Effects of Dyadic Peer-Relationship-Oriented Intervention for Chidren with High-Functioning ASD

Background: Friendship has important influences on children’s social development, and having a friend serves as a source of emotional support and protection from loneliness and social rejection (Bauminger et al., 2008). We hypothesize that sharing positive experiences through activities performed with a particular peer for a certain period of time promotes social development and mental health in children with high-functioning autism spectrum disorder (HFASD).

Objectives: We developed an intervention program to facilitate peer relationships in school-aged children with HFASD. This program was characterized by a “buddy system” comprising pairs of children with ASD. We report the outcome of this intervention.

Methods: Participants included 42 children (34 male, 8 female) with ASD from the second to the fourth grade (ages 8–10) and their parents. The average full scale IQ was 102 on the Wechsler Intelligence Scale for Children-III. All the children received treatment at Tokyo Children’s Rehabilitation Hospital. Twenty-two children (eleven fixed pairs) received the intervention, which consisted of regular treatment in addition to our program. The other twenty children, the waiting-list control group, received regular treatment only. The intervention, consisting of 16 sessions conducted once every two weeks, included training in conversation and emotional regulation skills, play activities with one’s buddy, and game activities in which all the participants gathered together and competed with other pairs. Supporters facilitated positive interaction among the children. Parents of all the children responded to the Child Behavior Checklist (CBCL/4-18) and the Strengths and Difficulties Questionnaire (SDQ) before and after the intervention period. The scores for “peer problems” (SDQ), “prosocial behavior” (SDQ), and “social problems” (CBCL) were measures for social development, and those for “emotional symptoms” (SDQ), “withdrawn” (CBCL), and “anxious/depressed” (CBCL) were measures for mental health.

Results: A two-way mixed ANOVA (2 (group: intervention versus control) × 2 (time: pre- versus post-intervention)) was conducted. The main effects of group were found in “peer problems,” “prosocial behavior,” “social problems,” “withdrawn,” and “anxious/depressed.” There were significant amounts of change in the scores in the post-assessment. Moreover, the interaction between age and the presence of ASD was significant only in “prosocial behavior” (F (1, 40) = 4.14, p < .05). The simple main effect of group (F (1, 40) = 8.70, p < .01) was significant. There was a significant amount of change in the scores in prosocial behavior in the intervention group compared to the control group.  

Conclusions: A significant improvement was observed for “prosocial behavior” in the intervention group compared to the control group. This SDQ subscale evaluates caring for others, sharing, support, and kindness. “Peer problems,” “emotional symptoms,” and “withdrawn” also improved in the intervention group, but the results for these were not more significant than those of the control group. These results suggest that the experience of engaging in activities with a particular peer for a certain period of time may facilitate empathy and supportive behavior toward another person in children with HFASD.