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Hindawi Publishing Corporation Autism Research and Treatment Volume 2011, Article ID 589539, 11 pages doi:10.1155/2011/589539 Research Article An Initial Investigation of the Generalization of a School-Based Social Competence Intervention for Youth with High-Functioning Autism 1 2 2 Carla Schmidt, Janine P. Stichter, Kristin Lierheimer, 2 2 Stephanie McGhee, and Karen V. O’Connor Juniper Gardens Children’s Project, The University of Kansas, Kansas City, KS 66101, USA Department of Special Education, The University of Missouri, Columbia, MO 65211, USA Correspondence should be addressed to Carla Schmidt, firstname.lastname@example.org Received 6 June 2011; Revised 4 August 2011; Accepted 20 September 2011 Academic Editor: Connie Kasari Copyright © 2011 Carla Schmidt et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This study evaluated the impact of generalization of the Social Competence Intervention-Adolescent (SCI-A) curriculum in a school setting for individuals with high-functioning autism or Asperger’s Syndrome (N = 6). This study examined to what degree the generalization of the SCI-A curriculum could be measured when delivered in a school setting. Across the six participants preliminary results suggest improvement on teacher reports of social skills and executive functioning. Some improvements were also evident in direct measures of facial-expression recognition. Data collected in the nonintervention settings indicated that some generalization of social interaction skills may have occurred for all six participants. Future research directions are discussed. 1. Introduction Although these individuals have intellectual functioning within the normal range (IQ 70+) and often excel in aca- Autism Spectrum Disorders (ASDs) are pervasive devel- demic subjects , deﬁcits in social functioning can prevent opmental disorders that have lasting impact on social these individuals from achieving full independence into interaction and communication skills, greatly inﬂuencing adulthood . Long-term outcome studies for individuals an individual’s independent functioning, and quality of with HFA/AS report persisting impairments in adaptive and life. According to the Diagnostic and Statistical Manual social functioning as well as psychiatric disorders throughout of Mental Disorders—4th Edition-Text Revision (DSM-IV- adulthood [4, 5]. Additionally, individuals with HFA/AS TR);, Pervasive Developmental Disorders (PDDs) are remain reliant on families or community services into all characterized by “severe and pervasive impairments in adulthood. In spite of obtaining high school, and even several areas of development: reciprocal social interaction college diplomas, these individuals have diﬃculty ﬁnding skills, communication skills, or the presence of stereotyped and maintaining employment . Meaningful relationships behaviors, interests, and activities” (page 69). Asperger’s are an additional challenge for this population with a number Syndrome (AS) or high-functioning autism (HFA) is part of participants never developing relationships outside of of the continuum of disorders classiﬁed as PDDs; yet their families. Howlin  note that due to these variables, individuals classiﬁed with these disorders tend to exhibit individuals with HFA/AS are at risk for frustration, loss milder autism symptomology compared to other disorders of self-esteem, anxiety, and severe depression. Therefore on the spectrum. Nevertheless these individuals remain the literature proposes that intervention goals should focus greatly impacted by deﬁcits in social competence. on social behaviors that allow individuals with HFA/AS to Deﬁcits in social competence, if unremediated, can lead improve the depth and quality of their social relationships, to a number of negative outcomes for adults with HFA/AS. in order to achieve satisfying, supportive, and meaningful 2 Autism Research and Treatment relationships [4, 5, 7]. It is hypothesized that an increase in ized assessments was used to examine the impact of partici- these relationships will have positive and long-lasting impact pation in the SCI on overall social abilities, theory of mind, across multiple domains . emotion recognition, and executive functioning. According Unfortunately to date there are insuﬃcient evidence- to the results, the SCI curriculum increased social compe- based social interventions for individuals with HFA/AS [8, tence for all participants. Speciﬁcally, participants showed 9]. In fact, The National Autism Center (NAC) recently signiﬁcant gains in overall social abilities, an increased ability published the National Standards Report , an extensive to correctly identify emotions and mental states, as well as evaluation of current evidence-based practices for ASD. marked improvement in executive functioning skills. The According to this report, a total of 11 treatments were iden- authors reported a high degree of variability in participant’s tiﬁed as established treatments and 22 as emerging. Interest- performance on the theory of mind measures and therefore ingly, of the established treatments, only two reported evi- no consistent pre-postimprovements were found. The results dence for individuals with HFA/AS and for the emerging of Stichter et al.  were consistent with and extended treatments only four treatments reported evidence for previous similar work using CBI-based interventions (e.g., HFA/AS, therefore, highlighting the need for more research [15, 16]). to validate social and behavioral interventions to support the Recently, guidelines have been developed to inform the speciﬁc deﬁcit areas of individuals with HFA/AS. design of research studies for psychosocial interventions for The ﬁeld has also called attention to the one persistent individuals with ASD . The working group identiﬁed challenge, to develop and validate interventions that promote four phases of research: (1) formulation and systematic generalization and maintenance of intervention skills . application of a new intervention technique, (2) developing a Although the challenge has been recognized, according to manual and research plan for evaluation of the intervention recent literature reviews, few