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Enhancing Social Initiations Using Naturalistic Behavioral Intervention: Outcomes from a Randomized Controlled Trial for Children with Autism

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Abstract

Deficits in social skills are common in children with Autism Spectrum Disorder (ASD), and there is an urgent need for effective social skills interventions, especially for improving interactions with typically developing peers. This study examined the effects of a naturalistic behavioral social skills intervention in improving social initiations to peers through a randomized controlled trial. Analyses of multimethod, multi-informant measures indicated that children in the active group (SIMI) demonstrated greater improvement in the types of initiations which were systematically prompted and reinforced during treatment (i.e., behavior regulation). Generalization to joint attention and social interaction initiation types, as well as collateral gains in broader social functioning on clinician- and parent-rated standardized measures were also observed.

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References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). Washington, DC: American Psychiatric Publishing.

    Book  Google Scholar 

  • Bauminger-Zviely, N., Karin, E., Kimhi, Y., & Agam-Ben-Artzi, G. (2014). Spontaneous peer conversation in preschoolers with high-functioning autism spectrum disorder versus typical development. Journal of Child Psychology and Psychiatry, 55(4), 363–373.

    Article  PubMed  Google Scholar 

  • Bellini, S., Peters, J. K., Benner, L., & Hopf, A. (2007). A meta-analysis of school-based social skills interventions for children with autism spectrum disorders. Remedial and Special Education, 28(3), 153–162.

    Article  Google Scholar 

  • Bruinsma, Y. E. M. (2005). Increases in the joint attention behavior of eye gaze alternation to share enjoyment as a collateral effect of Pivotal Response Treatment for three children with autism. Dissertation Abstracts International: Section B: The Sciences and Engineering, 65(9-B), 4811.

    Google Scholar 

  • Cappadocia, M. C., & Weiss, J. A. (2011). Review of social skills training groups for youth with Asperger syndrome and high functioning autism. Research in Autism Spectrum Disorders, 5(1), 70–78.

    Article  Google Scholar 

  • Chang, Y. C., & Locke, J. (2016). A systematic review of peer-mediated interventions for children with autism spectrum disorder. Research in Autism Spectrum Disorders, 27(3), 1–10.

    Article  PubMed  PubMed Central  Google Scholar 

  • Constantino, J. N., & Gruber, C. P. (2012). Social responsiveness scale: SRS-2 software kit. Torrance: Western Psychological Services.

    Google Scholar 

  • Dawson, G. (2008). Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Developmental Psychopathololgy, 20(3), 775–803.

    Article  Google Scholar 

  • de Boer, A., & Pijl, S. J. (2016). The acceptance and rejection of peers with ADHD and ASD in general secondary education. The Journal of Educational Research, 109(3), 325–332.

    Article  Google Scholar 

  • DeMayo, M. M., Young, L. J., Hickie, I. B., Song, Y. J. C., & Guastella, A. J. (2019). Circuits for social learning: A unified model and application to autism spectrum disorder. Neuroscience and Biobehavioral Reviews, 107, 388–398.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fredeen, R. (2005). Increasing initiations towards peers in children with autism using pivotal response training and collateral gains in quality of initiations. Santa Barbara: University of California.

    Google Scholar 

  • Gengoux, G. W. (2015). Priming for social activities: Effects on interactions between children with autism and typically developing peers. Journal of Positive Behavior Interventions, 17, 181–192.

    Article  Google Scholar 

  • Gengoux, G. W., & Vismara, L. A. (2019). Expanding friendship opportunities for children with autism spectrum disorder. In R. L. Koegel & L. K. Koegel (Eds.), Pivotal response treatment for autism spectrum disorders (2nd ed., pp. 81–104). Baltimore: Paul H. Brookes.

    Google Scholar 

  • Gengoux, G. W., Abrams, D. A., Schuck, R., Millan, M. E., Libove, R., Ardel, C. M., et al. (2019). A Pivotal Response Treatment package for children with autism spectrum disorder: An RCT. Pediatrics, 144(3), 23–34.

    Article  Google Scholar 

  • Gillies, R. (2016). Cooperative learning: Review of research and practice. Australian Journal of Teacher Education, 41(3). https://doi.org/10.14221/ajte.2016v41n3.3.

  • Guy, W. (1976). ECDEU assessment manual for psychopharmacology. Rockville: U.S. Department of Health, Education, and Welfare.

