A systematic review of school-based social skills interventions and observed social outcomes for students with autism spectrum disorder in inclusive settings

Assessing the Relationship Between Teacher Inclusive Beliefs, Behaviors, and Competences of Students with Autism Spectrum Disorders

This study examined the associations between teachers' beliefs and behaviors related to inclusive education (IE) and their evaluations of social and academic competences in students with Autism Spectrum Disorder (ASD) - important indicators of IE. Utilizing the Theory of Planned Behavior (TPB), the research investigated how teachers' intentions to implement IE and their supportive practices affected the social and academic competences of students with ASD. The study involved 267 teachers from 78 mainstream secondary schools in Hong Kong. Teachers completed a questionnaire assessing attitudes, subjective norms, perceived behavioral control, and intention to implement IE. Information on teachers' practices supporting students with ASD and their evaluations of social and academic competences of these students was also collected. Structural equation modeling (SEM) was used to analyze the relationships between these variables. Correlation analysis revealed positive and significant associations between teachers' beliefs, inclusive practices, and their evaluations of social and academic competences of students with ASD. SEM indicated that perceived behavioral control significantly and positively influenced the social and academic competences of students with ASD through teachers' inclusive practices. This study highlights the vital role of teachers' control beliefs and inclusive practices in fostering the social and academic competences of students with ASD. By applying the TPB and SEM, the research contributes to understanding how teachers' intentions and behaviors in implementing IE impact students' outcomes. The findings offer practical implications for enhancing inclusive education practices for supporting students with ASD in mainstream schools.

Effectiveness of a universal preschool-based program for emotional education in 3- to 5-year-old children with autism spectrum conditions

LAY ABSTRACT

There are numerous programs and interventions to improve social and emotional skills that expressly target children with autism spectrum conditions. However, there is less knowledge about the impact of universal (directed to all children) school programs of emotional education specifically on these children. In this context, the aim of our study was to evaluate the impact of the "1,2,3,emoció!" universal school program on them. The results show that children with autism spectrum conditions participating in the program improved their emotional competence more than the ones who did not participate. Therefore, we conclude that the "1,2,3,emoció!" universal program is effective in children with autism spectrum conditions. This promising outcome gives the opportunity to these children to benefit from group learning in an inclusive school setting, by complementing individual interventions with a universal program.

Content Analysis of Abstracts Published in Autism Journals in 2021: The year in Review

PURPOSE

Ever since Leo Kanner first described autism in 1943, the research in this field has grown immensely. In 2021 alone, 5837 SCOPUS indexed documents were published with a title that contained the words: "autism", "autistic", or "ASD". The purpose of this study was to examine the most common topics of autism research in 2021 and present a geographical contribution to this research.

METHODS

We performed a content analysis of 1102 abstracts from the articles published in 11 Autism journals in 2021. The following journals, indexed by the SCOPUS database, were included: Autism, Autism Research, Molecular Autism, Journal of Autism and Developmental Disorders, Research in Autism Spectrum Disorders, Focus on Autism and Other Developmental Disabilities, Education and Training in Autism and Developmental Disabilities, Review Journal of Autism and Developmental Disorders, Advances in Autism, Autism and Developmental Language Impairments, and Autism in Adulthood.

RESULTS

According to the analysis, the main research topics were: mental health, social communication, social skills, quality of life, parenting stress, ADHD, Covid-19, self-efficacy, special education, and theory of mind. In relation to geographic distribution, most studies came from the USA, followed by the UK, Australia, and Canada.

CONCLUSION

Research topics were aligned with the priorities set by stakeholders in autism, most notably persons with autism themselves and their family members. There is a big gap in research production between developed countries and developing countries.

School-based social skills group training (SKOLKONTAKT™): a pilot randomized controlled trial

Purpose

Differences in socio-communicative behaviors contribute to social challenges for autistic learners at school and, in turn, are associated with increased risks of educational underachievement, social exclusion, and mental health issues. Given that intervention delivery in natural contexts may enhance skills generalization, build support capacities in society, and have practical advantages for youth and families, SKOLKONTAKT™ has been adapted from the clinically based social skills group training KONTAKT™ for mainstream educational settings to mitigate these risks.