studies to date report general- across sites, (3) randomized clinical trials, and (4) commu- ization data. In a review of group-based social skills training nity eﬀectiveness studies . Stichter et al.  represents programs for adolescents, White et al. concluded the ﬁrst phase of research outlined by Smith and colleagues that generalization and ﬂexibility of skill use in natural . The current study represents one of several initial environments continues to be a challenge and that the lack evaluations of the second phase of research for this program. of investigation of the degree to which skills generalize is a The SCI-A curriculum was developed and implemented major methodological weakness in the social competence lit- across seven groups of adolescents over ﬁve semesters in an erature. In their review of early social communicative skills of after-school, clinic-based program. The SCI research team young children with ASD, Hwang and Hughes reported secured federal funding to further develop the SCI curricu- that only 9 of the 16 articles included reported generalization lum, translate the clinic-based curriculum to a school-based data. Rao et al.  reviewed the social skills training literature delivery, and implement this curriculum across multiple for individuals with HFA/AS and only three of the ten research sites. Therefore, the purpose of this study is to (1) studies reported generalization data. In conclusion, unless replicate and extend the work of Stichter and colleagues the social skills acquired through intervention can generalize  by conducting a preliminary evaluation of the Social to novel settings with novel individuals, the potential and Competence Intervention-Adolescent (SCI-A) curriculum in demonstrated eﬃcacy of social competence interventions for a school setting and (2) to examine to what degree the individuals with HFA/AS remains limited . generalization of the SCI-A curriculum could be measured One category of social competence intervention that when delivered in a school setting. A pre-post design was is beginning to report positive social and behavioral out- implemented in which the three core constructs of theory comes for individuals with HFA/AS is based on a cognitive of mind, emotion recognition, and executive functioning behavioral intervention (CBI) framework [15–17]. CBI is were assessed using individually administered standardized considered one of the emerging practices by the NAC  assessments. In order to examine the generalization of the for individuals with HFA/AS. interaction skills taught within SCI-A to nonintervention The success of interventions using a CBI framework settings, direct observation interactions of target students with this population may be due to the focus on constructs with adults and typically developing peers were measured such as theory of mind, emotion recognition, and executive before and throughout the SCI-A program. functioning, as it is these three core social competence constructs that have been suggested by the research literature 2. Methods to contribute to the unique social deﬁcits of individuals with HFA/AS (see ). Stichter and colleagues  have recently 2.1. Participants. All 6 participants were referred by teachers published encouraging ﬁndings for a social competence to project staﬀ as having social deﬁcits that would beneﬁt intervention (SCI) designed speciﬁcally to address these from enhanced intervention, would be able to have their unique social deﬁcits and is based on a CBI theoretical schedules adjusted to meet as a group at the same time, framework using applied behavior analysis principles. These and met the inclusion criteria. Participants had conﬁrmed authors reported results for 29 male participants with ASD diagnosis by either the Autism Diagnostic Observation HFA/AS between the ages of 11 and 14. This group-based Schedule (ADOS);  or Autism Diagnostic Interview- intervention was delivered in an after-school clinical setting Revised (ADI-R); , they were between the ages of 11 for a total of 20-hour, meeting twice weekly, for ten weeks. and 14, had a full-scale IQ of 75 or above, and participated A pre-post design using individually administered standard- in a general education setting for at least one hour a day. Autism Research and Treatment 3 Records review was utilized for obtaining IQ scores. Rec- 2.4. Measures ognizing the challenges and variations among the diﬀerent 2.4.1. Social Abilities. The Social Responsiveness Scale (SRS) intelligence/cognitive assessments and the divergent timing  is a 65-item questionnaire designed for children or of these assessments, we attempted to gather the Wechsler adolescents between the ages of 4 and 18 and was completed Abbreviated Scale of Intelligence (WASI) datawhenever by teachers for each participant. The questionnaire focuses possible, approximately 2–4 weeks prior to the start of SCI- on the social symptoms of ASD by assessing ﬁve social A instruction. All participants attended the same special areas and ﬁve treatment subscales. The social areas are education resource classroom in traditional middle school social awareness, social information processing, capacity for where they switched classes each period. Participants were reciprocal social communication, social anxiety/avoidance, receiving no other social skills instruction at the time of the and autistic preoccupation and traits. The ﬁve subscales are current study. Speciﬁc information on inclusion criteria and receptive aspects of social behavior, cognitive aspects of social subject characteristics are provided in Tables 1 and 2. behavior, expressive aspects of social behavior, motivational aspects of social behavior, and autistic mannerisms. A single 2.2. The Social Competence Intervention-Adolescent. The score is generated that serves as an index of severity of social SCI-A program was conducted in the schools to provide deﬁcits across the autism spectrum. The SRS uses a Likert participants with a targeted social competence program scale response format to assess symptom severity. Each item speciﬁc to a subtype of individuals with ASD. Participants on the scale is rated using a range from 0 (never true) to 3 for the current study were recruited from within the SCI-A (almost always true). The SRS has shown to be a consistently program. SCI-A is an extension of the original after-school reliable and valid measure [23–25]. model developed by Stichter and colleagues  and the current study was delivered within a midwestern middle 2.4.2. Theory of Mind. The SCI-A assessment battery in- school (6-7th grade). The intervention was delivered within cludes ﬁve ToM tasks. Participants were given two ﬁrst-order a special education resource classroom by a specially trained ToM tasks including the Sally-Anne false-belief task  site facilitator with a Master’s degree and teaching license and the Smarties false-belief task . First-order ToM tasks in special education and the licensed special education require participants to attribute mental states to another teacher who was scheduled to teach those students at that person . Participants were also given two second-order time. All participants attended the same special education ToM tasks including the Friends ABC Story (adapted from resource classroom and met as a group for the SCI-A ) and the Ice Cream Van Test . Second-order ToM program. The ﬁve curricular units include (a) recognizing tasks require participants to predict one person’s thoughts facial expressions, (b) sharing ideas, (c) turn taking in about another person’s thoughts . All of the ToM conversations, (d) recognizing feelings and emotions of measures were scored on a pass/fail basis. Additionally, the self and others, and (e) problem solving. The project staﬀ Faux Pas Stories were administered . This test consists was responsible for all curricular content as designed and of ten short narratives in which a social faux pas occurs. measures were taken to assure ﬁdelity across interventionists. The Faux Pas Stories are scored by the number of correctly identiﬁed faux pas scenarios out of ten, with higher scores 2.3. Intervention and Generalization Settings. In total, SCI indicating a greater accuracy of faux pas identiﬁcation . consisted of 20 hours of group intervention conducted twice a week for 10 weeks. SCI-A was delivered in ﬁve units (each comprised of four, one-hour lessons). Each of the ﬁve two- 2.4.3. Emotion Recognition. Twomeasureswereusedto week units scaﬀolded learning, building upon each skill, measure emotion recognition, the Diagnostic Analysis of with maintenance of learned skills reinforced throughout. Nonverbal Accuracy-2, Child Facial Expressions (DANVA 2- The SCI-A program was delivered in a special education CF); , and the Reading the Mind in the Eyes test . resource classroom during participant’s regularly scheduled The DANVA 2-CF consists of 24 photographs of child facial class time. In addition to the intervention setting, there were expressions and is used to measure the ability to recognize two generalization settings, lunch and math class, used in the facial expressions. The test includes an equal number of current study. Generalization data were collected for all six male (12) and female (12) faces and an equal distribution of participants in the lunch setting, and due to class schedule high and low intensity, happy, sad, angry, and fearful faces. conﬂicts data were collected for only three of the participants The DANVA 2-CF has been shown to be both a reliable in the math class. The lunch setting was chosen because this and valid measure of facial expression processing . The setting provides opportunity for naturally occurring social Reading the Mind in the Eyes consists of 28 photographs interaction with typically developing peers. The math setting of the eye regions of the face of both male and females. was chosen because the curriculum used by the target Middle The test is intended to measure how well participants can School by design aﬀords weekly opportunities for group interpret the mental states of others based on reading facial work and structured interaction. This structure was observed expressions. Scores were calculated as the number of correct to provide natural opportunities within an academic setting identiﬁcations, with higher scores indicating greater ability for the use of social competence skills. to interpret mental states based on facial cues. 4 Autism Research and Treatment Table 1: Participant demographics. Name Age Grade % Time in Gen Ed FS IQ score ADI score ADI sign. ADOS score ADOS sign. RSI = 18 Comm = 5 Shawn 13 7 76 99 Yes Yes (Autism) Comm = 14 RSI = 11 Beh =2Total = 16 RSI = 22 Comm = 3 Jason 13 7 76 84 Yes Yes (Autism) Comm = 14 RSI = 10 Beh =8Total = 13 RSI = 3 Comm = 4 William 13 7 70 106 No Yes (Autism) Comm =8RSI = 7 Beh =2Total = 11 RSI = 2 Comm = 1 Ryan 13 7 100 111 No Yes (Autism) Comm =5RSI = 7 Beh =0Total = 8 RSI = 20 Comm = 5 Chris 12 7 70 91 Yes Yes (Autism) Comm = 23 RSI = 10 Beh =6Total = 15 RSI = 19 Comm = 5 Jeremy 12 6 72 129 Yes Yes (Autism) Comm = 14 RSI = 9 Beh =3Total = 14 Notes: FS: full scale IQ; RSI: reciprocal social interaction; Comm: communication and language; Beh: restricted and repetitive, stereotyped interest and behaviors; Sign: signiﬁcance. Table 2: Participant baseline social characteristics. Name Baseline social characteristics (i) Limited social interaction with peers Shawn (ii) Social interaction primarily targeted towards adults (iii) Diﬃculty initiating and maintaining conversation (i) High rates of inappropriate social behavior (e.g., talking too loud, interrupting, dominating conversation) Jason (ii) Repetitive and stereotypic topics and interests (iii) Engaged in “self-talk” (e.g., continued conversation with no audience) (i) Limited social interaction with peers (ii) Social interaction primarily targeted towards adults William (iii) Engaged in “self-talk” (e.g., continued conversation with no audience) (iv) Repetitive and stereotypic topics and interests (i) Social interaction levels comparable to general education peers Ryan (ii) High rates of inappropriate social behavior (e.g., talking too loud, interrupting, dominating conversation, aggressive tone) (i) Social interaction levels comparable to general education peers Chris (ii) Limited social interaction (except for a select group of peers and adults) (i) Limited social interaction with peers (ii) Social interaction primarily geared towards adults Jeremy (iii) Pedantic conversation topics (iv) Diﬃculty initiating and maintaining conversation 2.4.4. Executive Functioning. The Behavior Rating Inventory 2.5. Procedure. This study was conducted across the span of Executive Function (BRIEF)  is an 86-item ques- of approximately ﬁfteen weeks. Two diﬀerent sets of data tionnaire designed to assess the behavioral manifestations were collected for this study. The ﬁrst data set included of children’s executive control functions in the home and pre- and postassessment data for the SCI-A assessment school environments. Decreasing scores on the BRIEF indi- battery administered by the SCI-A research team outlined cate improvements in perceived executive functioning. The above. Pre- and postassessment data were collected for all BRIEF is considered to be a reliable and valid measure of participants two weeks prior to and two weeks following executive function . the conclusion of the SCI-A program. The second data set Autism Research and Treatment 5 included the direct observation of in situ social behavior (tar- 2.6.3. Fidelity. During SCI-A delivery ﬁdelity was coded on get behaviors) within the untrained settings before (baseline) 100% of all 31 sessions by SCI-A staﬀ who were present and during the SCI-A program (intervention). Baseline data during the intervention implementation. Across all lessons, collection occurred for two weeks prior to the beginning mean ﬁdelity scores indicated acceptable high ﬁdelity within of the SCI-A program and intervention data collection each of the four coded domains: content: 90%; process: 92%; occurred for ten weeks during the implementation of the behavior: 97%; feedback: 78%. Interobserver agreement was SCI-A program. The ﬁrst, third, fourth, and ﬁfth authors, collected on 33% of all sessions and calculated by dividing who were knowledgeable of, but not directly involved in the total number of agreements by the total number of delivering the SCI-A program, collected all direct observa- agreements plus disagreements and multiplying by 100%. tion data. Consent and assent procedures were followed for IOA for each process code was the following: content: 90.4%; all participants, as outlined by the institutional review board, process: IOA = 90.2%; behavior: M = IOA = 83.3%; prior to initiating any study procedures. Additionally, ﬁdelity feedback: M = 74.0%. of implementation of the SCI-A program was measured throughout again by SCI-A staﬀ who were knowledgeable of, 3. Results but not directly involved in, delivering the SCI-A program. Participant scores on assessments prior to beginning SCI-A 2.6. Direct Observation and Reliability and after SCI-A are presented in Table 3. The percentage of change in participants’ scores from pre- to postintervention 2.6.1. Target Measures. Each observation of in situ social is indicated. Paired samples t-tests were conducted on the behavior was for 10 minutes. Target measures were collected pre- and postintervention scores to determine if diﬀerences via the Multi-Option Observation System for Experimental occurred. It should be noted that given the small sample size Studies (MOOSES) [35, 36], software designed speciﬁcally the signiﬁcance of the statistics below is questionable and for recording behavioral data. MOOSES automatically pro- should be viewed as an initial investigation of the use of the vided an output measure of both frequency and duration of SCI-A program in a school setting. Table 4 reports the mean each target behavior. level of initiations, responses, and continuation in baseline For all participants, data were collected on appropriate and during the SCI-A program in the lunch setting for all and inappropriate initiations, responses, and continuations six participants. The mean level of initiations, responses, and directed towards peers and to adults. Inappropriate initi- continuations in baseline and during the SCI-A program was ations, responses, and continuations occurred at such low available for three participants in the math setting and these rates that only appropriate initiations, responses, and con- data are reported in Table 4. tinuations are reported in this study. Initiations were deﬁned as any motor or vocal behavior directed to a peer or adult that 3.1. Social Abilities. One general education teacher, who attempted to occasion a response, including greeting, asking was blind to the details of the SCI-A program, completed and answering questions, commenting, sharing materials, the SRS, pre- and postassesment per participant. The SRS helping behavior, saying someone’s name, and gesturing to was intended to provide a general measure of change in an item while looking at a peer. Initiations were required social competence for individuals participating in the SCI- to be relevant to the context, socially appropriate, with Aprogram.The SRStotal scoreservesasanindex of no other conversation taking place prior to the initiation severity of social deﬁcits across the autism spectrum. The (appropriate interruptions to enter a conversation was an combined group showed an improvement on the total SRS exception). Responses were deﬁned as any motor or vocal score (Δ = 28%, t = 2.03, P< .10). Six participants behavior directed to a peer or adult that acknowledged an made positive improvements on the total SRS score from initiation within 5 seconds (e.g., looking when name was pre- to postassesment. In addition to the total score, the SRS called, following directions or request, answering a question, provides a score for ﬁve subscales including social awareness, and nodding head). Finally, continuations were deﬁned as social cognition, social communication, social motivation, response directed to a peer or adult that maintained an and autistic mannerisms. For the combined group improve- ongoing interaction (i.e., follows the response of another ments were found on the social communication subscale peer or adult or participants own response within 5 seconds). (Δ = 29.0%, t = 2.20, P< .10) and the social motivation subscale (Δ = 31%, t = 2.82, P< .05). In addition, four of the participants made positive gains on all ﬁve of the SRS subscales. 