Improving the Social Skills of Children with HFASD: An Intervention Study

The role of speech-language pathologists in supporting theory of mind through literacy-based activities

PURPOSE

This tutorial discusses the importance of speech-language pathologists (SLPs) supporting individuals with language disorders in their understanding of others' cognitive and affective states (theory of mind, ToM), with a special consideration given to applying these suggestions with individuals who are neurodivergent.

METHOD

I motivate this tutorial by first reviewing the literature related to ToM and language abilities for various populations of individuals with language difficulties, highlighting the need for explicitly targeting the language-related skills that are thought to underlie ToM for individuals with language disorders. I next present concrete examples of how to support ToM through literacy-based activities. I follow this discussion with a short description of how these activities may be applied with individuals who are neurodivergent through concrete examples, such as how inclusion of neurodivergent characters in storybooks can aid in educating children about understanding others' perspectives. It further emphasizes the importance of discussing various types of mental and emotional states for individuals who share as well as differ in their neurotypes.

CONCLUSIONS

Language skills are an integral part of ToM abilities. SLPs play an important role in supporting clients' academic, literacy, and social outcomes and can support important perspective-taking skills through associated language/communication skills. The various skills that fall under the umbrella term 'theory of mind' can be appropriately incorporated into intervention and literacy-based tasks in a way that respects differences in neurotype while still building important language and communication skills for clients.

Effects of a neuropsychosocial teleassistance intervention on social cognition and health-related quality of life of pediatric patients with neuromuscular diseases

OBJECTIVE

This study aimed to determine the effects of a neuropsychosocial teleassistance group-based intervention on improving social cognitive functioning and health-related quality of life (HRQoL) in pediatric neuromuscular diseases (NMD).

METHODS

Thirty-five pediatric patients with NMD were assigned to the neuropsychosocial intervention program (n = 20) or waiting list control condition (n = 15). The intervention group received an integrative approach that combines training in social cognition with cognitive behavioral therapy. All participants completed a neuropsychological and clinical assessment at baseline and follow-up, which included tests of social cognition, both for emotion recognition and theory of mind, and HRQoL. Repeated-measures multivariate analysis of covariance was used to determine the effects of the teleassistance program.

RESULTS

Group × Time interactions revealed significant improvements in the intervention group as compared with the control group for different social cognition's indicators (AR NEPSY-II: p = .003, η2p = .24; TM NEPSY: p < .001, η2p = .35; Verbal task: p < .001, η2p = .35; Happé's Strange Stories: p = .049, η2p = .11) and HRQoL (Psychosocial health: p = .012, η2p = .18; Emotional functioning: p = .037, η2p = 0.13; Social functioning: p = .006, η2p = .21; Total: p = .013, η2p = .17), showing medium to large effects.

CONCLUSIONS

Patients receiving the neuropsychosocial intervention showed improvements in their social cognition performance and psychosocial HRQoL, providing evidence about the positive effects of the program in pediatric patients with NMD. This should be considered in further research and interventions in this field.

Meta-analysis of Psychotherapy for Autistic Youth

In order to provide more individualized support, it is imperative to further understand the effectiveness of different types of psychotherapy on the clinical areas of need common in autistic youth (Wood et al. in Behav Ther 46:83-95, 2015). Randomized controlled trials of psychotherapy for autistic youth were included if published in English, included random assignment to treatment or control group, required a previous diagnosis of autism, had a mean age of 6-17 years, and provided outcome measure data from both intervention and control groups. A total of 133 measures were coded across 29 studies and included 1464 participants with a mean age of 10.39 years (1.89). A small mean effect size (0.38,95% CI [0.26, 0.47]) was found overall, with the largest effects for cognitive behavioral therapies on autism-related clinical needs (0.81) and overall mental health (0.78). The results show the significant impact of psychotherapy interventions for autistic youth. Additional research should further assess the details of the most effective psychotherapies for each area of clinical need.

What parents want: A qualitative analysis of a parent-implemented intervention for autistic children

Background and aims

Guidelines regarding social cognitive interventions for autistic children suggest incorporating a holistic approach. This includes increasing the family's understanding of difficulties associated with autism, integrations of natural environments, and parents as active agents in the intervention while being supported for their well-being. The current availability of holistic parent-implemented interventions for autistic children is limited, with no qualitative understanding of how parents view the benefits for themselves or their children.

Method

The current study expands the literature regarding holistic approaches through a qualitative understanding of parent perceptions of a parent-implemented social communication intervention for autistic children (TalkAbility™), which incorporates a 6-month follow-up. This study sought to gain a deeper understanding from parents on their perceptions of a holistic approach, including the impact on themselves, their families, and their autistic child.

