Social Tools and Rules for Teens (The START Program): Results of a Randomized Controlled Trial of an Experiential/Didactic Socialization Program for Adolescents with ASD

Background: Experiential learning, or the process of learning through authentic experiences and subsequent reflection on those encounters, is an essential process in the development of core social competencies. There is a unique benefit to gaining exposure to the full range of dynamic variables associated with real-world social encounters, which cannot be replicated via secondhand accounts and instructional lessons.  Unfortunately, adolescents with ASD often do not possess the prerequisite skillset and motivation to sustain the level of social immersion needed to benefit from this learning process. Additionally, these individuals may not have access to an accepting peer environment to facilitate acquisition of the very skills necessary to avoid future social rejection.  Their persisting social vulnerabilities can limit their long-term relational success, warranting a need for comprehensive social programming. There may be significant benefit to a group socialization program that combines a safe experiential learning context (i.e. an environment that allows for social experimentation and skill development) with a didactic format that emphasizes traditional skill instruction.

Objectives: This RCT evaluated a multi-component socialization intervention to simultaneously target motivational, conceptual, and skill deficits using a hybrid experiential/didactic treatment approach. This investigation evaluated the impact of the 20-week START program on the social functioning of adolescents with ASD through the use of survey and conversational measures.

Methods: Thirty-six adolescent participants were randomized to immediate or delayed treatment conditions.  The START socialization program consisted of 20 sessions offered once a week that placed equal emphasis on experiential social immersion and didactic social lessons.  Participants engaged in individual therapeutic check-in sessions, free socialization periods, structured social activities, discussion of specific skills, and checkout sessions with parents.  Program components included emphasis on creation of a club-like atmosphere, the inclusion of typically developing high school peer models, an individually identified target social skill for each participant (that was monitored, tracked, and updated every five weeks), use of self-management technology to discretely target these skills during the unstructured socialization time, skill depictions from popular television shows, and weekly social assignments. Participants in both groups were assessed at intake and after the 20-week duration of the program.

Results: Evidence of significant social competence improvements were observed exclusively in the immediate treatment group, including changes in Social Responsiveness Scale-2  (SRS-2) standard scores (pre=75.7, post=68.1, p<0.05), Social Skills Improvement System (SSIS) standard scores (pre=86.9, post=100.7; p<0.05) and Social Competence & Motivation Scale (SCMS) scores (pre=70.6, post=86.6; p<0.001).  Notable improvements were also noted in coded live conversation probes recorded pre to post-treatment.

Conclusions: The results of this RCT suggest that there may be unique benefits to a socialization curriculum that offers both experiential and didactic training components within a single peer-facilitated intervention.  These findings are an important step in identifying optimal strategies to simultaneously target the complex, intertwined factors that limit social progress in adolescents with ASD.  Specifically, creating an experiential context may give adolescents the opportunity to finally become fully immersed and accepted by a peer group, which then becomes the ideal forum in which to practice and master critical social competencies.