Methods

A pilot, randomized controlled trial with active controls was conducted in a mainstream Swedish high school. Autistic learners and students with social skills challenges (N = 33; MAGE = 17.5) were randomized to SKOLKONTAKT™ (n = 17) or active control (n = 16). Efficacy was measured at post and follow-up (3 months) on social skills [Social Skills Group Assessment Questionnaire (SSGQ); primary outcome] by parent-, self-, and (masked) teacher-report as well as self-reported life quality and social goal attainment.

Results

Despite COVID-19 challenges, 70.6% (n = 12) completed SKOLKONTAKT™, and 87.5% (n = 14) completed control groups. SKOLKONTAKT™ improved on a series of items on SSGQ as well as subjective life quality beyond controls. A larger proportion of social goals were attained, and side-effects were of little impact and proportionally fewer in SKOLKONTAKT™.

Conclusion

SKOLKONTAKT™ is a safe, feasible, and promising intervention option for autistic learners in mainstream educational settings. A larger-scale study is desirable to confirm the effects identified in this pilot study.

I-SOCIALISE: Results from a cluster randomised controlled trial investigating the social competence and isolation of children with autism taking part in LEGO® based therapy ('Play Brick Therapy') clubs in school environments

LAY ABSTRACT

Autism is characterised by keen interests and differences in social interactions and communication. Activities that help autistic children and young people with social skills are commonly used in UK schools. LEGO® based therapy is a new activity that provides interesting and fun social opportunities for children and young people and involves building LEGO® models together. This study looked at LEGO® based therapy for the social skills of autistic children and young people in schools. It was a randomised controlled trial, meaning each school was randomly chosen (like flipping a coin) to either run LEGO® based therapy groups in school over 12 weeks and have usual support from school or other professionals, or only have usual support from school or other professionals. The effect of the LEGO® based therapy groups was measured by asking children and young people, their parents/guardians, and a teacher at school in both arms of the study to complete some questionnaires. The main objective was to see if the teacher's questionnaire answers about the children and young people's social skills changed between their first and second completions. The social skills of participants in the LEGO® based therapy groups were found to have improved in a small way when compared to usual support only. The study also found that LEGO® based therapy was not very costly for schools to run and parents/guardians and teachers said they thought it was good for their children and young people. We suggest further research into different potential benefits of LEGO® based therapy.

Social engagement and loneliness in school-age autistic girls and boys

OBJECTIVES

This study examines the relationship between social engagement and loneliness in female and male autistic children and adolescents in school-based social settings. Secondary aims sought to explore the emergence of loneliness across different age groups and differences in social engagement and loneliness between genders.

METHODS

This study conducted an analysis of previously collected data from two multi-site randomized control trials. This study included 58 autistic students (29 females, 29 males) between the ages 6 through 18 years. Female and male participants were matched on age and intelligence quotient. Concurrent mixed methods were used to examine participants' social engagement and loneliness.

RESULTS

Findings revealed a significant relationship between joint engagement and loneliness, such that autistic students reported more loneliness when they were mutually engaged with social groups than when they were isolated or alone. Positive correlations between joint engage and loneliness were identified in elementary-age girls and secondary-age boys, suggesting that being mutually engaged with peers leads to increased loneliness. Negative correlations between parallel and loneliness identified in secondary-age boys suggested that boys in close proximity to peers felt less lonely than boys who were mutually engaged with peers. Qualitative analysis of social behaviors indicated that elementary girls and secondary boys were more likely to be mutually engaged or in close proximity to activities, but they had difficulty sustaining this engagement throughout the entire social period. Secondary girls and elementary boys, on the other hand, were more likely to be solitary and less likely to engage with peer groups.

CONCLUSION

Study findings highlight the relationship between social engagement and loneliness in school-based autistic populations, and that more engagement itself can lead to more loneliness for younger girls and older boys. The influence of age and gender on engagement and loneliness highlights a need to tailor social interventions to leverage existing social strengths.

Effectiveness of interventions for children and adolescents with autism spectrum disorder in high-income vs. lower middle-income countries: An overview of systematic reviews and research papers from LMIC

Background

There is a multitude of systematic reviews of interventions for children and adolescents with autism spectrum disorder (ASD). However, most reviews seem to be based on research conducted in High-Income Countries (HIC). Thus, summary findings may not directly apply to Lower Middle-Income Countries (LMIC). Therefore, we conducted a Meta-Review analyzing systematic reviews on the effectiveness of interventions for target outcomes in children and adolescents with ASD to find out whether there are differences in effectiveness between HIC and LMIC and which interventions can be considered evidence-based in LMIC.