Results

Following Braun and Clarke's model of thematic analysis, data was coded into four themes: (a) communication difficulties, frustrations, and progress, (b) social relationships and concerns, (c) communication strategies, and (d) thoughts and emotions surrounding TalkAbility™.

Conclusions

Parents report that many components of a holistic approach are instrumental in encouraging social communication in their autistic child. Results highlight the importance of considering parent experiences regarding interventions for their child's social communication skills through a qualitative viewpoint.

Implications

Knowing the intervention aspects that parents view as most valuable allows targeted program modifications that reflect actual parent needs. Further understanding regarding the influence of holistic parent-implemented social communication interventions on child communication skills, parenting frustrations, and parent-child relationships is needed.

Promoting Well-Being in Individuals With Autism: Applying Positive Psychology in Rehabilitation Counseling

Positive psychology is a subdomain that addresses the importance of human strengths and personal assets in individuals’ well-being. The principles of positive psychology align with the philosophy of rehabilitation counseling by emphasizing individuals’ strengths to promote psychosocial adjustment to disability. Considering the intersection between positive psychology and rehabilitation counseling, applying the positive psychology framework to rehabilitation counseling will be a promising foundation for improvement in services and outcomes. As the number of individuals on the autism spectrum increases, more innovative services are needed to keep abreast of their needs. This article discusses how positive psychology can be applied to the population of individuals with autism spectrum disorder (ASD) and explores possible practices that can be replicated by practitioners to provide quality services for this emerging disability population. Implications for education and research are also discussed.

A machine learning-based diagnostic model for children with autism spectrum disorders complicated with intellectual disability

Background

Early detection of children with autism spectrum disorder (ASD) and comorbid intellectual disability (ID) can help in individualized intervention. Appropriate assessment and diagnostic tools are lacking in primary care. This study aims to explore the applicability of machine learning (ML) methods in diagnosing ASD comorbid ID compared with traditional regression models.

Method

From January 2017 to December 2021, 241 children with ASD, with an average age of 6.41 ± 1.96, diagnosed in the Developmental Behavior Department of the Children's Hospital Affiliated with the Medical College of Zhejiang University were included in the analysis. This study trained the traditional diagnostic models of Logistic regression (LR), Support Vector Machine (SVM), and two ensemble learning algorithms [Random Forest (RF) and XGBoost]. Socio-demographic and behavioral observation data were used to distinguish whether autistic children had combined ID. The hyperparameters adjustment uses grid search and 10-fold validation. The Boruta method is used to select variables. The model's performance was evaluated using discrimination, calibration, and decision curve analysis (DCA).

Result

Among 241 autistic children, 98 (40.66%) were ASD comorbid ID. The four diagnostic models can better distinguish whether autistic children are complicated with ID, and the accuracy of SVM is the highest (0.836); SVM and XGBoost have better accuracy (0.800, 0.838); LR has the best sensitivity (0.939), followed by SVM (0.952). Regarding specificity, SVM, RF, and XGBoost performed significantly higher than LR (0.355). The AUC of ML (SVM, 0.835 [95% CI: 0.747-0.944]; RF, 0.829 [95% CI: 0.738-0.920]; XGBoost, 0.845 [95% CI: 0.734-0.937]) is not different from traditional LR (0.858 [95% CI: 0.770-0.944]). Only SVM observed a good calibration degree. Regarding DCA, LR, and SVM have higher benefits in a wider threshold range.

Conclusion

Compared to the traditional regression model, ML model based on socio-demographic and behavioral observation data, especially SVM, has a better ability to distinguish whether autistic children are combined with ID.

Qualitative Evaluation of a Social Cognitive Training Program for Parents of Children with Autism from Hong Kong

A key feature of autism spectrum disorder is a dysfunction in social participation. This study aimed to explore the parents' perceptions and experiences of social cognitive training for their child with autism in the Hong Kong context. Using a qualitative narrative approach, twenty-three parent participants were interviewed using purposive sampling techniques. Data were analyzed using content analysis method. Three themes included: Improvements and changes in children's social participation across different settings; Challenges in the implementation of and engagement in the social cognitive training; and Parents' views and suggestions about the training. The findings supported that there were parent perceived improvements in their child's social skills and social participation. The interviews also revealed generalization of social skills and behaviors across home, school and community settings. The results of this study can inform therapists to design appropriate social cognitive intervention and improve social participation for this population group.

Randomized Controlled Trial of a Video Gaming-Based Social Skills Program for Children on the Autism Spectrum

Families often face financial and geographical barriers to services for children with autism. The current study explored the effectiveness of a parent-supported adaptation of the computer game-based social skills program Secret Agent Society (SAS). Seventy child-parent dyads were randomized to SAS (n = 35) or a caregiver-supported cognitive skills training game (CIA—control comparison; n = 35), both completed over 10 weeks. Child participants were on the autism spectrum and aged seven to 12 years (60 boys, 10 girls). SAS participants improved more than CIA participants on parent-rated social skills and problem behaviors and teacher-rated social skills. Findings suggest the intervention may be a convenient, cost-effective therapeutic approach, especially during times of restricted face-to-face service access, such as COVID-19.

