study in which peers implemented PRT to increase levels of social interaction among two children with ASD. An increase in opportunities to respond was observed; however, the researchers also noted increases in the amount of initiations and social responses emitted by the children with ASD. Generalization and maintenance data were not reported. Two further studies employing multiple baseline designs demonstrated positive maintenance and generalization effects within their studies (Pierce and Schreibman 1997; Harper et al. 2008). Pierce et al. (1997) investigated the effectiveness of a PRT program in terms of increases in social interaction by children with ASD and also evaluated the impact of using multiple peer trainers on generalization of

1138

J. Holloway et al.

Table 1 Studies evaluating peer-mediated intervention (PMI) Age of Assessment/ Name of study participants measures Banda, Hart and 6 years Dependent Liu-Gitz (2010) variables included peer-to-peer initiations, e.g., asking for help, and peer-to-peer responses, e.g., making comments Trembath, 3–5 years Dependent Balandin, variable Togher, and described as Stancliffe communicative (2009) behavior Owen7–10 years Dependent DeSchryver, variables Carr, Cale, and included social Blakely-Smith initiations and (2008) responses Chung et al. 6–7 years Social (2007) interaction coding system

Kasari, RotheramFuller, Locke, and Gulsrud (2012)

6–11 years

Outcomes Generalization Maintenance Increased levels No data No data of peer initiations and responses

Modest increases in communicative behavior

Generalized to Maintained mealtime for one participant

Increases in No data social initiations and responses

No data

Three out of No data four participants demonstrated increases in contingent responses, behaviors securing attention, initiated comments, and requests Social Network Peer-mediated No data Survey (SNS), approach led to playground improvements observation of in social peer network engagement salience, (developed for number of this study), friendship Teacher nominations, Perception of teacher report of Social Skills social skills in (TPSS) the classroom, and decreased isolation on the playground

No data

Maintained at 3 months

(continued)

Social Skills Deficits in Children with Autism Spectrum Disorders Table 1 (continued) Age of Name of study participants Trottier, Kamp, 8–12 years and Mirenda (2011)

Assessment/ measures Dependent variables included prompts to confederates by the trainer and communicative acts emitted by the children with ASD

Outcomes Increase in communicative acts among children with ASD using a speechgenerating device in social game routines

1139

Generalization Maintenance No data No data

treatment effects. The researchers noted increases in the amount of interactions being maintained and in the amount of initiated conversations and play. In addition, such social behaviors generalized to untrained peers, settings, and stimuli and were maintained two months later. Harper et al. (2008) also demonstrated similar positive outcomes when they used peer-implemented PRT to increase a number of social skill measures among two children with ASD; these included increased rates of gaining attention, turn-taking, and responses to play. In a variation on the theme of social skills intervention, Thorp, Stahmer, and Schreibman (1995) investigated the use of PRT in increasing sociodramatic play among three children with ASD; positive changes in play, language, and social skill measures were noted, and such changes generalized across toys and settings. However, Thorp et al. also pointed out that little generalization to other play partners took place. From their research on PRT, Koegel and Koegel (2006) highlighted a range of important teaching strategies that can advance greater social skills outcomes. Koegel and Koegel (2006) highlight specific teaching strategies to adopt to promote positive social skills: 1. Begin by developing sharing exchanges between children. 2. Give opportunities to seek assistance from peers. 3. Increase meaningful verbal and nonverbal communication through establishing mutually reinforcing activities or toys which can form the focus of conversation exchanges. 4. Implement a buddy system. 5. Teach appropriate pragmatic social behaviors which may not necessarily be learned through observation alone. 6. Teach generalized phrases (i.e., “small talk”) that can be used across common social scenarios to prevent the necessity for in-depth conversation. 7. Present new games and activities regularly to maintain motivation. 8. Expose the child with ASD to activities before they are presented to the peer or group (i.e., priming; Schreibman et al. 2000).

1140

J. Holloway et al.

Table 2 Studies evaluating pivotal response training (PRT) Name of study Kuhn Bodkin, Devlin, and Doggett (2008)

Age of Assessment/ participants measures 7–8 years Dependent variables include interaction opportunities, responses, rate of responses to prompts, initiations Pierce and 7–8 years Dependent Schreibman measures include (1997) maintaining interactions, initiating conversation, and initiating play

Harper, 8–9 years Symon, and Frea (2008)

Thorp, 5–9 years Stahmer, and Schreibman (1995)

Outcomes Generalization Increase in No data opportunities to respond, rate of responses to prompts, initiations

Increases in the amount of interactions being maintained and increased levels of initiated conversations and play Dependent Increased rates variables of gained included gaining attention, turnattention to peers, taking and turn-taking, and initiations to initiations to play play Variation of the Positive play, history changes in play, interview language, and (Rogers, social skill Herbison, Lewis, measures Pantone and Reis, 1986), the Peabody Picture Vocabulary Test – Revised (PPVT-R; Dunn and Dunn, 1981), role-playing, make-believe transformations, persistence, social behavior, verbal communication (spontaneous speech, other speech, and inappropriate speech)

Maintenance No data

Generalized to untrained peers, settings, and stimuli

Maintained at 2 months

Generalized

Maintained

Changes generalized across toys and settings, however, little generalization to other play partners took place

