Social Skills Group Training for Children and Adolescents with Autism Spectrum Disorder, Kontakt: A Qualitative Responder Analysis

Background: Systematic reviews of autism spectrum disorder (ASD) treatments demonstrate that the evidence-base of most interventions is still limited. Social skills group training (SSGT) is a widely applied form of treatment for higher functioning ASD, which has shown low to moderate evidence in a number of smaller scale randomized controlled trials (RCT) on children and adolescents. Qualitative studies investigating SSGT participants’ experience of this form of intervention are scare. KONTAKT is a manualized SSGT for children and adolescents with ASD, which that has shown feasibility in several pilot studies, and now is evaluated in large scale, RCT multicenter study (NCT01854346).

Objectives: In a mixed qualitative/quantitative design, the objective of this study was to explore the thoughts and opinions of children, adolescents and parents participating in SSGT KONTAKT treatment. The aim was to investigate lived experiences especially in individuals responding and non-responding to the intervention.

Methods: Out of 129 RCT-participants included at that point (endpoint N=288) 6 responders and 5 non-responders, as well as their parents, were interviewed. Interviews were transcribed and analyzed using manifest thematic analysis. Responders and non-responders were defined according to their observed change in social skills as operationalized by the Social Responsiveness Scale (SRS), parent report, primary outcome measure in the RCT, pre-post 12 weeks of KONTAKT intervention. Participants were classified as responders if they had shown a relative increase in SRS total score of at least 30%, non-responders as those who had shown a decrease or a maximum of 10% increase.

Results: Both responders and non-responders (and their parents) reported improvements in social skills, awareness of own impairments,  self-confidence, and independence in everyday life.  Given examples were emotion expression, conflict management, social assertiveness, and social understanding. These experiences were richer and more frequent in the responders compared to the non-responder group. Participants were overall positive about the contents and structure of the training, but also provided useful ideas for improvement (e.g. more information on SSGT, choice of adequate SSGT age range and social embedding of the SSGT).

Conclusions: This study adds qualitative evidence to existing quantitative data on the usefulness of SSGT in children and adolescents. Interestingly, even participants not showing improvements on a primary quantitative outcome measure (“non-responders”) reported treatment satisfaction and   positive  intervention effects, although to a lesser extent than “responders”. This suggests that non-responders may have benefits from the treatment than are not captured by the SRS. Overall, findings endorse SSGT in pediatric ASD. Feedback from participants and relatives provide valuable insights for further improvements of manualized SSGT.