The Role of Executive Functioning in Predicting Social Competence in Children with and without Autism Spectrum Disorder

All children with autism spectrum disorder (ASD) experience social difficulties but they differ with regard to the type and severity of their challenges. Potentially powerful interventions targeting social skills in children with ASD may have limited effectiveness if they are not tailored to the child's specific needs. One factor that may influence social competence is executive functioning (EF). EF may impact social competence by facilitating higher-order strategies such as emotional and cognitive regulation which are necessary for social interactions. Participants included 132 children and adolescents, aged 7-13, including 77 with ASD (M = 10.11, SD = 1.94), and 55 without ASD (M = 9.54, SD = 1.67). Caregivers completed the Behavior Rating Inventory of Executive Functioning, Version 2 (BRIEF-2) Parent Form, assessing everyday EF skills, and the Multidimensional Social Competence Scale (MSCS). Hierarchical multiple regression analyses were conducted separately for the group without ASD and the group with ASD, with MSCS entered as the dependent variables and EF indices and scales of the BRIEF-2 as the main predictor variables. EF deficits in emotional control predicted poor emotion regulation for both children with and without ASD. For the group without ASD, better emotional control and initiation skills predicted empathic concern and social knowledge, respectively. Challenges in self-monitoring significantly predicted difficulties with social inferencing and social knowledge for children with ASD. The findings highlight the importance of targeting specific EF skills that contribute to various aspects of social competence to increase the effectiveness of interventions for children with ASD. Autism Res 2020, 13: 1856-1866. © 2020 International Society for Autism Research and Wiley Periodicals LLC LAY SUMMARY: We examined whether parents' ratings of their children's higher-order thinking skills (e.g., paying attention, organizing and planning, initiating tasks, regulating emotions, self-monitoring) predicted social competence among children with and without autism spectrum disorder (ASD). For children without ASD, emotional control and initiation skills were strongly linked to their displays of empathy and social knowledge, respectively. For children with ASD, their abilities to be aware of their own behaviors and its impact on others were strongly related to their ability to interpret social cues and their social knowledge. For both groups, the ability to regulate their emotions were important predictors of their ability to modulate their emotions in social contexts.

Neonate gut colonization: The rise of a social brain

BACKGROUND

The human gut microbiota constitutes an integral part of human physiology, playing an important role in maintaining health, and compositional or functional changes in intestinal microbiota may be associated with the emergence of several chronic diseases. Animal and human studies have shown that there is a dynamic cross-talk between intestinal microorganisms and brain networks which has an impact on neurodevelopment and may be extremely critical in shaping human social behavior.

PURPOSE

The aim of the current review is to appraise and present in a concise manner all findings linking the evolution of neonate and infant gut colonization with early social development and to formulate scientifically informed hypotheses which could guide future research on this field.

A Systematic Review of Group Social Skills Interventions, and Meta-analysis of Outcomes, for Children with High Functioning ASD

Group social skills interventions (GSSIs) are a commonly offered treatment for children with high functioning ASD. We critically evaluated GSSI randomised controlled trials for those aged 6–25 years. Our meta-analysis of outcomes emphasised internal validity, thus was restricted to trials that used the parent-report social responsiveness scale (SRS) or the social skills rating system (SSRS). Large positive effect sizes were found for the SRS total score, plus the social communication and restricted interests and repetitive behaviours subscales. The SSRS social skills subscale improved with moderate effect size. Moderator analysis of the SRS showed that GSSIs that include parent-groups, and are of greater duration or intensity, obtained larger effect sizes. We recommend future trials distinguish gains in children’s social knowledge from social performance.

A novel cognitive behavioural intervention with Theory of Mind (ToM) training for children with epilepsy: protocol for a case series feasibility study

BACKGROUND

Children with epilepsy have significant social impairments, yet evidence-based interventions to address these social difficulties are lacking. Emerging research has shown that social difficulties in children with epilepsy relate to underlying impairments in Theory of Mind (ToM). This paper outlines the protocol for a pilot study that will evaluate the feasibility, acceptability, and efficacy of a novel cognitive behavioural intervention with ToM training for children with epilepsy.

