Social Inclusion of Children with ASD at School: Effects of a Randomized Controlled Treatment Study

Background: Positive peer interactions and friendships remain elusive or problematic for most children with ASD. Children with ASD are often observed as isolated or on the periphery of social networks in their school environment. While many children are in social skills groups, these are often off campus or in a clinic. Few interventions are conducted in the child's natural environment of school. Objectives: The main objective of this study was to compare the intervention effects of four child conditions (child- or peer-mediated, combined, or no intervention) on the peer relationships and social networks of children with autism at school. A secondary objective was to examine the maintenance effects of the intervention over 3 months. Methods: Participants included 60 fully-included high functioning and ethnically diverse children with autism (54 male, 6 female) from grades 1-5 from 56 classrooms in 30 different schools across the Los Angeles area. They were an average of 8.14 years old (SD=1.56), with an average IQ of 90.97 (SD=16.33). Children with autism and their peers completed a friendship survey at the beginning and end of a 12 session, 6-week social skills intervention and once again at a 12-week follow-up that was coded following the methods outlined in Cairns and Cairns (1994). All intervention sessions occurred at the target child's school during recess periods twice a week. Results: Children with autism who received the combined treatment group had the most improvement in their social network salience and these effects were maintained at follow-up for 36 children who did not switch classrooms, F(1,28) = 0.24, p = 0.63. In addition, there was a significant main effect of peer treatments, F(1, 52) = 4.03, p<.05 after controlling for baseline scores. Pairwise comparisons revealed that children with autism who received a treatment with a peer -mediated component had significantly higher social network salience (0.49 ± 0.04) compared to children with autism who did not receive a treatment with a peer-mediated component (0.34 ± 0.04). Conclusions: This study reports changes in children's social network ratings and friendships in 12 school-based intervention sessions. Social skills can be taught to children with autism and the best avenue to do so is through a multi-agent model that involves the target child and typically-developing peers. Targeting only the child with autism did not improve the child's social position in the class or reciprocated friendships suggesting that an adult-mediated one-on-one approach at school may be more stigmatizing to the child, setting him/her apart from his/her classmates.