Social Cognition and Interaction Training In Autism (SCIT-A): Development, Feasibility and Preliminary Findings with Adolescents

Background:  Social Cognition and Interaction Training for Autism (SCIT-A; Turner-Brown et al., 2009) is group intervention that has shown promise for improving social-cognitive functioning for adults with ASD.  SCIT-A utilizes cognitive and behavioral techniques to target underlying deficits thought to lead to impairments in social functioning autism, such as emotion perception, theory of mind, as well as social attention. SCIT-A has not yet been evaluated with adolescents with ASD. 

Objectives:  The objectives of this study were to develop a comprehensive treamtent manual and conduct a small randomized trial to test initial efficacy of SCIT-A and estabilsh effect sizes for adolescents with ASD.

Methods:  The SCIT-A manual was developed based upon pilot study results, focus group feedback, and expert panel review.  The resulting manual describes a 12-week group therapy program for adolescents with accompanying parent education to focus on social attention, social cognition and social skills. Participants in the initial efficacy study included adolescents with ASD meeting the following criteria: a) age 15 – 22; b) Verbal IQ >= 80, c) ASD cutoff on ADOS, d) no visual/hearing impairment.  Baseline assessments included measures of social cognition, social functioning, and well-being, and included a combination of estabilshed and newly developed measures tapping parent report and adolescent performance for each construct.  Participants were randomized into the SCIT-A condition or a Treatment as Usual (TAU) condition.  Twelve adolescents were randomized into the SCIT-A condition and ten into the TAU condition across two cohorts.  No significant differences between SCIT-A and TAU groups for gender, ethnicity, age, IQ, or baseline functioning were present. Participants returned for post- and 3-month follow-up assessments.

Results:  Feasibility. Group attendance was very high; no participant missed more than one session in either cohort. Satisfaction. Satisfaction ratings for adolescents and their parents were positive in both cohorts.  Social cognition.  Within group effect sizes for SCIT-A participants from baseline to post-SCIT-A were medium (d = .78) for parent report of social cognition, while no effects were found for performance on social cognitive tasks (ds = .07 - .18).  Social Functioning. Within group effect size for SCIT-A participants from baseline to post-SCIT-A were large for social functioning (ds = .96 – 1.29) and medium for self-reported perceived well being (d = .78).  Similar results were found at 3-month follow-up. Changes in all measures were not statistically different from changes noted in the TAU condition. However, within group effect sizes for the TAU condition for all measures indicated no effect to small effects across all measures at post- and 3-month follow-up assessments.

Conclusions:  Results of this small randomized trial were encouraging. SCIT-A was feasible and acceptable to families, and parents found the intervention to be useful for their adolescents. Effect sizes for social cognition and functioning were medium to large for SCIT-A participants, as were self-reports of perceived well being, suggesting SCIT-A holds promise as a group-based intervention for adolescents with ASD. Given the lack of significant differences found between SCIT-A and TAU, replication with a larger sample size is warranted. Future directions will be discussed.