    Google Scholar 

  • Hardan, A. Y., Gengoux, G. W., Berquist, K. L., Libove, R. A., Ardel, C. M., Phillips, J., et al. (2015). A randomized controlled trial of Pivotal Response Treatment Group for parents of children with autism. Journal of Child Psychology and Psychiatry, 56(8), 884–892.

    Article  PubMed  Google Scholar 

  • Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381.

    Article  PubMed  Google Scholar 

  • Kamps, D., Royer, J., Dugan, E., Kravits, T., Gonzalez-Lopez, A., Garcia, J., et al. (2002). Peer training to facilitate social interaction for elementary students with autism and their peers. Exceptional Children, 68(1), 173–187.

    Article  Google Scholar 

  • Ke, F., Whalon, K., & Yun, J. (2018). Social skill interventions for youth and adults with autism spectrum disorder: A systematic review. Review of Educational Research, 88(1), 3–42. https://doi.org/10.3102/0034654317740334.

    Article  Google Scholar 

  • Koegel, L. K. (2012). Improving socialization in individuals with autism. Santa Barbara: University of California.

    Google Scholar 

  • Koegel, R. L., & Koegel, L. K. (2019). Pivotal response treatment for autism spectrum disorders (2nd ed.). Baltimore: Paul H. Brookes.

    Google Scholar 

  • Koegel, L. K., Stiebel, D., & Koegel, R. L. (1998). Reducing aggression in children with autism toward infant or toddler siblings. Journal of the Association for Persons with Severe Handicaps, 23(2), 111–118.

    Article  Google Scholar 

  • Koegel, L. K., Koegel, R. L., Shoshan, Y., & McNerney, E. (1999). Pivotal response intervention II: Preliminary long-term outcome data. Journal of the Association for Persons with Severe Handicaps, 24(3), 186–198.

    Article  Google Scholar 

  • Koegel, R. L., Werner, G. A., Vismara, L. A., & Koegel, L. K. (2005). The effectiveness of contextually supported play date interactions between children with autism and typically developing peers. Research and Practice for Persons with Severe Disabilities, 30(2), 93–102.

    Article  Google Scholar 

  • Koegel, R. L., Vernon, T. W., & Koegel, L. K. (2009). Improving social initations in young children with autism using reinforcers with embedded social interactions. Journal of Autism and Developmental Disorders, 39(9), 1240–1251.

    Article  PubMed  PubMed Central  Google Scholar 

  • Koegel, L. K., Vernon, T. W., Koegel, R. L., Koegel, B. L., & Paullin, A. W. (2012). Improving social engagement and initiations between children with autism spectrum disorder and their peers in inclusive settings. Journal of Positive Behavior Interventions, 14(4), 220–227.

    Article  PubMed  PubMed Central  Google Scholar 

  • Koegel, L. K., Park, M. N., & Koegel, R. L. (2014a). Using self-management to improve the reciprocal social conversation of children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(5), 1055–1063.

    Article  PubMed  PubMed Central  Google Scholar 

  • Koegel, R. L., Bradshaw, J. L., Ashbaugh, K., & Koegel, L. K. (2014b). Improving question-asking initation in young children with autism using pivotal response treatment. Journal of Autism and Developmental Disorders, 44, 816–827.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule, second edition (ADOS-2) manual (part I): Modules 1–4. Torrance: Western Psychological Services.

    Google Scholar 

  • Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3–10.

    Article  PubMed  Google Scholar 

  • National Autism Center. (2015). Findings and conclusions: National standards project, phase 2. Randolph: Author.

    Google Scholar 

  • Niemiec, R. M., Shogren, K. A., & Wehmeyer, M. L. (2017). Character strengths and intellectual and developmental disability: A strengths-based approach from positive psychology. Education and Training in Autism and Developmental Disabilities, 52(1), 13–22.

    Google Scholar 

  • Olsson, M. B., Holm, A., Westerlund, J., Hedvall, A. L., Gillberg, C., & Fernell, E. (2017). Children with borderline intellectual functioning and autism spectrum disorder: Developmental trajectories from 4 to 11 years of age. Neuropsychiatric Disease and Treatment, 13, 2519–2526.