2.6.2. Reliability. In order to obtain interobserver agreement (IOA) a second observer was present for 22 (24.4%) of the study’s 90 observation sessions. The mean rate of agreement 3.2. Theory of Mind. The Theory of Mind (ToM) tasks and for all 22 sessions was 82%. Secondly, MOOSES provides a the Faux Pas stories measure changes in theory of mind Cohen’s Kappa coeﬃcient and the mean score for the total and perspective taking. For the ToM tasks, all participants IOA sessions was .66. Kappa is always less than or equal to 1. passed the Candy Box test in both pre- and postassessment. A value of 1 represents perfect agreement and values less than For the Sally-Anne task, two participants failed in pre- 1 represent less than perfect agreement therefore, a kappa but then passed on the postassessment while the other coeﬃcient of .66 represents substantial agreement . participant passed in pre- but failed in postassessment. All 6 Autism Research and Treatment Table 3: SCI-A assessment battery: percent change from pre- to postassesment (n = 6). Individual change pre- to postassesment Group level Mean % Shawn Jason William Ryan Chris Jeremy t-value Student performance data ToM: Candy Box P/P P/P P/P P/P P/P P/P ToM: Sally-Anne P/P P/P F/P P/P F/P P/P ToM: Friends ABC Story F/P P/P P/P P/P P/P P/P ToM: Ice Cream Story P/P F/P F/P P/P P/P P/P Reading in Mind’s Eye 0 11 0 −19 50 0 0.42 Faux Pas Stories −11 29 −10 11 12 12 1.00 DANVA 0 5 5 10 20 24 3.05 Teacher reports SRS total 46 46 54 4 −30 48 2.03 Social awareness 67 20 38 −9 −17 27 1.66 Social cognition 43 50 69 0 −57 58 1.34 Social communication 48 44 51 11 −35 54 2.20 Social motivation 37 53 50 21 −25 50 2.82 Autistic mannerisms 33 54 61 −11 −13 38 1.48 BRIEF global executive composite 18 7 20 −40 21 2.29 Behavioral regulation 8 4 23 −4 −425 1.51 Metacognition 21 8 18 −21 17 2.70 Notes: ToM measures P: pass, F: fail, indicated as pre/postassesment; Mind’s Eye, Faux Pas, DANVA percent change calculated as (post-pre)/preassesment; SRS and BRIEF percent change calculated as (pre-post)/preassesment. participants passed the Friends ABC Story in both pre- postassesment per participant by the same general education and postassessments, except one participant who failed teacher who completed the SRS. The BRIEF is made up of during pre- but passed during postassesment. Finally, four two subscales that are combined to create the Global Exec- participants passed the Ice Cream Story in both pre-and utive Composite. According to teacher report, there was an postassesment yet, Jason and William both failed in pre- improvement on the Global Executive Composite (Δ = 10%, but passed in postassessments. In summary, the results t = 2.29, P< .10) as well as the Metacognition Index (Δ = indicate somewhat mixed results however this is congruent 11%, t = 2.70, P< .05). Four participants made positive with previous studies using ToM tasks with the HFA/AS gains on the Behavioral Rating Index however the group population [17, 38, 39]. mean score for this index from pre- to postintervention was not signiﬁcant. 3.3. Emotion Recognition. The DANVA 2-CF and the Read- ing the Minds in the Eyes test provide a measure of change 3.5. Generalization Results. Data for all six participants who from pre- to postintervention in the ability to recognize facial expressions and to interpret emotional and mental were monitored during lunch suggest that generalization states. For the DANVA, the combined group showed an may have occurred beyond the SCI-A intervention setting. improvement from pre- to postassessment (Δ = 10%, t = For each participant, a total social interaction (TSI) per- 3.05, P< .05). Five participants showed an improvement centage was calculated in addition to initiations, responses, on the ability to recognize facial expressions and to interpret and continuations (IRC) for each generalization setting. emotional and mental states. The percent changes from pre- TSI is deﬁned by the combination of all appropriate and to postassessment for the Reading the Mind in the Eyes test inappropriate IRC behavior (including IRC to peers and and the Faux Pas Stories for the combined group were not adults) within a 10-minute coding session. TSI was calculated signiﬁcant. Two participants showed a positive change from by adding the duration in seconds of all social interaction pre- to postassessment on the Reading the Mind in the Eyes within a 10-coding session. As noted previously, separate and four participants showed an improvement on the ability rates for inappropriate IRC were not provided as these to recognize the social faux pas that were portrayed in the behaviorsoccurredatverylow rates. Table 4 shows that all vignettes. participants, with the exception of Ryan, made increases in TSI from baseline to intervention. The three participants for 3.4. Executive Functioning. The BRIEF is included in the SCI- whom data was available in the math setting all made positive A assessment battery to provide a measure of change in gains as well in TSI from baseline to intervention and these executive functioning. The BRIEF was completed pre- and data are presented in Table 4. Autism Research and Treatment 7 Table 4: Mean percentage of 10 min sessions engaged in IRC in lunch and math. Lunch Math Subject Dependent variable Baseline Intervention Baseline Intervention Initiation to peer .2 (0–.5) 1.38 (0–4.8) 0 1.5 (0–10.8) Response to peer .2 (0–.5) 6.4 (1.5–11.6) 0 1.8 (0–7.5) Continuation to peer 1.95 (0–4.5) 12 (1–35.8) 0 2.8 (0–14.3) Shawn Initiation to adult 1.86 (.6–3.4) 1.14 (0–4) .29 (0–.89) .8 (0–5.16) Response to adult 1.02 (0–2.3) 1.4 (0–3.16) 1.7 (1.2–3.9) 1.7 (0–3.5) Continuation to adult 1.04 (0–1.9) 2.5 (0–6.6) 2.1 (1.3–4.98) 1.0 (0–3.7) Total social interaction 9.1 (1–13.2) 24.9 (10.5–49.7) 3.9 (0–9.8) 9.7 (1–30.8) Initiation to peer 7.3 (2.17–12.2) 10.9 (3.5–17.3) 11.6 (9.5–14.3) 9.1 (1.83–32.17) Response to peer 5.9 (2.3–7.3) 4.5 (1.3–9.8) 11.2 (6.83–18.16) 5.8 (2.83–8.83) Continuation to peer 22.7 (1–46.5) 10.5 (0–32.2) 31.2 (27.5–35.16) 12.4 (0–32.5) Jason Initiation to adult 3.8 (0–9.8) 5.9 (2.3–10.3) .61 (.16–.83) 1.8 (0–4.83) Response to adult 7.4 (0–19.5) 6.79 (2.2–10.2) .9 (0–1.16) 3.7 (0–9.5) Continuation to adult 12.67 (0–30.3) 22.7 (10.3–43.2) 1 (0–2.3) 4.9 (0–14.33) Total social interaction 67.7 (59.3–74.6) 73.0 (54.3–86.2) 61.6 (51.6–75.3) 43.9 (14.8–87) Initiation to peer 1.9 (1.3–2.5) .9 (0–2.5) .8 (0–1.5) 2.2 (0–4.6) Response to peer 3.9 (0–8.2) 2.2 (0–8.6) .8 (0–1.6) 1.9 (0–5.3) Continuation to peer 9 (0–18) 7.3 (0–52.6) .8 (0–1.5) 1.0 (0–3.6) William Initiation to adult 6.61 (0–12.6) 3.9 (0–6.5) 1.5 (1–1.9) 1.5 (0–5.5) Response to adult 4.4 (0–7.5) 7.3 (0–12.5) .83 (0–1.6) 4.6 (1.2–9.6) Continuation to adult 7.3 (0–14) 18.4 (0–19.2) 0 9.9 (0–32.5) Total social interaction 41.3 (28.1–60.6) 41.7 (19.6–85.6) 3.83 (0–9) 23.9 (11.5–23) Initiation to peer 2.3 (1–4.3) 8.9 (2.7–14) Response to peer 4.8 (1.3–9.5) 13.4 (.83–19) Ryan Continuation to peer 18.6 (5–61.3) 21.5 (0–31.6) Total social interaction 54.6 (34.8–78.5) 47.3 (3.0–61.7) Initiation to peer 9.72 (8.8–10.6) 11.6 (4.8–20.6) Response to peer 7.2 (5.8–9.5) 10.4 (4.6–15.8) Chris Continuation to peer 12.8 (2.8–28) 19.7 (0–30.7) Total social interaction 31.2 (21.0–49.2) 41.8 (11.8–88.8) Initiation to peer 5.5 (0–16.5) 8.65 (1–19.3) Response to peer .66 (0–1.9) 12.65 (6.8–18.5) Jeremy Continuation to peer 6.78 (0–16.5) 23.9 (7–57) Total social interaction 23.1 (1.7–46.3) 48.7 (34.8–76.8) 4. Discussion promising as part of an ongoing multiphase research plan . The results reported here provide initial evidence that The preliminary results reported here indicate that the SCI- the SCI-A curriculum can be successfully implemented in A curriculum has potential in increasing social competence a school setting with meaningful outcomes for adolescents for adolescent with high-functioning ASD in a school setting. with HFA/AS. The results also contribute to the growing Moreover, the direct observation data provide evidence that evidence for using cognitive behavioral-based interventions the SCI-A program may also have potential in positive  to address the social and behavioral deﬁcits of individu- changes in social competence within additional school alswithHFA/AS[15–17, 41]. environments beyond the intervention setting. Although the measures used within the SCI-A battery have been used not only in repeated CBI-based social compe- tence literature, as well as in national clinical research trials, 4.1. SCI-A in a School Setting. The results for the SCI- A assessment battery in the current study are similar to debate remains surrounding the appropriateness of some of these assessments. One notable and consistent example of ﬁndings from other studies using interventions that are this can be found within the variability of response among based on cognitive behavioral interventions for individuals with HFA/AS [15–17, 40]. Given the insuﬃcient evidence- the ToM tasks. There is ongoing debate in the literature based social interventions for individuals with HFA/AS, the regarding the term Theory of Mind, and if it too narrowly ﬁndings from the SCI-A assessment battery are particularly describes a larger construct of social perspective taking, as 8 Autism Research and Treatment well as the utility of the most commonly used ToM measures. social behavior such as self-talk for long periods of time Some authors have found ToM tasks to be a reliable in which his conversation seemed to have no audience. instrument , yet others have noted problems with these During lunch Jason often sat next to the special education assessments, particularly when used in applied research, and teacher who would occasionally comment or respond to in particular for those considered high functioning [43, Jason’s self-talk, possibly perpetuating this behavior. Jason, 44]. Baron-Cohen et al.  caution the interpretation of like numerous individuals with HFA/AS, has a remarkable ToM tasks and note that children may fail such tests for a verbal ﬂuency , however, he lacked the understanding of variety of reasons, most notably that reading comprehension social cues that indicated when he was talking too much. problems may interfere with success on these tasks. This The SCI-A program may not have impacted Jason’s social is relevant for individuals with HFA/AS as some literature behavior as much as desired in the lunch setting due to the suggest reading comprehension diﬃculties in this population long reinforcement history  and proximity to the special . Furthermore, according to Stichter and colleagues, education teacher, therefore making this behavior more the research has not provided suﬃcient validation of these resistant to the SCI-A strategies. However, from baseline to measures as either screeners, or as pre- postassesment for intervention in the math setting Jason demonstrated positive growth. In light of the variable results found in this study changes with a decrease in IRC behavior toward peers, and others, these results should be interpreted with caution. which can be interpreted as an improvement in turn-taking skills for this participant. The SCI-A program is designed to promote self-monitoring and awareness and perspective 4.2. Generalization of SCI-A. Inline with the secondary taking ; therefore the decrease in IRC toward peers purpose of the study, the current results indicate promise may have been Jason’s increasing awareness of sharing the for the potential of the SCI-A program to generalize to conversational space with others. untrained settings. Evidence for some generalization was William maintained a consistent level of total social found in the current study in the math and lunch settings interaction from baseline to intervention in the lunch setting. for all participants as measured by their positive change in The positive outcome for this participant was evident in the overall social interaction. Unique to this study is the ability shift in the type of interaction he was having from baseline to explore generalization as captured not only by the total to intervention. Speciﬁcally, he reduced his rate of initiations social interaction (TSI) measure, but also speciﬁc areas of and increased his responses and continuations to adults social interaction (initiations, responses, and continuations). resulting in appropriate reciprocal conversations. Similar This multifaceted approach to measuring social behavior is to Jason, William exhibited a high level of verbal ﬂuency particularly relevant for individuals with ASD in that each and also engaged in self-talk