Objectives: This study examines the efficacy of improving overall social functioning among preschool children with ASDs using the UCLA Preschool Applied Learning of Social Skills (PALS) Program, a 15-week manualized social skills intervention.
Methods: 29 children participated in the PALS intervention as part of their enrollment in an intensive therapeutic social recreational program for children ages 3 to 6 with an ASD. Many participated in PALS multiple times due to continued enrollment in the broader social recreational program. Prior to treatment and after each round of the PALS intervention, parents and teachers rated Social Skills, Problem Behaviors, and Social Responsiveness using the Social Skills Rating System (SSRS; Gresham & Elliot, 1990) and the Social Responsiveness Scale (SRS; Constantino, 2005). PALS includes 20-minute treatment sessions administered 2-3 times per week using puppet-facilitated scripted didactic lessons with role-playing exercises by group leaders and peer models, structured and unstructured behavioral rehearsal of skills with peers, and weekly handouts for parents with strategies for reinforcing skills in other settings. Children learn concrete rules and steps of social etiquette for social communication, turn-taking, sharing, peer entry, good sportsmanship, teamwork, helping behavior, and body boundaries.
Results: Within-subjects ANOVAs were conducted for approximately 18 participants to examine treatment efficacy and improvement in social skills over time. Children who received PALS only once and/or who had missing data were excluded from the analyses. Tukey-Kramer pairwise comparisons were completed post-hoc to investigate potential continued improvement after participating in PALS a second time, followed by Bonferroni correction for conservative reporting of results. Parent-reported overall Social Responsiveness (p < .05) and Social Cognition (p < .01) on the SRS improved significantly after receiving PALS once. Teacher-reported overall Social Skills (p < .01) , Cooperation (p < .05), and Assertiveness (p < .01) on the SSRS, and parent-reported Social Communication (p < .01) on the SRS also improved significantly after receiving PALS once, and continued to improve after receiving PALS a second time. Teacher-reported overall Social Responsiveness (p < .05) and Social Awareness (p < .01) on the SRS, and Self-Control (p < .01) on the SSRS improved significantly after receiving PALS twice. Trends were found for improved teacher-reported Problem Behaviors (p = 0.0585) and Hyperactivity (p = 0.069) on the SSRS, and Social Motivation on the SRS (p = 0.054) after participating in PALS twice. Preliminary analysis of predictors of treatment success demonstrated that parent-reported Social Motivation at baseline significantly predicted parent-reported overall Social Responsiveness following PALS (p < .01); parent-reported Autistic Mannerisms was tested but not found significant.
Conclusions: These findings suggest that PALS may be efficacious in improving the social functioning of preschool-aged children with ASDs, with additional improvements expected after continued participation in PALS.