Does Peer Composition and Intervention Approach Matter for Improving Peer Engagement during Recess for Children with ASD?

Background: Social impairment may be the most complex and intractable challenge facing children with autism spectrum disorder (ASD). Clinic-based social skills groups can improve social impairment but often improvements do not generalize to community settings, such as school. To examine whether including typically developing children in social skills interventions would improve generalization, we compared two social skills group models, both conducted at school.  One group mirrored a clinic-based didactic teaching group and was composed of children with disabilities including ASD, with each child from a different class (SKILLS).  The other group included typical children and children with ASD from the same classroom in a 2 or 3 to 1 ratio (typical to ASD) using an activity-based model of naturalistic, behavioral intervention (ENGAGE).  Each group was composed of 6 to 8 children.

Objectives: The goal was to compare SKILLS vs ENGAGE on joint engagement of the target children with ASD during recess at school.

Methods: Study participants included school-aged children with ASD recruited across four sites (Los Angeles, Baltimore, Seattle, Ann Arbor) over the course of two years (AIR-B Network). One hundred and fifty children with ASD (IQ >70) from 99 general education classrooms were randomized to the ENGAGE or SKILLS group. Children met ADOS research criteria for ASD.  Interventions were carried out weekly for 3 months with a 3 month follow up.  Children were observed twice within one week on their recess playground by blinded observers at entry, exit and follow up using the Peer Observation of Playground Engagement.  Joint engagement and solitary behavior were coded.

Results: The percentage of time spent in joint engagement with peers was evaluated using a linear mixed model.  On average, all children significantly increased time spent engaged with their peers from the start of the treatment to the end of the treatment (p=0.002).  Children in the SKILLS group improved significantly more than the children in the ENGAGE group (p=0.031).  The treatment effect was maintained within the SKILLS group at follow-up since their follow-up engagement was significantly higher than their entry engagement (p=0.013).

Conclusions: Children who received a structured, didactic intervention with similarly impaired peers at school were observed as more engaged during recess.  These results differ from previous studies that find peer-mediated interventions involving typical peers are more successful for peer engagement (Bauminger et al., 2008; Kasari et al., 2012).  However, mixed (typical and ASD) groups have not been directly compared to more homogeneous groups (all disability) of children at school as in this study.  These data suggest there can be benefits to children’s social interaction skills regardless of group composition and that direct instruction of social skills also is beneficial.