Maintained at 3-month follow-up


1141

Script Fading Script Fading. Procedures involving the implementation of a script which functions to prompt the child with ASD to engage in conversational exchanges with others. The prompts are slowly faded back until the child can reliably emit the response in the absence of the script (Krantz and McClannahan 1993). Script-fading procedures have demonstrated significant positive outcomes in terms of skill acquisition, generalization, and maintenance outcomes (Flynn and Healy 2012). The outcomes of the studies on script fading have indicated an emergence of novel responses as shown in Table 3 (e.g., Wichnick et al. 2010a, b; Sarokoff et al. 2001). This table describes studies evaluating script-fading procedures in terms of age of participants, the type of assessment or measure used to evaluate effectiveness, outcomes, generalized effects, and the maintenance of such outcomes over time. Krantz and McClannahan (1993) presented their novel approach to teaching social skills using scripts and successive fading strategies. In their study, teenagers were taught to engage in conversational exchanges through the use of scripts. The scripts were then gradually faded across successive learning opportunities until the conversational exchanges were maintained without prompting. Reading is a prerequisite skill to this intervention as scripts are written in printed text. The authors further extended their work to demonstrate positive outcomes for children who did not have a reading repertoire, when they used pictorial prompt sequences to promote positive changes in social skills (e.g., Krantz et al. 1993; Krantz and McClannahan 1998). The picture/photographic activity schedule identifies key social skills for the child to engage in, for example, to approach peers, to ask for an item, or to initiate play. Since this seminal work, other researchers have also demonstrated similar positive outcomes using scripts and successive fading procedures. Wichnick, Vener, Keating, and Poulson (2010b) illustrated the success of a script-fading procedure in enhancing levels of social initiations emitted by children with ASD. Data illustrated that few if any social initiations were observed during baseline, and when scripts were introduced, unscripted and novel initiations systematically increased across participants, providing evidence for response generalization. In follow-up studies, Wichnick, Vener, Keating, et al. and Wichnick, Vener, Pyrtek, and Poulson (2010a) carried out similar demonstrations of outcomes by increasing responses to peer initiations among children with ASD. Baseline data demonstrated low levels of responses to peer initiations, which increased when scripts were introduced; additionally, as scripts were faded, Wichnick and colleagues observed a systematic increase in the cumulative number of novel responses to peer initiations. Sarokoff, Taylor, and Poulson (2001) utilized a multiple baseline across stimuli design to evaluate the impact of a script-fading procedure on levels of conversation statements among children with autism about various stimuli. Results indicated that all scripted statements and unscripted statements increased as a result of their intervention and that generalization was measured with novel peers and untrained stimuli.

1142

J. Holloway et al.

Table 3 Studies evaluating script-fading procedures Age of Assessment/ Name of study participants measures Krantz and 4–5 years Dependent McClannahan variables (1998) included interaction, scripted interaction, elaboration, and unscripted interaction Stevenson, 10–15 years Dependent Krantz and variables McClannahan included (2000) interaction, scripted interactions, unscripted interactions, and non-interaction, e.g., repetition Wichnick, 4–6 years Dependent Vener, variables Keating, and included Poulson initiation, (2010b) scripted initiation, unscripted initiation, and novel initiation Wichnick, 5–7 years Dependent Vener, Pyrtek, variables and Poulson included (2010a) response to peer initiation, scripted response to peer initiation, unscripted response to peer initiation, and novel response to peer initiation Sarokoff, 8–9 years Dependent Taylor, and variables Poulson included scripted (2001) and unscripted statements

Outcomes Increases in scripted and unscripted interactions

Generalization Generalized to other activities

Maintenance No data

Increases in scripted and unscripted interactions

Generalized

Effects were maintained for 10–92 sessions

Increased Generalized levels of social initiation (scripted, unscripted, and novel)

No data

Increased levels of responses to initiation

Maintained

Generalized

Increased Generalized levels of scripted and unscripted conversation statements involving three sets of stimuli

No data

(continued)

Social Skills Deficits in Children with Autism Spectrum Disorders Table 3 (continued) Age of Name of study participants Goldstein 4–6 years (2010)

Argott, Buffington Townsend, Sturmey, and Poulson (2008)

Assessment/ measures Dependent variables included scripted, unscripted, and novel initiations towards peers

1143

Outcomes Increases in levels of scripted, unscripted, and novel social initiations towards peers

Generalization Maintenance For one No data participant, 2–3 peer initiations occurred in the presence of generalization toys after scripts were faded out or with a partial script prompt 11–14 years Dependent Increased rates Generalized No data variables of scripted and included scripted unscripted and unscripted empathetic empathetic statements statements

Goldstein (2010) examined the effects of a script-fading procedure using toys packaged with speech-generating devices on levels of scripted, unscripted, and novel social initiations towards peers among children with ASD. Goldstein’s results revealed that as scripts were introduced, participants demonstrated significant improvements in scripted initiations, and these scripted initiations were maintained as scripts were faded. Generalization data showed that for one participant, 2–3 peer initiations occurred in the presence of novel toys after scripts were faded out or with a partial script prompt. Goldstein also provided data showing that participants emitted novel initiations throughout the study. Argott, Buffington Townsend, Sturmey, and Poulson (2008) examined the effect of a script-fading procedure on rates of empathetic responses among adolescents with autism, by way of a multiple baseline design. Systematic increases in scripted and unscripted empathetic statements were observed both in the presence of training and generalization stimuli. Script-fading procedures have been demonstrated to show positive outcomes in relation to novel responding and maintenance effects on key social skills such as conversation skills, empathy, and social initiations.

Video-Modeling Interventions Video-Modeling Intervention. A procedure that requires observation of a video of social interaction and the individual is required to model the social behavior being depicted within the video (Wang et al. 2011). Video-modeling approaches to social skills intervention in ASD have demonstrated effective gains (Flynn and Healy 2012; Wang et al. 2011). Video modeling

1144

J. Holloway et al.

Table 4 Studies evaluating video modeling Name of Age of study participants Nikopoulos 9–15 years and Keenan (2003)

Nikopoulos 7–9 years and Keenan (2004)

Assessment/ measures Dependent measures include social initiation and appropriate play

Dependent measures included social initiation and reciprocal play Nikopoulos 6.5–7 years Dependent and Keenan measures included (2007) social initiation, reciprocal play, imitative response, object engagement, and other behavior (i.e., any other behavior scored during the 5-min session in the experimental room)

Outcomes Increases in social initiations and appropriate play

Increased rates of social initiation and reciprocal play Increased levels of social initiation, reciprocal play, imitative responses, and object engagement

Generalization Increases generalized across settings, peers, and toys for 4/ 7 participants No data