    Article  Google Scholar 

  • Pickard, H., Happé, F., & Mandy, W. (2018). Navigating the social world: The role of social competence, peer victimisation and friendship quality in the development of social anxiety in childhood. Journal of Anxiety Disorders, 60, 1–10.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pierce, K., & Schreibman, L. (1995). Increasing complex social behaviors in children with autism: Effects of peer-implemented pivotal response training. Journal of Applied Behavior Analysis, 28(3), 285–295.

    Article  PubMed  PubMed Central  Google Scholar 

  • R Core Team. (2019). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. https://www.R-project.org/

  • Rao, P. A., Beidel, D. C., & Murray, M. J. (2008). Social skills interventions for children with asperger’s syndrome or high-functioning autism: A review and recommendations. Journal of Autism and Developmental Disorders, 38, 353–361. https://doi.org/10.1007/s10803-007-0402-4.

    Article  PubMed  Google Scholar 

  • Reichow, B., & Volkmar, F. R. (2010). Social skills interventions for individuals with autism: Evaluation for evidence-based practices within a best evidence synthesis framework. Journal of Autism and Developmental Disorders, 40(2), 149–166.

    Article  PubMed  Google Scholar 

  • Reichow, B., Steiner, A. M., & Volkmar, F. (2013). Cochrane review: Social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD). Evidence- Based Child Health: A Cochrane Review Journal, 8(2), 266–315. https://doi.org/10.1002/ebch.1903.

    Article  Google Scholar 

  • Rodriguez, P. P., & Gutierrez, A. (2017). A comparison of two procedures to condition social stimuli to function as reinforcers for children with autism. Behavioral Development Bulletin, 22(1), 159–172.

    Article  Google Scholar 

  • Roid, G. H. (2003). Stanford-Binet intelligence scales (5th ed.). Itasca: Riverside Publishing.

    Google Scholar 

  • Scahill, L., & Lord, C. (2004). Subject selection and characterization in clinical trials in children with autism. CNS Spectrums, 9(1), 22–32.

    Article  PubMed  Google Scholar 

  • Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., et al. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411–2428.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schulz, K. F., Altman, D. G., Moher, D., & for the CONSORT Group. (2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. Annals of Internal Medicine, 152. Epub 24 March.

  • Shrout, P. E., & Fleiss, J. L. (1979). Intraclass correlations: Uses in assessing rater reliability. Psychological Bulletin, 86(2), 420–431.

    Article  PubMed  Google Scholar 

  • Simonoff, E., Kent, R., Stringer, D., Lord, C., Briskman, J., Lukito, S., Pickles, A., Charman, T., & Baird, G. (2020). Trajectories in symptoms of autism and cognitive ability in autism from childhod to adult life: Findings from a longitudinal epidemiological cohort. Journal of the American Academy of Child & Adolescent Psychiatry, 59(12), 1342–1352.

    Article  Google Scholar 

  • Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales: Second edition (Vineland II), survey interview form/caregiver rating form. Livonia, MN: Pearson Assessments.

    Google Scholar 

  • Stahmer, A. C. (1995). Teaching symbolic play skills to children with autism using pivotal response training. Journal of Autism and Developmental Disorders, 25(2), 123–141.

    Article  PubMed  Google Scholar 

  • Steinbrenner, J. R., Hume, K., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2020). Evidence-based practices for children, youth, and young adults with Autism. The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism Evidence and Practice Review Team.

  • Tomaszewski, B., Hepburn, S., Blakely-Smith, A., & Rogers, S. J. (2020). Developmental trajectories of adaptive behavior from toddlerhood to middle childhood in autism spectrum disorder. American Journal on Intellectual and Developmental Disabilities, 125, 155–169.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vernon, T. W., Koegel, R. L., Dauterman, H., & Stolen, K. (2012). An early social engagement intervention for young children with autism and their parents. Journal of Autism and Developmental Disorders, 42(12), 2702–2717.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vismara, L. A., Gengoux, G. W., Boettcher, M. A., Koegel, R. L., & Koegel, L. K. (2006). Facilitating play dates for children with autism and typically developing peers in natural settings: A training manual. Santa Barbara: University of California.

    Google Scholar 

  • Watkins, L., Kuhn, M., Ledbetter-Cho, K., Gevarter, C., & O’Reilly, M. (2017). Evidence-based social communication interventions for children with autism spectrum disorder. The Indian Journal of Pediatrics, 84(1), 68–75.