METHODS

The intervention will be evaluated in a single-arm case series feasibility study. Ten to 12 children with common forms of epilepsy (8 to 12 years old) will be recruited to participate in 4 small group workshops, held over 4 consecutive weeks. Parents will attend a brief review at the end of each session with their child. Children will complete 4 one-to-one assessments with an investigator assessing ToM and social competence: twice at baseline (4 weeks and 1 day before the intervention), at post-intervention (last day of the intervention) and at follow-up (4 weeks post intervention). Parents will complete online questionnaires at these same 4 time points assessing ToM and social competence of their child. Parents and children will both complete a weekly measure of social competence from baseline 1 to follow-up. Following completion of the intervention, parents will complete two standardised questionnaires assessing treatment acceptability and barriers and facilitators to attendance; children will complete a single questionnaire on treatment acceptability. Information about feasibility outcomes (i.e. recruitment and retention, processing time, suitability of tasks) will be gathered by investigators during the trial. Together, outcomes will be used to refine research methods and make a decision about whether the intervention should be evaluated in a larger scale trial.

DISCUSSION

To our knowledge, this is the first psychosocial intervention to address social competence problems in children with epilepsy. Findings will provide information about a potentially effective treatment that could improve longer term social outcomes for this group.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12618000974202, registered June 8 2018.

Discrepancies When Assessing Interpersonal Problem-Solving Skills in Autism Spectrum Disorder: A Diagnostic Indicator

In children with autism spectrum disorder (ASD), there are often discrepancies between direct assessment and third-party reports. We compared these children with groups with/without difficulties in interpersonal problem-solving skills in order to determine whether these discrepancies appear and if they could be a diagnostic indicator for ASD. There were 91 participants (ages 7-13): 28 children with ASD, 36 in a high family risk situation, and 27 typically developing children, all tested with direct measures and third-party reports. Results showed discrepancies only in the ASD group. Consequently, direct performance measures and third-party reports seem to be evaluating different constructs in children with ASD. In addition, both types of measures discriminate between groups, such that both are needed, especially in diagnostic assessments.

To be understood: Transitioning to adult life for people with Autism Spectrum Disorder

INTRODUCTION

The purpose of this study was to explore the viewpoints of parents of young people with Autism Spectrum Disorder (ASD) in relation to their child's transition to adulthood.

METHODS

Data were collected during four structured focus groups with 19 parents of young people with ASD with average to high intellectual capacities. Condensed meaning units were identified and checked during focus groups, and were subsequently linked to the International Classification of Functioning, Disability and Health (ICF).

RESULTS

Three major themes emerged: to be understood, to understand the world and to succeed. The ICF domains of activity and participation and environmental factors emerged as having the greatest potential to influence transition outcomes.

CONCLUSIONS

Policies and services should focus on strengths to maximise participation in higher education, employment and independent living amongst young people with ASD. Interventions targeting environmental factors could be effective in improving participation in adult life. Person-centred and individualised approaches could further complement this approach supporting the transition to adulthood for people with ASD, ultimately improving outcomes in adulthood.

Friendship: Operationalizing the Intangible to Improve Friendship-Based Outcomes for Individuals With Autism Spectrum Disorder

PURPOSE

Individuals with autism spectrum disorder (ASD) have social deficits that affect making and maintaining friends. Many empirically tested methods to address these social deficits are available, yet difficulties related to the establishment and maintenance of authentic friendships persist.

METHOD

This viewpoint article (a) briefly reviews the current state of the science relative to social and friendship skills training for individuals with ASD, (b) considers the potential links (or lack thereof) between current social and friendship skill interventions for individuals with ASD and outcomes related to making and maintaining friends, (c) examines how friendship-related outcomes might be maximized, and (d) proposes a framework for intervention planning that may promote these valued outcomes.

RESULTS

There are several key concepts to consider in planning intervention targeting friendship as an outcome. These concepts include (a) equal status, (b) mutually motivating and authentic opportunities for interaction, and (c) frequent opportunities for interaction.

CONCLUSIONS

There are many aspects about friendship development that cannot be controlled or contrived. Much is still to be learned about the achievement of better friendships for individuals with ASD. Reconceptualizing the way we design intervention may promote better outcomes for individuals on the autism spectrum.

Training children's theory-of-mind: A meta-analysis of controlled studies

BACKGROUND

Theory-of-mind (ToM) refers to knowledge and awareness of mental states in oneself and others. Various training programs have been developed to improve ToM in children.

OBJECTIVES

In the present study, we conducted a quantitative review of ToM training programs that have been tested in controlled studies.

DATA SOURCES

A literature search was conducted using PubMed, PsycInfo, the Cochrane Library, and manual searches.

REVIEW METHODS

We identified 32 papers with 45 studies or experiments that included 1529 children with an average age of 63 months (SD=28.7).

RESULTS

ToM training procedures were more effective than control procedures and their aggregate effect size was moderately strong (Hedges' g=0.75, CI=0.60-0.89, p<.001). Moderator analyses revealed that although ToM training programs were generally effective, ToM skill-related outcomes increased with length of training sessions and were significantly higher in active control studies.

CONCLUSION

ToM training procedures can effectively enhance ToM in children.