Examining Efficacy of a Social Skills Development Program For Autism

1. Fidelity to SDP model Group # __ Session # __Behavior Present /absent?  Date/ Notes Friends Group Principle 1. Greeting Group Psychotherapy: attention to group process as well as attention to individual members Leader states purpose of group during greeting. 2. Give me Five! Leaders/group members review rules for behavior. Children are told the explicit purpose of each session and what are the learning objectives. 3. Planet Game 4. Snack Leaders and members acknowledge absent members or changes in schedule. 5. Quiz Show Issues raised by members about group interactions are addressed by leaders. 6. Closing Behavior is acknowledged and addressed directly. Curriculum is specific to the composition of the students in the group and the skills they need to learn (documented in written form.) Applied Behavioral Analysis principles incorporated and acted upon by leaders Objectives for the group are operationally defined. Behaviors that impede learning are addressed through pre-planned strategies that consider the function of the behavior. Behaviors to be learned are explicitly described to group members. Member’s attempts to participate and learn new behavior are reinforced. Natural and logical reinforcers are incorporated to shape behavior. Reinforcers are designed based on child preferences. Children are allowed to make choices and indicate preferences. (At least) one strategy for promoting generalization, e.g. self monitoring, is practiced following skill mastery in the group. Evaluation of skill acquisition is planned for each new behavior taught; measurement system is defined. Examining Efficacy of a Social Skills Development Program For Autism Moira Lewis M.S., Susan Williams, Ph.D., Monika Lau M.A., Larry Scahill, MSN Ph.D., & Kathleen Koenig MSN Abstract Group Characteristics Typical Group Session Results: Randomization • Targeted N = 60 • Autism, Asperger’s Disorder, or PDD-NOS • Age 8 to 11 years; Boys & Girls • Weekly sessions; 16-week program • IQ > 70 • Parents consent for random assignment • Child assent • Co-Leaders: Psychologists, SLP’s In this randomized clinical trial of a social skills development program, 33 children with a diagnosis on the autism spectrum were randomly assigned to treatment or waiting list for a social skills program. The program entailed a 16-week intensive group socialization experience with four to five affected children and typical peers. Baseline measures of social functioning were collected, and these measures were repeated after 16 weeks for children in both groups. Using the Clinical Global Impressions Scale as the primary outcome measure, the treatment group shows significant improvement in social behavior as compared with the waiting list children. Social Skills Development Program: Yale Child Study Center Peer Tutors as Models • Ages 11-12; Boys & Girls • No clinical concerns based on the Child Behavior Checklist • Recruited from local public schools • Given a general overview and specific instructions for tutoring, prompting, or modeling each week A method for developing and enhancing social reciprocity skills in children with autism spectrum disorders. The teaching approach is based on learning theory and the science of applied behavioral analysis. Skills are taught explicitly and reinforcement is applied consistently to help the child develop a particular skill. The emphasis is on the experienceof the child in a group of peers, as group leaders and peer tutors work to shape behavior in this context. Clinical Global Impression: Improvement Score Visual Schedule for Group Sessions Peer Tutor Worksheet • Children with Autism Spectrum Disorders can: • Have trouble understanding language, especially if sentences are complicated • Keep language simple • Have trouble understanding things they can’t see, like ‘yesterday’ or ‘next week’ • Use pictures to teach things that are hard to think about abstractly • Have difficulty knowing whether their voice is too loud or too soft • Tell the child directly that they are speaking too loudly or too softly • Have trouble with touching other children when they should keep their hands to themselves • Tell the child the rule “keep your hands on your own body” What basic assumption underlies the goal of teaching social skills? • Change can be effected in a basic, innate mechanism that drives social interest and social motivation. • Changes in behavior will change the dynamic of social interaction for a child with autism from no meaningful social interaction to some meaningful social interaction. Aims Research Timeline for Groups Χ2= 9.64, p = .002 • To confirm a clinically significant change in behavior as a result of this program, • To determine the acceptability of our approach, • To assess the degree to which parent and behavioral observation measures converge, and • To develop a treatment manual for this intervention program for future studies. Baseline16 weeks32 weeks Assessing Maintenance of Gains: 9 Month Follow-Up randomization Critical Issue randomization Translating what we know about social development and what we know about learning in ASD’s into a structured program, and measuring results. Sample Activity Pre and Post-Assessment • Pre-treatment • Autism Diagnostic Interview /Social behavior Questionnaire • Autism Diagnostic Observation Schedule • Social Competence Inventory • Observation of Social • Behavior at school • Vineland Adaptive Behavior Scales • Post-treatment • Vineland Adaptive Behavior Scales • Social Competence Inventory • Observation of Social Behavior at School • Clinical Global Impressions (Rater is blinded to treatment condition) • Parent Satisfaction survey Future Directions • Replication study at Virginia Commonwealth University • Susan Williams, Ph.D. Principal Investigator • Multi-site study: clinical and community settings • Kathleen Koenig, MSN, Principal Investigator • Development of change measures for social behavior targeted towards the deficits in ASD’s, using computerized measurement of relevant behaviors • Development of a Social Interaction Laboratory in collaboration with Dr. Ami Klin to quantify social behaviors using computational systems that can provide objective, quantitative measurements of social cues. • Development of intervention that combines Social Skills Development with • Computerized Face training in collaboration with Dr. Robert Schultz. Treatment Plans for Each Child Critical Components Child: Date: Parent Concerns: Prosocial target behaviors: specific behavioral goals (Examples: initiating appropriately with peers, maintaining personal space boundaries, etc) Reinforcement/teaching strategies: methods to be used during the groups to increase frequency of the target behaviors. Use naturally occurring reinforcers when possible: praise, responsibility to do a special task, attention to the child. Competing behaviors: child’s behaviors that are interfering with his or her use of appropriate target social behaviors. Use information from functional analysis conducted during the first three group sessions. List motivators for each behavior. Strategies for prevention/replacement behaviors: methods to be used during the groups to decrease frequency and severity of competing behaviors. (Examples: ignoring, punishment (describe), teaching functional communication skill, teaching replacement behavior, etc.) Fidelity To Social Skills Program Model: A Checklist Activities designed to learn and practice appropriate Interaction Parent Participation Manual Development Typically Developing Peers • Conceptual basis of the SSDP program • Learning principles • Structure of the group • Curriculum, Use of peer tutors • 4. Research with SSDP • Fidelity, Efficacy • 5. Measurement of progress • Activity Modules Functional assessment of behavior Group therapy experience: focus on process Funding • Organization for Autism Research • 2003-2004 • Beatrice Renfield –Yale School of Nursing Clinical Initiatives Fund • 2005-2006 Moira.Lewis@yale.edu, Kathy.Koenig@yale.edu www.autism.fm ASHA 2006