Moderators of Short-Term Effects and Maintenance from Social Cognitive Group Therapies: Results from a Randomized, Comparative Trial of Seaver-Nett

Background:  Several recent reviews indicate social skills groups are evidence-based interventions for verbal school-aged children with ASD. To date, the majority of studies have compared outcomes in treatment groups to no-treatment or wait list control immediately following treatment.

Objectives:  The purpose of this analysis was to evaluate 3-month outcomes and moderators of treatment effects from two models of social skills group interventions: 1) social cognitive behavioral therapy (Seaver Nonverbal synchrony, Emotion recognition, and Theory of mind Training); and 2) child-directed play.  Outcomes included immediate (12-week) and maintenance (3-month no treatment follow-up).  Both neural (e.g., fMRI) and behavioral outcomes were collected with behavioral data highlighted in this abstract.

Methods:  Participants (n=69), ages 8-11 were randomized into Seaver-NETT or comparison conditions.  Both treatments involved 12, 90-minutes sessions, with concurrent parent and child intervention groups.  Outcomes were conducted at baseline, endpoint, and at a 3-month follow-up visit to assess maintenance. Outcomes included blinded, direct assessments of social cognition (e.g. DANVA2, RMET, Strange Stories) and caregiver reports of social behavior (e.g. Griffith Empathy Scale, CCC social and nonverbal subdomains), as well as neural processing of emotions in faces and voices.  Linear mixed models, with age and IQ entered as moderators, were used to evaluate treatment effects on derived composite scores of social behavior and social cognition.

Results:  Results from analysis of social behavior composites suggest age and IQ were significant moderators of group X time effects. Older children in the CBT intervention showed improved ratings at endpoint (p=.032) relative to the comparison intervention.  The interaction effect was no longer significant at 3-month follow-up although scores did not revert back to baseline levels (p=.14).  No effect of time, age, or IQ was found for the comparison condition. Results from analysis of social cognition composites suggest a main effect of IQ across groups (p<.00) but not on the interaction.  A trend towards improvement on social cognition composites was found for IQ for children enrolled in the social cognitive intervention (p= .10), with follow-up analyses indicating significant improvements at endpoint on low-intensity (difficult to identify) child faces on the DANVA2 (p<.01).

Conclusions: This study supports a growing body of literature suggesting positive short-term outcomes from CBT-based social groups, primarily in the domain of social competency rather than social cognition (Reichow, et al., 2012). Descriptive data suggest gains in ratings of social behavior relative to baseline at 3-month follow-up for both groups, although changes were not statistically significant.  Age and IQ were significant moderators of treatment effects for social behavior, and IQ only on main effects of social cognition.  Intermediate effects of Seaver-NETT were observed on neural measures of processing irony and eye gaze (Wang et al., 2013). In contrast, trends on behavioral tasks of social cognition were not significant, indicating a need for augmentative treatment models for social cognitive deficits in ASD.