    Article  PubMed  Google Scholar 

  • Watkins, L., O’Reilly, M., Kuhn, M., & Ledbetter-Cho, K. (2019). An interest-based intervention package to increase peer social interaction in young children with autism spectrum disorder. Journal of Applied Behavior Analysis, 52(1), 132–149.

    Article  PubMed  Google Scholar 

  • Wetherby, A. M. (1986). Ontogeny of communicative functions in autism. Journal of Autism and Developmental Disorders, 16(3), 295–316.

    Article  PubMed  Google Scholar 

  • Wetherby, A. M., & Prutting, C. (1984). Profiles of communication and cognitive-social abilities in autistic children. Journal of Speech and Hearing Research, 27(3), 364–377.

    Article  PubMed  Google Scholar 

  • Wetherby, A. M., Cain, D. H., Yonclas, D. G., & Walker, V. G. (1988). Analysis of intentional communication of normal children from the prelinguistic to the multiword stage. Journal of Speech, Language, and Hearing Research, 31(2), 240–252.

    Article  Google Scholar 

  • White, S. W., Keonig, K., & Scahill, L. (2007). Social skills development in children with autism spectrum disorders: A review of the intervention research. Journal of Autism and Developmental Disorders, 37(10), 1858–1868.

    Article  Google Scholar 

  • Wolfberg, P., DeWitt, M., Young, G. S., & Nguyen, T. (2015). Integrated play groups: Promoting symbolic play and social engagement with typical peers in children with ASD across settings. Journal of Autism and Developmental Disorders, 45(3), 830–845.

    Article  PubMed  Google Scholar 

  • Wong, C., & Kasari, C. (2012). Play and joint attention of children with autism in the preschool special education classroom. Journal of Autism and Developmental Disorders, 42(10), 2152–2161.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This project was funded by a grant from the Stanford Maternal & Child Health Research Institute and the Lucile Packard Foundation for Children’s Health. This work was also supported in part by The Teresa and Charles Michael Fund for Autism Research and by the Stanford Clinical and Translational Science Award (CTSA) to Spectrum (UL1 TR001085). The CTSA program is led by the National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Author notes

  1. Jessica M. Schwartzman

    Present address: Vanderbilt University Medical Center, 1501 23rd Avenue South, Nashville, TN, 37209, USA

  2. Rachel K. Schuck

    Present address: University of California Santa Barbara, Special Education, Disability, and Risk Studies, 18 Ocean Road, Santa Barbara, CA, 93117, USA

  3. Andrés A. Ruiz

    Present address: Sharp Health Care, Sharp Mesa Vista Hospital, 7850 Vista Hill Ave., San Diego, CA, 92123, USA

Authors and Affiliations

  1. Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, 401 Quarry Road, Stanford, CA, 94305-5719, USA

    Grace W. Gengoux PhD, Jessica M. Schwartzman, M. Estefania Millan, Rachel K. Schuck, Andrés A. Ruiz & Antonio Y. Hardan

  2. Department of Medicine, Quantitative Sciences Unit, Stanford University, 1701 Page Mill, Palo Alto, CA, 94304, USA

    Yingjie Weng & Jin Long

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  1. Grace W. Gengoux PhD
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Contributions

Drs. Gengoux and Hardan conceptualized and designed the study, supervised data collection, and reviewed and revised the manuscript; Dr. Gengoux supervised treatment implementation; Dr. Schwartzman assisted in the collection, analysis, and interpretation of data and drafted the initial manuscript; Ms. Millan and Ms. Schuck coordinated treatment implementation and data acquisition and reviewed and revised the manuscript. Dr. Ruiz and Dr. Schwartzman completed analyses of the Peer Play Observations and contributed to data acquisition and interpretation; Ms. Weng and Dr. Long provided statistical expertise to aid in the study design, analysis and interpretation of data, and description of results. All authors critically reviewed the manuscript for important intellectual content, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work.

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Correspondence to Grace W. Gengoux PhD.

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The research activities with human subjects were performed under approval of the Institutional Review Board with informed consent from the child’s parent.

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Gengoux, G.W., Schwartzman, J.M., Millan, M.E. et al. Enhancing Social Initiations Using Naturalistic Behavioral Intervention: Outcomes from a Randomized Controlled Trial for Children with Autism. J Autism Dev Disord 51, 3547–3563 (2021). https://doi.org/10.1007/s10803-020-04787-8

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