Emotion-Based Social Skills Training: A Controlled Intervention Study in 55 Mainstream Schools for Children with Autism Spectrum Disorder

Background:

Children with Autism Spectrum Disorder (ASD) have significant difficulties with emotional understanding and emotion regulation. However, there is a dearth of evidence-based social-emotional programmes for children with ASD in schools. Emotion-based Social Skills Training (EBSST; Wong, Lopes & Heriot, 2010; Ratcliffe, Grahame & Wong, 2010) is a theory-based, developmentally appropriate group intervention which aims to enhance social-emotional skills in children across the Autism Spectrum.

Objectives: This study aimed to evaluate the effectiveness of delivering EBSST to children with ASD, their parents and teachers by school counsellors in schools using a quasi-experimental treatment versus control group design.  It was hypothesized that children in the treatment group would improve on teacher and parent report measures of emotion skills, social skills and mental health, across time (pre-treatment, post-treatment, and 6 month follow-up) compared to the control group.

Methods: Fifty five school counsellors from government schools in NSW, Australia nominated themselves and children in their schools to participate.  School counsellors were trained in one of two manualised versions of EBSST:  EBSST for High Functioning Autism and Asperger’s Syndrome (HFA/AS) or EBSST for ASD and Mild Intellectual Disability (ID).  331 participants with a confirmed or suspected ASD aged 6–13 years were enrolled in the study. Of those, 161 participants were in the treatment group (106 HFA/AS; 55 ASD and Mild ID) and 170 participants were in the control group(111 HFA/AS; 59 ASD and Mild ID).

Parent and teacher questionnaires for emotional competence (Emotions Development Questionnaire, Wong, Heriot & Lopes, 2009), social skills (Social Skills Improvement System, Gresham & Elliott, 2008) and mental health (Strengths and Difficulties Questionnaire, Goodman, 1997; Developmental Behaviour Checklist, Einfeld & Tonge, 2002) were completed to measure change across time. Children in the treatment group received 16 sessions of EBSST, delivered by their school counsellor in small groups of 3-8 children. Sessions were divided into three modules over three school terms with a booster session at six month follow-up. Teachers and parents also received two EBSST sessions per module and a six month booster session in separate groups

Results: EBSST significantly improved teacher reported emotional competence for both children with ASD with HFA/AS and Mild ID and the effect size was large. This improvement was sustained at 6 month follow-up. Significant improvements in teacher reported social skills were also found for children with HFA/AS when controlling for pre-treatment child mental health. There were no significant differences between treatment and control groups on parent reported emotional competence, social skills or mental health.

Conclusions:

This study is the first large-scale investigation of a theoretically-based social-emotional treatment programme for children with ASD, delivered by school counsellors in mainstream Australian schools. Results suggest EBSST improves emotional competence and social skills at school for children with HFA/AS and ASD and mild ID and that treatment gains are maintained over time. There are several possible explanations for the lack of parent reported treatment gains. This study provides a valuable basis for future research and development.