Neural Effects of Social Skills Groups for School-Aged Children with ASDs: A Randomized, Comparative Study

Background: Social skills groups are a common treatment for individuals with autism spectrum disorders (ASD). However, research evaluating the efficacy of such treatments is limited and more work is needed to identify effective techniques for improving social skills. Several neuroimaging studies have found that individuals with ASD underactivate key brain regions involved in social cognition. However, there is also evidence that activity in normative neural networks can be increased significantly by providing children with ASD with explicit instructions to attend to important social cues. This suggests that a cognitive behavioral approach to social skills treatment may help increase not only social behavior but also the activation of normative neural systems that support social functioning.

Objectives: This study aims to examine the neural and behavioral effects of two approaches to social skills groups: cognitive behavioral therapy (CBT) and child-directed play. Here we present the short-term neural effects using two previously validated fMRI tasks that probe targeted skill domains: 1) interpreting communicative intent, and 2) processing gaze direction in emotional faces.

Methods: Verbally fluent children with ASD, 8-11 years of age, were randomized to the CBT or child-directed play group. Both treatment approaches consisted of 12 weekly 90-minute sessions (4-6 children in each group) with a concurrent parent group. Behavioral assessments and fMRI were conducted at baseline, end of treatment, and at a 3-month follow up. While undergoing fMRI, children viewed cartoon drawings of characters in a conversational setting while listening to short scenarios ending with a comment made by one of the characters. Participants decided whether the speaker meant what she said.

Results: Following treatment, children in the CBT group showed greater activity in the ventromedial prefrontal cortex (vmPFC), the ventrolateral PFC, the inferior frontal gyrus, and the superior temporal gyrus (STG)/temporal pole relative to baseline. In contrast, children in the child-directed play group did not show any regions of increased activity post- vs. pre-treatment. When directly comparing the two groups on changes in brain activity, we found that children in the CBT group showed greater increases in regions relevant for theory of mind (MPFC), emotion recognition (STG/temporal pole) and language processing (inferior frontal gyrus) compared to children in the play group.

Conclusions: Further analyses are being conducted, but these results suggest that a CBT approach that capitalizes on top-down explicit processing may facilitate increased activity in brain regions playing an important role in social cognition after a relatively brief intervention period. It will be important to assess whether these changes are maintained at follow up. By exploring the relationship between changes in brain activity and changes in social behavior, we hope to develop hypotheses about the neural mechanisms underlying response to treatment.