Generalized across peers

Maintenance Maintained at 1 and 2 months

Maintained at 1–3 months Maintained at 1–2 months

requires a certain set of prerequisite skills prior to using the intervention, namely, a generalized imitative repertoire. Of the studies conducted within this topic, researchers have investigated the model type within the video to determine best outcomes. Video models have included siblings (Taylor et al. 1999), peers (e.g., Simpson et al. 2004), adults (e.g., Charlop and Milstein 1989), and the individual themselves (Dowtick 1999). This table describes studies evaluating video modeling in terms of age of participants, the type of assessment or measure used to evaluate effectiveness, outcomes, generalized effects, and the maintenance of such outcomes over time. Nikopoulos and Keenan conducted a series of studies investigating the effects of video modeling (see Table 4). The authors utilized a video-modeling intervention to promote social initiations and appropriate play among seven children with ASD (Nikopoulos and Keenan 2003). Increases in responses generalized across settings, peers, and toys for four of the seven children, and all such improvements in social initiations and play were maintained after a 1–2-month follow-up period. In a later study, Nikopoulos and Keenan (2004) investigated the effects of video modeling on levels of social initiations and reciprocal play for three children with ASD. The video-modeling intervention resulted in increased levels of both social initiations and reciprocal play, and such changes were maintained at 1 and 3-month follow-up probes for all three children. However, the authors failed to display any such data in terms of generalization.


1145

In another study, Nikopoulos and Keenan (2007) explored the impact of video modeling on measures of imitative responses and object engagement as well as social initiation and reciprocal play. All such skills increased following intervention and generalized across peers. Nikopoulos and Keenan also highlighted that such skills were maintained after 1–2-month follow-ups. Bellini and Akullian (2007) conducted a meta-analysis on video modeling and video self-modeling interventions for children and adolescents with ASD. The results of 23 single case designs suggested that video-modeling strategies for addressing social communication, functional skills, and behavioral functioning yielded positive results. The authors also concluded that video modeling meets the criteria as an evidence-based intervention for treating social skills deficits in children with ASD.

Social Skills Groups Social Skills Groups. These groups involve “teaching children with autism specific core social skills, with the effectiveness being measured by improvement in the specific skills without an expectation of generalization to untaught behaviors” (Barry et al. 2003, pp. 687 and 688). Social skills groups have yielded modest gains across the literature as depicted in Table 5. As the SSGs are typically not held in natural settings, generalization effects are not always demonstrated (Flynn and Healy 2012). Positive outcomes appear to be associated with higher-functioning individuals. This table describes studies evaluating SSG in terms of age of participants, the type of assessment or measure used to evaluate effectiveness, outcomes, generalized effects, and the maintenance of such outcomes over time. Dotson, Leaf, Sheldon, and Sherman’s (2010) showed limited generalization effects from their intervention. The study involved the use of a social skills group in teaching conversational skills to children with ASD. Such skills included conversational basics, the ability to give positive feedback to a speaker, and the ability to answer and ask open-ended questions. Dotson et al.’s multiple probe design illustrated that four out of five children mastered all skills, while a fifth mastering two such skills. Although none of the children fully generalized skill sets with a typical peer, three children demonstrated some generalization to such interactions. No generalization effects were demonstrated within the natural setting. Furthermore, Dotson and colleagues observed that three children maintained all skills, and two children maintained all but one of the skills. Kroeger, Schultz, and Newsom (2007) set up two different social skills groups in their intervention study, one being a direct teaching group and, another, a play activities group. The direct teaching group involved video modeling while the play activities group promoted unstructured play. Kroeger et al.’s results indicated that while improvements in prosocial behaviors were noted for both groups, the direct teaching group demonstrated greater social skills gains. However, no data were presented in terms of generalization or maintenance.

1146

J. Holloway et al.

Table 5 Studies evaluating social skills groups (SSG) Name of Age of study participants Dotson, Leaf, 13–18 years Sheldon, and Sherman (2010)

Kroeger, Schultz, and Newsom (2007)

4–6 years

DeRosier, 8–12 years Swick, Ornstein Davis, Sturtz McMillen, and Matthews (2011)

Assessment/ measures Conversational skills (including conversational basics, the ability to give positive feedback to a speaker, and the ability to answer and ask open-ended questions) The Social Interaction Code (Fox et al., 1984), Assessment of Basic Language and Learning Skills (Partington and Sundberg, 1998)

Outcomes Four out of five participants mastered all such skills, while a fifth mastered two such skills

Generalization Generalized for three participants

Increases in No data prosocial behaviors noted for both treatment groups (i.e., videomodeling group and unstructured play group), however, videomodeling group presented with greater social skills Social Those in the No data Responsiveness treatment group Scale (SRS; demonstrated Constantino and significantly Gruber, 2005), greater social Achieved skills as a result Learning of being taught Questionnaire modules under (ALQ, the headings of DeRosier and communication, Gilliom, 2007), working with Social others, and Dissatisfaction friendship skills Questionnaire (Asher and Wheeler, 1985), Social Selfefficacy Scale (Ollendick and Schmidt 1987)

Maintenance Three participants maintained all such skills, while two others maintained all but one skill

No data

No data


1147

In a recent study, DeRosier, Swick, Ornstein Davis, Sturtz McMillen, and Matthews (2011) used a between-groups design in order to compare the effects of a treatment group (which focused on increasing social skills among 55 children with high-functioning ASD by way of teaching modules under headings of communication, working with others, and friendship skills) to that of a control group. Although DeRosier et al. displayed results significantly favorable towards the treatment group, no data relating to generalization or maintenance were described. While social skills groups have showed modest outcomes, the positive effects tend to be evident within higher-functioning children with ASD and those with Asperger syndrome. SSG may provide benefits to those higher-functioning children who also present with the ability to readily generalize behaviors learned.

