Enhancing Social Motivation in Inclusive Settings: Outcomes from a Randomized Controlled Trial for Preschool Children with Autism Spectrum Disorder

Background:  Studies of children with autism spectrum disorder (ASD) have repeatedly documented low rates of social initiations especially to peers, even among children without intellectual disability. Given existing support for motivation-based interventions in improving communication and reducing problem behavior, an important next step is to investigate how these techniques can be applied during social skills treatment to increase initiations with peers.

Objectives:  This presentation reviews data from a randomized controlled pilot trial of a social group intervention aimed at motivating children with ASD to initiate interactions with peers.

Methods: Participants included 32 children with ASD (30 males; 2 females) ranging from 4-6 years old (M=5.16) assigned to one of two conditions: Social Initiation Motivation Intervention (SIMI; n=18) or Delayed Treatment Group (DTG; n=14). Participants in the SIMI condition participated in 8 weekly 75-minute social group sessions with typically-developing peers. Adult facilitators arranged cooperative play activities so that children with ASD received frequent reinforcement of social initiations directly from peers. Participants in the DTG continued community treatment for the duration of the 8-week trial and were compared to participants in the SIMI condition at post-treatment.

Results:  Group differences between participants in SIMI and DTG were assessed on five outcome measures following treatment: Clinical Global Impressions-Improvement Scale (CGI-I), Social Responsiveness Scale-2 (SRS-2), Quality of Play Questionnaire (QPQ), Vineland Adaptive Behavior Scales-II (VABS-II), Social Skills Improvement System (SSIS), and Aberrant Behavior Checklist (ABC). On the SRS-2, significant group differences were observed on the Severity of Symptom category (F=4.249, p<0.05), such that participants in the SIMI condition exhibited significantly lower overall ASD severity scores (M=2.00 Mild, SD=1.4) than participants in the DTG condition (M=3.25 Moderate, SD=0.97) following treatment. On the CGI-I, significantly greater improvement was observed in the SIMI group compared to DTG in the areas of Communication (F=4.308, p<.05), Social Communication Integration (F=4.376, p<.05), and Maladaptive Behaviors (F=34.286, p<.05). On the QPQ, significant group differences were observed in the number of playdates to which participants were invited by others (F=5.534, p<.05). Specifically, participants in the SIMI condition exhibited greater treatment gains in joint activities with peers such as computer/video games (F=7.963, p<.05), playing cards (F=3.867, p<.10), and watching tv/movies (F=3.445, p<.10), and exhibited decreased arguments (F=5.264, p<.05) and teasing (F=7.004, p<.01) during playdates than participants in the DTG condition. On the SSIS, participants in the SIMI condition exhibited greater change from baseline to post treatment in self control skills (F=5.416, p<.05) and overall socialization standard score rating (F=8.394, p<.01). Results did not reveal significant differences between groups on the ABC or VABS-II following treatment.

Conclusions:  Findings from this pilot investigation suggest that the SIMI treatment focused on enhancing motivation to initiate to peers was effective in augmenting broad aspects of social functioning including improved social communication skills, reduced symptom severity, and greater frequency of joint play with peers during playdates. Implications for design of effective inclusive social skills programming and future research directions for improving meaningful social outcomes will be discussed.