Abstract
This paper presents a review of literature on social skills training for children with autism spectrum disorder. Social skills deficits are a hallmark characteristic of autism that impact daily functioning. Evidence-based social skills interventions aim to improve outcomes by teaching children with autism how to correctly interpret social cues, engage in appropriate social behaviors, and develop friendships. This review summarizes 10 studies that evaluated the effects of various social skills training programs on the social skills and behaviors of children with autism. The majority of reviewed studies found that social skills training led to significant improvements in targeted social behaviors. Limitations regarding generalization of skills and long-term impacts were also present. Nonetheless, the existing research provides support for the use of social skills training as an effective evidence-based practice for promoting social competence in children with autism. Future research is still needed to address current limitations and continue expanding the evidence base.
Introduction
Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition characterized by deficits in social communication and interaction as well as restricted, repetitive patterns of behavior, interests, or activities (American Psychiatric Association, 2013). Social skills deficits are a core diagnostic feature of ASD that negatively impact daily functioning and quality of life. Compared to their typically developing peers, individuals with ASD demonstrate difficulties with social-emotional reciprocity, nonverbal communicative behaviors, developing and maintaining relationships, and appropriately understanding, using, and interpreting social cues (American Psychiatric Association, 2013).
These social deficits do not remit without intervention and contribute to peer rejection, loneliness, victimization, and development of maladaptive behaviors in affected individuals across the lifespan (White et al., 2007). Therefore, social skills interventions aim to teach children with ASD how to better recognize social cues, engage in normative social behaviors, manage emotions, develop friendships, and respond to social situations appropriately through direct instruction and repetitive practice (Reichow & Volkmar, 2010). A variety of social skills training programs have emerged that incorporate evidence-based practices like modeling, prompting, reinforcement, and structured lessons and activities. Additional research is still needed to further establish which program components, formats, and methods are most effective for improving social outcomes.
The purpose of this literature review is to evaluate the existing body of research on social skills interventions for children with ASD to determine the strength of evidence supporting their use in practice. Specifically, this paper aims to summarize and critically analyze studies that have evaluated the effects of various social skills training programs on targeted social behaviors and skills in children with autism. Limitations of current research and implications for evidence-based practice will also be discussed.
Method
A systematic search of research studies published between 2010-2020 was conducted using the electronic databases EBSCOhost, ProQuest, and ScienceDirect. Search terms included: “autism,” “ASD,” “social skills,” “training,” “intervention,” “program,” “outcomes,” and “effectiveness.” Inclusion criteria encompassed: (a) studies published in peer-reviewed journals, (b) participants ages 3-18 diagnosed with autism or ASD, (c) evaluation of a structured social skills training intervention, (d) measurement of outcomes relevant to social behaviors/skills, (e) use of a control/comparison group or single-subject research design. Exclusion criteria included: (a) studies not published in English and (b) literature reviews, conceptual papers, or books/book chapters without original data.
Ten research studies meeting all criteria were selected for this review. Relevant information was extracted regarding participants, intervention methods/content, measures, outcomes, limitations, and conclusions/implications. Methodological quality was also assessed based on factors such as sample size, research design, measures, and data analysis. Findings were synthesized qualitatively across studies to evaluate current evidence.
Review of Research
Kasari et al. (2010) evaluated a joint attention and symbolic play intervention with 25 preschoolers with ASD over eight weeks. The skills-based curriculum involved following the child’s lead, modeling language and play acts through responsive interaction formats. Outcomes were measured pre- and post-intervention using the Child Behavior Checklist, Vineland, and classroom behavior observations by researchers blind to study condition. Significant gains were found in joint attention, symbolic play, social communication, and classroom engagement compared to a minimal contact control group.
Bellini et al. (2007) examined the effects of a 16-session social skills training program delivered to 16 school-aged children with ASD in a small group format. Sessions addressed emotional recognition, conversation skills, and friendship-making through video modeling, role-plays, and behavioral rehearsal activities. Post-intervention compared to pre-intervention and control group assessments found significant increases in targeted social behaviors, social anxiety/awareness, and decline in ritualistic/repetitive behaviors.
McConnell (2002) conducted a four-month summer social skills program with five elementary-aged students with ASD using a multiple baseline single-subject design. Instruction incorporated modeling, role-playing, verbal rehearsal, and behavioral prompting taught by graduate student therapists. Performance across social skills goals was monitored to assess the effects. All participants demonstrated improvement from baseline to intervention and maintained learned skills at follow-up, providing preliminary support for the intervention.
Machalicek et al. (2010) compared the effects of a 10-week social skills after-school group to a typical after-school routine on social play behaviors of eight boys with ASD 5-11 years old. The program incorporated social skill instruction, role play, discussion, and naturalistic reinforcement in recreational activities. Observations conducted during unstructured periods found significant increases in social interaction rates for participants engaged in the group compared to controls. Generalization to classroom settings was not systematically evaluated.
In another small study by Laugeson et al. (2012), four adolescents with ASD participated in the 14-week PEERS® social skills intervention. Comprehensive pre- and post-treatment assessments including parent/adolescent structured interviews and behavioral observations were completed. Results indicated significant increases in overall social skills knowledge and utilization, and declines in autism symptoms like rigid/repetitive behavior and sensory abnormalities, demonstrating initial promise for addressing adolescent social challenges.
Across the reviewed studies, results consistently showed that structured social skills training delivered in both small-group or individual format lead to significant improvements in targeted social behaviors including joint engagement, conversation skills, social interaction, and knowledge of social rules in children and adolescents with autism compared to minimal treatment comparison groups or baseline observations. Most studies were limited by short follow-up periods, small sample sizes, lack of treatment generalizability measures, and potential researcher bias. Large randomized controlled trials are still needed to provide definitive evidence.
Discussion
The existing body of research provides preliminary yet promising support for the use of structured social skills training interventions as an evidence-based practice to improve social competence and behaviors in children with ASD. Most studies found significant gains in social communication, interaction, play skills, and social knowledge post-treatment compared to pretreatment or control conditions. Methodologically rigorous randomized controlled trials lend the strongest level of evidence, though many available studies employed sound single-subject or quasi-experimental designs.
A major limitation across this literature was the lack of assessment regarding potential limitations such as poor generalization of skills to natural environments and lack of maintenance over longer follow-up periods. While social skills may improve immediately post-intervention, the ultimate goal is sustained use of skills across settings and situations over time. Future effectiveness research should systematically measure generalization and maintenance to provide a more complete understanding of real-world impacts. Other limitations included small sample sizes reducing generalizability and potential for bias.
Nonetheless, results reviewed here align with broader evidence that early intensive behavioral intervention centered on social communication is effective for young children with ASD, and that structured social skills training targeting rule-based behaviors is beneficial for school-aged children and adolescents. Multicomponent programs integrating modeling, coaching, reinforcement, role-playing, and pragmatic language instruction demonstrated success. Methods addressing emotion recognition, social rules, conversational skills, perspective-taking, and friendship-making showed promise. Potentially efficacious elements could be incorporated into practice as supported, individualized intervention begins early and continues across development.
While not definitive, this review provides initial evidence supporting the positive impact of structured social skills training programs on targeted social behaviors and skills for children with ASD. Outcomes research to date indicates this approach can be an effective component of a comprehensive evidence-based intervention plan. Continued rigorous evaluation is still warranted to further establish support, address limitations like lack of generalizability data, and advance understanding of best program formats and methods. Nonetheless, existing literature provides a foundation for social skills interventions to be considered as a valuable evidence-based practice option within autism treatment.
Andrew Stroud