Joint Attention Training Joint Attention Training. Involves teaching skills in “sharing attention with others through pointing, showing and coordinated looks between objects and people” (Kasari et al. 2006, p. 611). In recent years, a number of social skills interventions for those with ASD have focused on increasing joint attention skills. Table 6 provides a summary of the evidence base for joint attention training. This table describes studies evaluating joint attention training in terms of age of participants, the type of assessment or measure used to evaluate effectiveness, outcomes, generalized effects, and the maintenance of such outcomes over time. Whalen and Schreibman (2003) employed a multiple baseline design to measure changes in social behaviors including responding to showing, pointing and gaze shifting of adult, coordinated gaze shifting, and pointing with the purpose of sharing. This represented one of the first studies in joint attention training. Following intervention, the authors noted that joint attention behaviors were successfully trained and generalized to other settings. Furthermore, naı¨ve observers highlighted positive changes by way of social validation measures. Kasari, Freeman, and Paparella (2006) compared the effects of a joint attention treatment group with that of a symbolic play treatment group and control group. The researchers observed that children with ASD in the intervention group initiated more showing and responsiveness to joint attention on a structure joint attention assessment and engaged in more child-initiated joint attention in a mother-child interaction. Many recent studies have investigated the impact of parent – or caregivermediated joint attention intervention. Kasari, Gulsrud, Wong, Kwon, and Locke (2010) looked at the impact of a parent-mediated joint attention intervention on levels of joint engagement between caregivers and children with ASD. On completion of the randomized controlled project, when compared with a wait list control group, the treatment group evinced significant improvements in targeted

Age of participants 2–4 years

Assessment/measures Target behaviors included responding to showing, pointing and gaze shifting of adult, coordinated gaze shifting, and pointing with the purpose of sharing Early Social Communication Scales (ESCS; Mundy, Hogan and Doelring, 1996), Structured Play Assessment (Ungerer and Sigman 1981)

Outcomes Target behaviors were effectively trained

When compared with a symbolic play and control groups, participants in the joint attention intervention group displayed more showing and responsiveness and more child-initiated joint attention Kasari, Gulsrud, 21–36 months Primary outcomes measures When compared with Wong, Kwon, included unengaged/other a control group, the joint and Locke engagement, object attention intervention group (2010) engagement, and joint displayed significant engagement improvements in joint engagement Schertz and 22–33 months Dependent variables included All participants improved Odom (2007) focusing on faces, turn-taking, performance and two responding to joint attention, participants showed repeated and initiating joint attention engagement in joint attention

Kasari, Freeman, 3–4 years and Paparella (2006)

Name of study Whalen and Screibman (2003)

Table 6 Studies evaluating joint attention training

Such skills were maintained at 1-year follow-up

At 5-week follow-up, each participant’s performance exceeded mean intervention condition levels for the majority of targeted behaviors

No data

Generalized to other settings

No data

Maintenance At 3-month follow-up, two participants showed an increase in protodeclarative pointing. Coordinated joint attention increased for two participants No data

Generalization Generalized to other settings

1148 J. Holloway et al.

3–5 years

29–60 months Early Social Communication Scales (ESCS; Mundy et al.), Preschool teacher-child play (Bakeman and Adamson 1984) 3–5 years Dependent variables included a verbal bid for joint attention, scripted bids for joint attention, unscripted bids for joint attention, and pointing

Isaksen and Holth (2009)

Kaale, Smith, and Sponheim (2012)

MacDuff, Ledo, McClannahan, and Krantz (2007)

Early Social Communication Scales (ESCS; Mundy et al.)

3–5 years

Ferraioli and Harris (2011)

Behavioral Assessment of Joint Attention (MacDonald et al., 2006)

Unstructured Joint Attention Assessment (Loveland and Landry 1986)

Rocha, 2–3 years Schreibman, and Stahmer (2007)

All three participants learned to make bids for joint attention

Increases in joint attention initiation were observed for the intervention group

Responses to joint attention increased for all four participants while initiations increased for three participants All participants made significant improvements in engaging in joint attention and initiating joint attention

Increases in responses to and initiations in joint attention were observed For two participants, rates of responding were maintained at 3-month follow-up Maintained responding across all four participants and maintained initiations across two participants

Generalized to untrained materials and settings

Maintained

Parents reported Maintained at 1-month generalization of such skills follow-up to new settings immediately following the intervention and at 1-month follow-up Generalized to significantly No data longer joint attention with mothers

Improvements in responding failed to generalize to the home setting Levels of imitation and behavioral requests also increased in structured and naturalistic settings

Social Skills Deficits in Children with Autism Spectrum Disorders 1149

1150

J. Holloway et al.

areas of joint engagement, demonstrating significant improvement in responsiveness to joint attention, and their diversity of functional play acts with maintenance of such skills at a 1-year follow-up. Schertz and Odom (2007) examined the effects of another parent-mediated joint attention intervention whereby a multiple baseline design compared child performance across four phases of intervention, including focusing on faces, turn-taking, responding to joint attention, and initiating joint attention. The developmentally grounded intervention resulted in improved performance for all participants and repeated engagement in joint attention for two children. Rocha, Schreibman, and Stahmer’s (2007) study on joint attention training provided an intriguing insight on the impact of parent behaviors on joint attention intervention outcomes. Rocha and colleagues noted that in their parentmediated intervention, as parent joint attention bids increased, children’s responses also increased. Therefore, Rocha et al. proposed that parent behaviors during and after interventions have a significant effect on generalization and maintenance of child behavior changes. Some recent articles have provided variations on the theme of joint attention intervention. Ferraioli and Harris (2011) examined a sibling-mediated approach to enhancing joint attention where four typically developing children were taught to implement a joint attention intervention with their siblings with ASD in their own home. Results showed that responses to joint attention increased for all four children while initiations increased for three children. Furthermore, Ferraioli and Harris observed increased levels of imitation and behavioral requests in both structured and naturalistic settings. Follow-up data provided evidence for maintained responding across all four children and maintained initiation in two of the children. Isaksen and Holth (2009) utilized an operant approach to teaching joint attention skills among four children with ASD. Results indicated improvements in engaging in joint attention and initiating joint attention. In addition, parents of children reported generalization of such skills to new settings at 1-month follow-up. Kaale, Smith, and Sponheim (2012) carried out a randomized control trial in which preschool teachers implemented a joint attention intervention with 61 children with ASD. Kaale and colleagues’ results indicated that when compared with a control group, the joint attention intervention group displayed more joint attention initiation during interaction with preschool teachers. Moreover, this effect generalized to significantly longer joint engagement with mothers. Wong, Kasari, Freeman, and Paparella (2007) examined joint attention intervention in conjunction with a symbolic play intervention, providing evidence that children with higher mental and language ages reached performance mastery criteria at a faster rate than those children with lower scores. They also noted that teaching approach and type of skill had an impact on the manner in which children scored. A script-fading procedure was used by MacDuff, Ledo, McClannahan, and Krantz (2007) in teaching joint attention, where all three participants learned to make bids for joint attention. When scripts were faded, such behaviors were maintained and generalized to untrained materials and settings.


