Social Skills Groups for Children with Developmental Disabilities: Issues of Providing Care in Rural Communities

Background:  Deficits in social skills comprise a common impairment seen in children with developmental disabilities (DD), including spectrum disorders (ASD). Despite a clear need for social skills intervention for children with DD, many school systems do not routinely provide formal social skills interventions; as a result, families often seek these services from community providers. Many community providers use social skills groups to improve social skills in children with DD; however, there is currently very limited well-designed, high quality research to determine the efficacy of these interventions (Kasari & Patterson, 2012). 

Objectives:  The objective of the current study was to evaluate the feasibility and effectiveness of a social skills group intervention for middle school aged boys with DD diagnoses in a rural community. 

Methods: Families (n = 83) who expressed interest in the group and met inclusion criteria were contacted for participation. Families who agreed to participate were scheduled for an initial visit. Reasons for declining participation were recorded for families who did not participate. At the initial visit, participants (n= 4) were evaluated with the Comprehensive Assessment of Spoken Language (CASL) Pragmatic Judgment subtest, and the Social Responsiveness Scale (SRS). Parents also completed the Parent Stress Index (PSI) and identified specific social skills deficits in their child. Children engaged in a video-taped play session for coding of prosocial behaviors. Seven group interventions sessions were conducted, and included direct instruction, video modeling, live modeling, and practice. The CASL-PJ and PSI were readministered again after the last group session, and the children participated in an additional 30 minutes of video-taped play for coding. Parents also completed a satisfaction survey. The SRS was administered at a 6-month follow-up. 

Results: We examined trends in families’ reasons for declining participation in the groups. Common reasons included transportation and scheduling difficulties, despite great interest in participation. In addition, we used a within-subjects design to examine improvements across measures pre- and post-intervention. Comparisons of the CASL-PJ raw scores at pre-intervention and post-intervention demonstrated improvements that approached significance. All video data from pre- and post-intervention will be analyzed by blinded coders for prosocial behaviors.  Parental feedback was overwhelmingly positive; all parents agreed that their child benefitted from participation and a majority expressed interest in continued participation.

Conclusions: While our intervention indicates potential effectiveness of social skills groups, our study brought to light challenges associated with providing clinical services in rural areas. These challenges prompt the consideration of alternative methods of providing clinical services, such as telemedicine, in order to reach a greater population. Such techniques have been utilized for cognitive-behavioral therapy (Griffiths, Blignault, & Yellowlees, 2006) and speech therapy (Mashima & Doarn, 2008), but have not yet been systematically employed for social skills interventions within pediatric populations. Opportunities and feasibility of providing social skills groups via telemedicine for families in underserved, rural areas will be discussed.