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Study summary:
This study addresses the need for effective interventions to improve peer relationships at school. In this study, we compare the effects of two separate, manualized school-based interventions designed to improve social outcomes for young children with autism. These interventions took place in small groups during lunch and recess – times when children with autism are most likely to be isolated. The first intervention (referred to as the SKILLS group) is a therapist-led curriculum that teaches social behavioral skills to children having identified social difficulties. In the second type of intervention (called the ENGAGE group), the interventionist used a social engagement curriculum to create opportunities for the child with ASD to interact naturally with peers from their class. This model is more interactive and peer-directed. The results of the interventions will be compared, providing information regarding the type of service delivery, generalizability, and necessary components that are critical for social success at school.

Background:
Children with ASD are integrating into general education classrooms at a higher rate than ever. Many parents prefer these inclusion classrooms for the social opportunities they offer. Unfortunately, these children are at a distinct disadvantage when it comes to developing and maintaining peer relationships, particularly in the less structured, more socially driven activities like lunch and recess. Without direct aid and instruction to address these issues, children with ASD are often isolated and without the skills necessary to pursue satisfying relationships. A consistent message in current studies is that social skills generalize weakly if at all to new settings and individuals, so there is a need for interventions that reach beyond these challenges.

Research Design:
Study participants include 120 school-aged children with ASD and their typical peers recruited across the four participating sites over 3 years. We targeted schools with fully included children with ASD, specifically in areas with diverse, underserved populations. Children ages 6 to 12 (1st to 5th grade) were randomized to either the SKILLS or the ENGAGE social skills group for 20-30 minute sessions, twice a week, over the course of 8 weeks.

 

SKILLS Model*: The SKILLS intervention group targeted a specific set of social skills and behaviors through a guided curriculum. The intervention was delivered to a small group of children – the target child with ASD plus 2-3 children from other classrooms (students that teachers nominated as needing additional social support). In each session, children received lessons, practiced new skills, and reviewed materials from the previous weeks. They were also given weekly homework assignments to reinforce the topics discussed in the group, such as: greetings and goodbyes, body language, dealing with emotions, and friendship tips. These sessions took place in a classroom during lunch and on the playground during recess. *The manual for this intervention was developed by the Seattle Children’s Hospital Research Foundation.

ENGAGE Model*: The ENGAGE intervention promoted social skills through fostering natural relationships between a child with ASD and 2-3 of their typical classmates (students that teachers nominated as ideal social models). Interventionists focused on teaching peer acceptance and social engagement with peers through direct instruction and practice in common social situations. The first half of the session took place in a classroom, where the group participated in activities like conversational exercises, structured games, free play, improvised story-telling and music. The second half took place on the playground, expanding the context and giving the child with ASD an opportunity to practice new skills in their natural environment with the help of their peers. *The manual for this intervention was developed by UCLA.


 
 
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This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UA3 MC 11055 (AIR-B). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
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