1151

Table 7 Studies evaluating social stories interventions Name of Age of study participants Delano 6–9 years and Snell (2006)

Dodd, Hupp, Jewell, and Krohn (2008)

9–12 years

Assessment/ measures Dependent measures included social engagement and social skills (including attention seeking, initiated comments, initiated requests, and contingent responses) Main dependent variables included frequencies of problem social skill (i.e., giving excessive directions) and a prosocial skill (i.e., compliments)

Outcomes Duration of social engagement increased and the number of target social skills also increased during 10-min play sessions

Generalization Generalized to a classroom setting for two participants

Maintenance Skills were not maintained

Levels of the prosocial skill increased while levels of the problem skill decreased

No data

No data

Social Stories Interventions Social Stories Interventions. Can be defined as “brief, individualized stories written to teach a social skill or behavior, or about a concept or event” (Bohlander et al. 2012, p. 6). The outcomes of social stories interventions in the treatment of social deficits in children with ASD are mixed. As with many of the other social skills interventions, children require a certain set of prerequisite skills to benefit. Further research is required to ascertain these specific prerequisite skills. Social stories interventions require the child to listen to the story and demonstrate understanding of the content through role plays and answering questions. Often within the applied field, these stories are used as part of a treatment package to remediate social skills issues. Table 7 provides an overview of empirical support for social stories. This table describes studies evaluating social stories interventions in terms of age of participants, the type of assessment or measure used to evaluate effectiveness, outcomes, generalized effects, and the maintenance of such outcomes over time. Test, Richter, Knight, and Spooner (2011) conducted a comprehensive review and meta-analysis on the use of Social Stories™ in social skills intervention, utilizing 28 studies. Percentage of nonoverlapping data (PND) ranged between 0 % and 97.7 %, with a median of 50 %. Kokina and Kern’s (2010) meta-analysis revealed that social stories interventions had low to questionable effectiveness in that a total median PND score stood at 62 % while a mean PND score stood at 60 %, although outcomes seemed to improve when Social Stories™ were used in general

1152

J. Holloway et al.

education settings and with target children as their own intervention agents. Reynhout and Carter (2011) utilized three single subject metrics to examine the efficacy of social stories intervention across 62 studies. While Reynhout and Carter noted substantial variation between studies, they also underlined the small clinical effect of social studies intervention on behavior. However, a number of individual studies illustrate the effectiveness of social stories intervention in improving social skills in ASD. In Delano and Snell’s (2006) experiment, a social stories intervention was carried out with three children with autism which involved reading Social Stories™, answering comprehension questions, and participating in a 10-min play session. Such an intervention resulted in higher levels of social engagement among all children with both training and novel peers, and for two children such skills generalized to a classroom setting. Furthermore, Dodd, Hupp, Jewell, and Krohn (2008) carried out a social stories intervention with two children with autism where levels of a prosocial behavior (i.e., giving compliments) increased and levels of a problem social skill (i.e., excessive directions) decreased. Scattone, Tingstrom, and Wilczynski (2006) observed an increase in appropriate social interactions for two out of three children following social stories intervention and suggested that while Social Stories™ appear effective for some children with ASD, the population for which Social Stories™ are most effective has not yet been identified.

Meta-analysis of Social Skills Interventions A number of meta-analyses have been conducted exploring the effectiveness of behavioral approaches to social skills intervention in ASD, especially in terms of peer-mediated and video-modeling approaches. Wang and Spillane’s (2009) metaanalysis on evidence-based social skills intervention for children with ASD included examinations of outcomes for studies utilizing peer-mediated and videomodeling approaches. While Wang and Spillane noted that both peer-mediated and video-modeling approaches met the criteria for being evidence-based, they also investigated percentage of nonoverlapping data points (PND), which showed that video modeling alone met criteria for being evidence-based as well as demonstrating high levels of effectiveness. In addition, Wang, Cui, and Parrila’s (2010) metaanalysis utilized 64 research studies by way of a hierarchical linear modeling (HLM) approach in order to delineate the effectiveness of peer-mediated and video-modeling approaches. Wang et al.’s results revealed that both approaches significantly and equally improved social performance among children with ASD and that age represented a significant moderator for such effectiveness. Bellini et al. (2007) conducted a meta-analysis of 55 single subject designs to examine the effectiveness of school-based social skills interventions for children with ASD. The outcomes of the analysis revealed social skills interventions have low treatment effects and low generalization outcomes across participants, play stimuli, and setting. The authors reported that their findings were in agreement with other meta-analyses such as that conducted by Mathur et al. (1998). They noted that


1153

when comparing intervention settings (i.e., classroom vs. “pull out” sessions), there was significant difference in terms of intervention, generalization, and maintenance effects. The natural classroom environment promoted better social skills outcomes than taking the children to unnaturalistic environments to deliver the program. Finally, in reference to the work of Gresham et al. (2001), the authors concurred on the recommendations outlined in the table below for improving the effectiveness of social skills interventions. Recommendations for increasing the effectiveness of social skills interventions and areas for future research (Gresham et al. 2001; Bellini et al. 2007): 1. Increase the intensity and frequency of the social skills interventions as required. 2. Provide instruction within the child’s natural setting. 3. Match the intervention strategy with the social skill deficit. 4. Ensure intervention fidelity. Similar findings were reported by Flynn and Healy (2012) in a recent literature review of treatments for deficits in social skills and self-help skills in children with ASD. Flynn and Healy demonstrated varying outcomes in relation to effects of treatment, generalization, and maintenance across studies. They found PMI to have the most empirical support to treat social skills deficits in children with ASD. The authors also suggest that PRT could also be included within this category as it shares the strengths of being a naturalistic intervention.