behavior. However, his special individual presents distinctive social competence deﬁcits and education teacher referred William in part because he tended as was evident in the current study, intervention resulted in to focus his verbalizations on repetitive and stereotypic unique outcomes for each participant. topics and interests. Again, the special education teacher For Shawn, from baseline to intervention, the most was very familiar with William’s interests and would often notable change in the lunch setting was his continuations comment on his self-talk, therefore possibly maintaining to adults and to typically developing peers. It was observed the conversation. However, William’s increase in responses in baseline and throughout the study that Shawn was a and continuations during intervention suggest that he was very shy individual and relied on others to initiate social using appropriate conversational skills highlighted in the interaction. Shawn’s increase in continuations indicates SCI-A curriculum such as turn-taking and sharing ideas in that once an adult or peer initiated with him, he was conversation. In the math setting, although William showed attempting to maintain the conversation more so than an increase in all IRC behavior to adults and peers the most prior to intervention. Shawn’s reduced rates of behavior substantial change was in his interactions with adults. During change in the math setting can be attributed somewhat intervention William was maintaining his conversations with to the setting. Though social interaction was encouraged adults in the math setting more so than in baseline. during small group activities, it was observed that if a During baseline observations Ryan demonstrated levels participant was working diligently on the assignment the of social interaction that were comparable to his general math teacher rarely prompted the participants to work with education peers. However, Ryan often exhibited inappropri- others. During direct observation sessions, Shawn was often ate conversation skills with his peers during conversation. observed independently completing his math work and not Ryan showed an increase in initiations, responses, and engaging in social interaction. continuations from baseline to intervention. Moreover, it was Jason’s data from baseline to intervention indicates that observed that Ryan decreased his inappropriate conversation he did increase his social interaction in the lunch setting, skills almost completely. He showed the most growth in his and as expected, the primary change was with adults as his ability to independently initiate an interaction with his peers baseline rates with peers were already fairly high. It was as well as respond to social bids from others. Conversation skills are a core component of the SCI-A program with observed throughout the study that Jason exhibited very high rates of the target behaviors and unique to other participants a speciﬁc focus on turn-taking in conversation as well as in this study, teachers targeted decreases in several areas of understanding the roles of a good speaker and a good listener . It was clear that Ryan wanted to be social and made social communication as a goal for Jason while in the SCI- A program. At times Jason would engage in inappropriate a number of attempts to be social with his peers during Autism Research and Treatment 9 baseline however it appeared that he lacked the knowledge of deﬁcits for individuals with HFA/AS. Speciﬁcally, the SCI- exactly how to execute an interaction successfully. The SCI- A program teaches appropriate conversation skills, to enable A program therefore provided the necessary tools for this participants to interact successfully with their peers and success. therefore contact natural communities of reinforcement. Chris exhibited appropriate levels of social interaction Second, training diversely refers to maintaining the minimal during baseline observations. From baseline to intervention level of training control possible while still producing Chris demonstrated an increase in his initiations, responses, behavior change [46, 48]. The SCI-A program utilizes a and continuations to peers. The most substantial increase unique scaﬀolding of curricular constructs, meaning the in social behavior was his level of continuations to peers. program provides a process for the acquisition of skills sets Again, continuations indicate that this participant was able to in combination with opportunities to practice these skills engage in more reciprocal social interaction during the SCI- over time with multiple partners in multiple role-playing A program as compared to baseline. In addition to Chris’ scenarios . Therefore as participants progress through changes in initiations, responses, and continuations, it was the curriculum they are provided more complex skill sets also observed that Chris showed changes in the type of and aﬀorded more and more opportunities to practice interactions that he had with individuals with whom he was resulting in higher levels of ﬂuency of skills as they complete less familiar. Throughout the study it was noted that Chris the program. Finally, incorporating functional mediators primarily interacted with a small group of peers and if other refers to taking advantage of relevant discriminative stimuli peers or adults with whom he was not comfortable attempted in the training environment that can be transferred to to engage in conversation with him he would typically other environments to promote generalizations [46, 48]. ignore these initiations or respond in a rude manner. As An integral component of the SCI-A curriculum is within Chris moved through the SCI-A curriculum, it was reported a foundation of applied behavior analysis; the teaching anecdotally from teachers that he was more tolerant of of cognitive strategies that are intended to result in self- others and was more likely to demonstrate appropriate social monitoring and self-management processes that participants behavior with individuals outside of his group of familiar can recall in social situations to aid in appropriate social peers. responding across multiple environments and multiple social Jeremy demonstrated relatively low