Peer Training Outperforms Traditional Autism Interventions

Training classmates produces greater gains in social inclusion than even one-on-one training between therapist and child 

 

Many children with autism attend mainstream classrooms for at least part of the school day. Many struggle socially and are at risk of being isolated or bullied. The most common intervention involves enrollment in social skills training in a clinic or therapist’s office. The instructor models appropriate social skills either one-on-one or with a group of socially challenged children. Both types of intervention improve social skills – at least within the clinics and academic centers where they’ve been studied. Their results in real-world settings have been less clear.

This year, the findings of a landmark study argue for a shift away from relying solely on such standard social-skills training and toward greater emphasis on teaching classmates how to interact with children who have social challenges.

The study was led by educational psychologist Connie Kasari, Ph.D., of the UCLA Center for Autism Research and Treatment. It appeared in the April issue of the Journal of Child Psychology and Psychiatry.

The researchers enrolled 60 students with autism spectrum disorder (ASD), in grades 1 through 5. All attended mainstream classes for at least 80 percent of the school day. The researchers randomly assigned them into one of four groups:

  • One group received one-on-one training with an adult for six weeks. The provider helped the child practice social skills such as how to enter a playground game or conversation.
  • One group didn’t receive any social skills training, but had three typically developing classmates learn strategies for engaging children with social difficulties. These classmates did not know the identity of the child with autism.
  • One group received both one-on-one and classmate training.
  • One group received neither intervention in the first phase of the study and later participated in one of the interventions.

All training sessions lasted 20 minutes, twice weekly for six weeks. During the intervention, observers watched and noted playground behaviors. These observers did not know which children had received which intervention. Three months after training completion, the investigators returned to observe the children with autism and interview them and their teachers.

Those whose classmates received training – including those who themselves received no social skills counseling – spent less time alone on the playground and had more classmates naming them as friends, compared to those who received only one-on-one training or no intervention.

In addition, their teachers reported that the students with autism showed significantly improved classroom social skills following training of their peers. By comparison, the teachers noted no changes in the social skills of children with autism who received one-on-one coaching without any training of their classmates. Like the playground observers, the teachers were not told who had received which intervention.

In the situation where classmates were trained, the children with autism continued to demonstrate improved social connectedness even after they changed classrooms and classmates with the new school year.

“I thought working through the peers would be more indirect, and yet we found the exact opposite,” Dr. Kasari said of her surprise findings. “The model where an adult works directly with the child with autism just wasn’t as effective.”

However, the study also highlighted areas of continued concern. For example, while peer engagement lessened isolation on the playground, it did not improve interactions across all areas of playground behavior. Many of the children with autism still struggled with taking turns, engaging in conversations and other joint activities. Also, despite greater inclusion in social circles, the children with ASD did not seem to recognize that they had more friends.

“We found that even if a child with autism is popular, he still has a really tough time on the playground,” Dr. Kasari said.

The National Institutes of Health (NIH) sponsored the research. Dr. Kasari has also received several Autism Speaks research grants that build on her work in schools and with underserved populations of children with ASD. Two of her Autism Speaks pilot grants became the basis of larger NIH-sponsored research studies.

“This is ground-breaking work that points to the most effective ways of helping children with autism successfully navigate their social worlds at school,” noted Geri Dawson, Ph.D., chief science officer at Autism Speaks. “It is so important that these interventions be tested in real-world settings so we can more easily adapt research findings to the community. That is one of the strengths of this study.” 

Kasari C, Rotheram-Fuller E, Locke J, Gulsrud A. Making the connection: randomized controlled trial of social skills at school for children with autism spectrum disorders. J Child Psychol Psychiatry. 2012; 53(4): 431-9.

Next: Arbaclofen Shows Promise for Treating Core Symptoms of Autism

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