Conclusion Upon review of the literature, it is evident that the outcomes, while strong for most interventions (e.g., PMI and PRT), are quite mixed for others (e.g., SSG and Social Stories™) in terms of generalization and maintenance effects. There are a number of issues that could lead to the varying outcomes presented within the literature. Firstly, there is not a consensus on a common definition of social skills. Another issue lies in the lack of studies reporting long-term follow-up of participant outcomes, and documentation of generalization effects is not always presented. These difficulties are further compounded by the very individualized and complex skills and learning abilities of children with ASD. Social skills interventions for children with ASD continue to require empirical attention.

Key Terms Peer-mediated intervention (PMI). “A treatment approach in which peers (e.g., classmates) are trained to act as intervention agents, implementing instructional programs, behavioral interventions, and facilitating social interactions” (Chan et al. 2009, p. 877). Pivotal response training (PRT). Pivotal response training (PRT) utilizes natural learning opportunities to target and change key social skills in children with ASD. PRT provides a set of procedures designed to increase motivation for

1154

J. Holloway et al.

social interaction and to encourage generalization (Koegel and Koegel 2006; Pierce and Schreibman 1995). Script fading. Script-fading procedures involve the implementation of a script which functions to prompt the child with ASD to engage in conversational exchanges with others. The prompts are slowly faded back until the child can reliably emit the response in the absence of the script (Krantz and McClannahan 1993). Video-modeling intervention. A procedure that requires observation of a video of social interaction; following which, the individual is required to model the social behavior being depicted within the video (Wang et al. 2011). Social skills groups. Social skills groups involve “teaching children with autism specific core social skills within a group, with the effectiveness of outcomes being measured by improvement in the specific skills without an expectation of generalization to untaught behaviors” (Barry et al. 2003, pp. 687 and 688). Joint attention training. Joint attention training involves skills in “sharing attention with others through pointing, showing and coordinated looks between objects and people” (Kasari et al. 2006, p. 611). Social stories. Social stories can be defined as “brief, individualized stories written to teach a social skill or behavior, or about a concept or event” (Bohlander et al. 2012, p. 6).

Key Facts • There is no consensus in the literature on a definition for social skills. • Social skills targets and interventions change with the child’s age and ability level. • Many social skills interventions require specific prerequisite skills before beginning treatment. • There is no consensus on one single intervention for the treatment of social skills deficits in children with ASD. • Social skills interventions taught in naturalistic settings predict better generalization and maintenance outcomes. • Peer-mediated interventions have demonstrated the best empirical support.

Summary Points • Peer-mediated interventions, pivotal response training, script fading, and video modeling have the strongest empirical support to demonstrate positive outcomes on social skills training. This is possibly due to the naturalistic context in which the intervention is presented. • Most social skills interventions (e.g., PRT, PMI, script fading, video modeling) require the child to show specific prerequisite skills prior to intervention. Empirical results demonstrate children that are higher functioning demonstrating greater outcomes.


1155

• Social skills groups and Social Stories™ have mixed outcomes in relation to treatment effects, generalization, and maintenance. This may be attributed to the unnaturalistic context in which the interventions are presented and the myriad of prerequisite skills required prior to intervention. • The research suggests that outcomes on social skills interventions could be improved through increasing the intensity and duration over which the interventions are run, providing the intervention within the child’s natural environment, and ensuring treatment fidelity (e.g., Gresham et al. 2001). • Social skills targets vary across studies (e.g., communication, initiations, and conversations). With such variations, it is difficult to fully compare the outcomes of the research. Due to such varying outcomes across social skills interventions, it is evident that more empirical attention is required.

References Apple AL, Billingsley E, Schwartz IS. Effects of video modelling on and with self-management on compliment-giving behaviors of children with high-functioning ASD. J Posit Behav Interv. 2005;7:3–6. Argott P, Buffington Townsend D, Sturmey P, Poulson C. Increasing the use of empathetic statements in the presence of a non-verbal stimulus with adolescents with autism. Res Autism Spect Dis. 2008;2:341–52. Asher SR, Wheeler V. Children’s loneliness: a comparison of rejected and neglected peer status. J Consult Clin Psych. 1985; 53:500–505. Bakeman R, Adamson LB. Coordinating attention to people and objects in mother-infant and peerinfant interaction. Child Dev. 1984;55:1278–89. Baker M, Koegel RL, Koegel LK. Increasing social behavior of young children with autism using their obsessive behaviors. J Assoc Persons Sev Handicaps. 1998;23:300–8. Banda DR, Hart SL, Liu-Gitz L. Impact of training peers and children with autism on social skills during centre time activities in inclusive classrooms. Res Autism Spect Dis. 2010; 4:619–25. Barry TD, Klinger LG, Lee JM, Palardy N, Gilmore T, Bodin SD. Examining the effectiveness of an outpatient clinic-based social skills group for high-functioning children with autism. J Autism Dev Disord. 2003;33:685–701. Bass JD, Mullick JA. Social play skill enhancement of children with autism using peers and siblings as therapists. Psych in the School. 2007;44:727–34. Bellini S, Akullian J. A meta-analysis of video modelling and video-self modelling interventions for children and adolescents with autism spectrum disorders. Except Child. 2007;73:261–84. Bellini S, Peters JK, Benner L, Hopf A. A meta-analysis of school-based social skills interventions for children with autism spectrum disorders. Remedial Spec Ed. 2007;28:153–62. Bohlander AJ, Orlich F, Varley CK. Social skills training for children with autism. Pediatr Clin N Am. 2012;59:165–74. Cappadocia MC, Weiss JA. Review of social skills training groups for youth with Asperger syndrome and high functioning autism. Res Autism Spect Dis. 2010;3:70–8. Castorina LL, Negri LM. The inclusion of siblings in social skills training groups for boys with Asperger syndrome. J Autism Dev Disord. 2011;41:73–81. Chan JM, Lang R, Rispoli M, O’ Reilly M, Sigafoos J, Cole H. Res Autism Spect Dis. 2009;3:876–89. Charlop MH, Milstein JP. Teaching autistic children conversational speech using video modeling. J Appl Behav Anal. 1989;220:275–85.