rates of social behav- partners. ior during baseline observations. He would attempt to initiate conversation with peers however he had diﬃculty 4.3. Limitations. Limitations of the current study include the maintaining conversations for any length of time. From ongoing challenge in identifying and using appropriate and baseline to intervention, Jeremy made improvements in his valid ToM measures to capture growth in this domain for initiations, responses, and continuations. However, he made the particular subset of participants studied in this project. the most gains in his responses and continuations indicating To this end, standard measures used in previous studies a substantial improvement in this ability to maintain a were accessed to stay consistent with the desire to replicate conversation with this peers. Often Jeremy was observed and extend in the area of setting and generalization without initiating topics of conversation that were overtly academic additional new variables. A small number of participants and often uninteresting to his peers. The positive changes is also a limitation of the current study. A small sample in Jeremy’s social behavior may be attributed to his use size is indicative of a pilot study; however this greatly of skills learned in the SCI-A curriculum that enabled impacts the generalizability of the ﬁnding. Additionally him to accurately interpret the social cues provided by his constraints manifested that were indicative of measuring peers. For example understanding facial expressions could have helped Jeremy realize when peers began to get bored social interaction in applied settings. These included not with a conversation or skills from sharing ideas could have being able to control for variable environmental stimuli inﬂuenced his willingness to share the conversation space in each measured setting. For example, although the math with his peers. class was designed to be a cooperative learning environment, The results discussed above indicate that there is evidence it was not consistently delivered by the teacher in this for some generalization of skills from the SCI-A program manner. The lunch setting included multiple conversation to the lunch and the math settings. The SCI-A program partners and included a special education teacher that on consists of a number of curricular components that are occasion created her own social stimulus. For example, consistent with suggestions from the generalization literature although the math class was designed to be a cooperative to promote generalized skill use and in part explains the learning environment, it was not consistently delivered by results found in the current study. Stokes and Osnes pro- the teacher in this manner. The lunch setting included varied vide principles and tactics for generalization programming; conversational partners and included a special education these include (1) taking advantage of natural communities of teacher that on occasion created her own social stimulus. reinforcement, (2) training diversely, and (3) incorporating An additional limitation is that both the individuals who functional mediators. First, taking advantage of natural conducted the direct observations, as well as the coders for communities of reinforcement refers to using elements of the ﬁdelity of the SCI-A program, were knowledgeable of the the natural environment that already function to maintain study and therefore could have introduced their own bias the target behavior . The SCI-A program is designed into the data. Also, due to study constraints and the end of to promote relevant behaviors to address social competence the school year it was not possible to investigate maintenance 10 Autism Research and Treatment of changes over time. Finally, due to limited research staﬀ it of Autism and Developmental Disorders, vol. 38, no. 2, pp. 353– 361, 2008. was not possible to investigate generalization of the SCI-A  National Autism Center, National Standards Report: The program to other school environments such as recess, free National Standards Project-Addressing the Need for Evidence- time, and to community and home settings. Based Guidelines for Autism Apectrum disorders,NAC,Ran- In summary, the present investigation replicated and dolph, Mass, USA, 2009, http://www.nationalautismcenter extended previous research demonstrating the eﬃcacy of .org/aﬃliates/reports.php. a social competence intervention based on a cognitive  F. M. Gresham, G. Sugai, and R. H. Horner, “Interpreting behavioral framework. More importantly, this study showed outcomes of social skills training for students with high- that social competence skills acquired in a school-based incidence disabilities,” Exceptional Children,vol. 67, no.3,pp. social competence intervention may have the potential to 331–344, 2001. generalize to multiple school environments. These ﬁndings  S. W. White, K. Keonig, and L. Scahill, “Social skills are particularly relevant in light of the current critique development in children with autism spectrum disorders: a review of the intervention research,” Journal of Autism and regarding a lack of generalized outcomes for social and Developmental Disorders, vol. 37, no. 10, pp. 1858–1868, 2007. behavioral interventions in the ﬁeld of autism spectrum  B. Hwang and C. Hughes, “The eﬀects of social interactive disorders as well as the overwhelming need for evidence- training on early social communicative skills of children with based practices for adolescents with HFA/AS. However the autism,” Journal of Autism and Developmental Disorders, vol. current study was designed as an initial investigation and 30, no. 4, pp. 331–343, 2000. therefore all ﬁndings should be interpreted with caution.  S. Bellini, J. K. Peters, L. Benner, and A. Hopf, “A meta-analysis Future research should continue the validation of the SCI- of school-based social skills interventions for children with A program by pursuing the next phases of research suggested autism spectrum disorders,” Remedial and Special Education, by Smith and colleagues  including an evaluation of the vol. 28, no. 3, pp. 153–162, 2007. eﬃcacy of SCI-A in large-scale randomized clinical trials as  N. 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