Preschool Social Skills Intervention for Children with Autism Spectrum Disorders: a Child Directed Approach

Background: Impaired social communication skills including delayed imitation, turn taking, and pretend play are some of the earliest symptoms of ASD.  These impairments have been related to later difficulties in language development, play skills, and social relationships.  Although adult-directed early intensive behavioral intervention approaches used in most preschool autism education settings have been shown to increase IQ and language abilities, they have not been shown to improve social skills (Kasari et al., 2006).  Thus, there is a need for social skills intervention programs that utilize more child-directed intervention approaches.

Objectives: To design a child-directed social skills curriculum that can be implemented by a variety of social interaction partners within a preschool (teachers, speech therapists, or peers with typical development) or home setting (parents or siblings).  This child-directed intervention therapy program was developed to target spontaneous imitation, turn-taking, joint attention, and social reciprocity in preschoolers with ASD.  The goals of this program include increasing the child’s attention to other people, increasing the child’s eye contact and ability to combine eye contact with sounds or words, increasing the child’s ability to learn through imitation, increasing the child’s turn-taking during play, and increasing the child’s playfulness when interacting with others.

Methods: Thus far, nine children (chronological ages 27-55 months) have completed a multiple baseline design intervention program.  The program consisted of a pre-assessment, 4 to 8 free play baseline sessions, 10 twice weekly 30 minute intervention sessions, and a post-assessment.  This intervention contained 3 phases that built on each other:  imitation in which the adult imitated the child, turn-taking in which the adult imitated the child after pausing briefly to create a turn-taking game, and joint attention in which naturalistic rewards were provided when the child made a spontaneous nonverbal or verbal request for an object.  Outcome was evaluated by measuring imitation, joint attention and turn-taking changes from pre- to post-treatment using the Early Social Communication Scales (ESCS), the Screening Tool for Autism in Two-Year-Olds (STAT), and the Motor Imitation Scale.  Additionally, targeted probes were administered at the beginning and end of each therapy session.

Results: Preliminary results from the pre- to post-treatment data indicate significant increases in spontaneous (i.e., child directed) social skills.  Specifically, ESCS measures of gaze shifts, vocalizations, and gestures to initiate joint attention and STAT measures of turn-taking increased significantly from pre- to post-treatment.  Preliminary results indicate no significant changes on measures of adult directed social skills (i.e., responses to adult bids for joint attention or imitation).  Analyses are ongoing for measures collected during each therapy session.

Conclusions: Preliminary results indicate that a developmentally-based child-directed intervention therapy program for children with ASD has a positive impact on the development and use of spontaneous early social skills.  The fact that adult directed behaviors did not improve during the intervention suggests that this intervention has a specific effect on the type of child directed skills that were targeted.  Future research is needed to examine the effectiveness of teaching parents and peers these intervention techniques.