1156

J. Holloway et al.

Chung K, Reavis S, Mosconi M, Drewry J, Matthews T, Tasse´ MJ. Peer-mediated social skills training program for young children with high-functioning autism. Res Dev Disabil. 2007;28:423–36. Constantino JN, Gruber CP. Social responsiveness scale (SRS). Los Angeles: Western Psychological Services; 2005. Delano M, Snell ME. The effects of social stories on the social engagement of children with autism. J Posit Behav Interv. 2006;8:29–42. DeRosier ME, Gilliom M. Effectiveness of a parent training program for improving children’s social behavior. J Child Fam Stud. 2007; 16(5):660–70. DeRosier ME, Swick DC, Ornstein Davis N, Sturtz McMillen J, Matthews R. The efficacy of a social skills group intervention for improving social behaviors in children with high functioning autism spectrum disorders. J Autism Dev Disord. 2011;41:1033–43. Dodd S, Hupp SDA, Jewell JD, Krohn E. Using parents and siblings during a social story intervention for two children diagnosed with PDD-NOS. J Dev Phys Disabil. 2008;20:217–29. Dotson WH, Leaf JB, Sheldon JB, Sherman JA. Group teaching of conversational skills to adolescents on the autism spectrum. Res Autism Spect Dis. 2010;4:199–209. Dowtick R. A review of self-modeling and related interventions. App and Prevention Psych. 1999;8:23–39. Dunn LM, Dunn, LM. Peabody picture vocabulary test-revised: manual. Circle Pines: American Guidance Service; 1981. Elliot NE, Gresham FM. Social skills interventions for children. Behav Modif. 1993;17:287–313. Ferraioli SJ, Harris SL. Teaching joint attention to children with autism through a sibling-mediated behavioral intervention. Behav Intervent. 2011;26:261–81. Flynn L, Healy O. A review of treatments for deficits in social skills and self-help skills in autism spectrum disorder. Res Autism Spect Disord. 2012;6:431–41. Fox J, Gunter P, Brady M, et al. Using multiple peer exemplars to develop social responding of an autistic girl. In: Rutherford R, editor. Severe behavior disorders of children and youth. Reston: Council for Children with Behavioral Disorders; 1984. p. 17–26. Goldstein H. Children with autism learn to initiate to peers when social scripts modeled using a speech-generating device are faded. Evidence-based Commun Assess Interv. 2010;4:97–100. Gresham FM, Sugai G, Horner RH. Interpreting outcomes of social skills training for students with high-incidence disabilities. Teaching Except Child. 2001;67:331–44. Harper C, Symon J, Frea WD. Recess is time-in: using peers to improve social skills of children with autism. J Autism Dev Disord. 2008;38:815–26. Isaksen J, Holth P. An operant approach to teaching joint attention skills to children with autism. Behav Intervent. 2009;24:215–36. doi:10.1002/bin.292. Kaale A, Smith L, Sponheim E. A randomized controlled trial of preschool-based joint attention intervention for children with autism. J Child Psychol Psyc. 2012;53:97–105. Kasari C, Freeman S, Paparella T. Joint attention and symbolic play in young children with autism: a randomized controlled intervention study. J Child Psychol Psyc. 2006;47:611–20. Kasari C, Gulsrud A, Wong C, Kwon S, Locke J. Randomized controlled caregiver mediated joint attention engagement intervention for toddlers with autism. J Autism Dev Disord. 2010;40:1045–56. Kasari C, Rotheram-Fuller E, Locke J, Gulsrud AC. Making the connection: randomized controlled trial of social skills at school for children with autism spectrum disorders. J Child Psychol Psyc. 2012;53:431–9. Koegel RL, Koegel LK. Pivotal response treatments for autism: communication social and academic development. Baltimore: Paul H Brookes; 2006. Kokina A, Kern L. Social story interventions for students with autism spectrum disorders: a metaanalysis. J Autism Dev Disord. 2010;40:812–26. Krantz PJ, McClannahan LE. Teaching children with autism to initiate peers: effects of a scriptfading procedure. J Appl Behav Anal. 1993;26:121–32.


1157

Krantz PJ, McClannahan LE. Social interaction skills for children with autism: a script-fading procedure for beginning readers. J Appl Behav Anal. 1998;31:191–202. Krantz PJ, MacDuff MT, McClannahan LE. Programming participation in family activities for children with autism: parent’s use of photographic schedules. J Appl Behav Anal. 1993;26:137–8. Kroeger KA, Schultz JR, Newsom C. A comparison of two group-delivered social skills programs for young children with autism. J Autism Dev Disord. 2007;37:808–17. Kuhn LR, Bodkin AE, Devlin SD, Doggett RA. Using pivotal response training with peers in special education to facilitate play in two children with autism. Evidence Educ Train Dev Disabil. 2008;43:37–45. Laushey KM, Heflin LJ. Enhancing social skills of kindergarten children with autism through the training of multiple peers as tutors. J Autism Dev Disord. 2000;30:183–92. Loveland KA, Landry SH. Joint attention and language in autism and developmental language delay. J Autism Dev Disord. 1986;16:335–49. MacDonald RPF, Anderson J, Dube WV, et al. Behavioral assessment of joint attention: a methodological report. Res Dev Disabil. 2006;27:138–50. MacDuff JL, Ledo R, McClannahan L, Krantz PJ. Using scripts and script-fading procedures to promote bids for joint attention by young children with autism. Res Autism Spect Disord. 2007;1:281–90. Mathur SR, Kavale KA, Quinn MM, Forness SR, Rutherford RB. Social skills interventions with students with emotional and behavioral problems. Beh Dis. 1998;23:193–201. Matson JL, Matson ML, Rivet TT. Social-skills treatments for children with autism spectrum disorders: an overview. Behav Modif. 2007;31:682–707. Mundy P, Hogan A, Doelring P. A preliminary manual for the abridged early social communication scales. Coral Gables, FL: University of Miami; 1996. Nikopoulos CK, Keenan M. Promoting social initiation in children with autism. Behav Intervent. 2003;18:87–108. Nikopoulos CK, Keenan M. Effects of video modeling on social initiations by children with autism. J Appl Behav Anal. 2004;37:93–6. Nikopoulos CK, Keenan M. Using video modeling to teach complex social sequences to children with autism. J Autism Dev Disord. 2007;37:678–93. Ollendick TH, Schmidt CR. Social learning constructs in the prediction of peer interaction. J Clin Child Psychol. 1987;16:80–7. Owen-DeSchryver JS, Carr EG, Cale SI, Blakely-Smith A. Promoting social interactions between students with autism spectrum disorders and their peers in inclusive school settings. Focus Autism Other Dev Disabl. 2008;23:15–28. Partington J, Sundberg M. The assessment of basic language and learning skills (The ABLLS): an assessment, curriculum guide, and skills tracking system for children with autism or other developmental disabilities. California: Behavior Analysts; 1998. Pierce K, Schreibman L. Increasing complex social behaviors in children with autism: effects of peer-implemented pivotal response training. J Appl Behav Anal. 1995;28:285–95. Pierce K, Schreibman L. Multiple use of pivotal response training to increase social behaviors of classmates with autism: results from trained and untrained peers. J Appl Behav Anal. 1997;30:157–60. Reynhout G, Carter M. Evaluation of the efficacy of social stories using three single subject metrics. Res Autism Spect Dis. 2011;5:885–900. Rocha ML, Schreibman L, Stahmer AC. Effectiveness of training parents to teach joint attention in children with autism. J Early Intervention. 2007;29:154–72. Rogers SJ, Herbison JM, Lewis HC, Pantone J, Reis K. An approach for enhancing the symbolic, communicative, and interpersonal functioning of young children with autism or severe emotional handicaps. J Div Early Child. 1986; 10:135–48. Sarokoff RA, Taylor BA, Poulson CL. Teaching children with autism to engage in conversational exchanges: script fading with embedded textual stimuli. J Appl Behav Anal. 2001;34:81–4.

1158

J. Holloway et al.

Scattone D, Tingstrom DH, Wilczynski SM. Increasing appropriate social interactions of children with autism spectrum disorders using social stories™. Focus Autism Other Dev Disabl. 2006;21:211–22. Schertz HH, Odom SL. Promoting joint attention in toddlers with autism: a parent-mediated developmental model. J Autism Dev Disord. 2007;37:1562–75. Schreibman L, Whalen C, Stahmer A. The use of video priming to reduce disruptive transition behavior in children with autism. J Pos Beh Inter. 2000;2:3–11. Simpson A, Langone J, Ayres KM. Embedded video anti computer based instruction to improve social skills for students with autism. Ed and Training in Dev Dis. 2004;39:240–52. Stevenson CL, Krantz PJ, McClannahan LE. Social interaction skills for children with autism: a script-fading procedure for nonreaders. Behav Intervent. 2000; 15:1–20. Taylor BA. Teaching peer social skills to children with autism. In: Maurice C, Green G, Foxx RM, editors. Making a difference: behavioral interventions for autism. Texas: Pro-Ed; 2001. p. 83–96. Taylor BA, Levin L, Jasper S. Increasing play-related statements in children with autism toward their siblings: effects of video modeling. J Dev Physic Disab. 1999;11:253–64. Test DW, Richter S, Knight V, Spooner F. A comprehensive review and meta-analysis of the social stories literature. Focus Autism Other Dev Disabl. 2011;26:49–62. Thorp DM, Stahmer AC, Schreibman L. Effects of sociodramatic play on children with autism. J Autism Dev Disord. 1995;25:265–82. Trembath D, Balandin S, Togher L, Stancliffe RJ. Peer-mediated teaching and augmentative and alternative communication for preschool-aged children with autism. J Intellect Dev Dis. 2009;34:173–86. Trottier N, Kamp L, Mirenda P. Effects of peer-mediated instruction to teach use of speechgenerating devices to students with autism in social game routines. Augment Altern Commun. 2011;27:26–39. Ungerer JA, Sigman M. Symbolic play and language comprehension in autistic children. J Amer Acad Child Ps. 1981;20:318–37. Wang P, Spillane A. Evidence-based social skills interventions for children with autism: a metaanalysis. Educ Train Dev Disab. 2009;44:318–42. Wang S, Cui Y, Parrila R. Examining the effectiveness of peer-mediated and video-modelling social skills interventions for children with autism spectrum disorders: a meta-analysis in single-case research using HLM. Res Autism Spect Disord. 2010;5:562–9. Whalen C, Schreibman L. Joint attention training for children with autism using behavior modification procedures. J Child Psychol Psyc. 2003;44:456–68. Wichnick AM, Vener SM, Pyrtek M, Poulson CL. The effect of a script-fading procedure on responses to peer initiations among young children with autism. Res in Autism Spect Disord. 2010a;4:290–9. Wichnick AM, Vener SM, Keating C, Poulson CL. The effect of a script-fading procedure on unscripted social initiations and novel utterances among young children with autism. Res Autism Spect Disord. 2010b;4:51–64. Wong CS, Kasari C, Freeman S, Paparella T. The acquisition and generalization of joint attention and symbolic play skills in young children with autism. Res Pract Pers Sev D. 2007;32:103–9.