Methods

Electronic databases (PsycINFO, PubMed, Cochrane database of systematic reviews) were searched for reviews on interventions for ASD in children and adolescents from January 2011 through December 2021, which included studies not coming from HIC. Systematic reviews with qualitative and quantitative syntheses of findings were included. Two investigators independently assessed studies against predetermined inclusion/exclusion criteria and extracted relevant data including quality and evidence assessments. Evidence for different types of interventions in HIC vs. LMIC was planned to be compared, but none of the reviews assessed potential differences. Therefore, a narrative review of the studies from LMIC was conducted including an assessment of quality and evidence.

Results

Thirty-five reviews fulfilled the inclusion criteria. Eleven considered findings from HIC and LMIC. Sixty-nine percent included studies with various research designs; 63% provided a qualitative synthesis of findings; 77% percent assessed the quality of studies; 43% systematically assessed the level of evidence across studies. No review compared evidence from HIC and LMIC. A review of the studies from LMIC found some promising results, but the evidence was not sufficient due to a small number of studies, sometimes poor quality, and small sample sizes.

Conclusion

Systematic reviews on interventions for children and adolescents with ASD did not look for potential differences in the effectiveness of interventions in HIC and LMIC. Overall, there is very little evidence from LMIC. None of the interventions can be considered evidence-based in LMIC. Hence, additional research and mutually agreed methodological standards are needed to provide a more secure basis for evidence-based treatments in LMIC trying to establish evidence-based practices.

Developmental Issues Associated with Adolescent School Refusal and Cognitive-Behavioral Therapy Manuals

It is important to consider developmental issues when addressing school refusal (SR) in adolescence. Referral rates appear to be higher among adolescents relative to children, and treatment appears to be less effective among adolescents. This paper provides an in-depth review of developmental issues associated with adolescent SR and treatment via cognitive-behavioral therapy (CBT). It begins by considering the reasons for the higher referral and poorer treatment outcomes, including the higher level of absenteeism in adolescence, higher rates of concurrent social anxiety disorder and depressive disorder, and the developmental challenges inherent to adolescence. Such challenges include increased academic and social demands in the secondary-school environment, and increasing autonomy which may contribute to family conflict. These developmental issues may potentiate and exacerbate an adolescent's difficulty attending school, make it difficult for families to cope, and complicate practitioners' efforts to provide effective treatment for SR. Further, the review describes CBT manuals for SR and the extent to which they are developmentally sensitive. There are five CBT manuals, which vary in their sensitivity to developmental issues. Various multimodal treatments employ interventions in addition to CBT, such as medication or inpatient treatment, to address the complexity of SR in adolescence. Nevertheless, nonresponse to treatment for adolescent SR ranges from one-third to two-thirds of youths. Attention thus needs to be given to ways of improving treatment outcomes.

Social participation interventions targeting relational outcomes for young people with physical and developmental disabilities: an umbrella review and narrative synthesis

Purpose: To synthesize knowledge about social participation interventions targeting relational outcomes for young people with physical and developmental disabilities.Method: An umbrella review with a narrative synthesis was conducted to integrate findings of review articles examining social participation interventions targeting relational outcomes (e.g., peer interaction and friendships). Six databases were searched to identify reviews published between 2010 and 2021.Results: Five reviews were identified, examining participation interventions, social/community integration interventions, recreational sport programs, online peer mentorship programs, and augmentative and alternative communication interventions to promote social interaction with peers. Interventions associated with improvements in relational outcomes included group-based programs, programs involving personalized goals, arts-based programs, and multi-component social communication interventions. Recommendations for future research included better description of interventions to identify active ingredients and key mechanisms, measurement of participants' experiences, and the need for interventions to be aligned with the nature of the outcomes examined. Preliminary intervention principles are proposed to guide the design of social participation interventions: individualizing, contextualizing, and immersion in social settings.Conclusions: There are multiple pathways by which to influence the relational outcomes of young people with disabilities. There are implications for the design of social participation interventions based on an ecological/experiential and relational perspective.IMPLICATIONS FOR REHABILITATIONImprovements in relational outcomes are associated with participation in group-based programs, programs involving personalized goals, arts-based programs, and multi-component social communication interventions.Three evidence-informed principles can help guide the design of social participation interventions: (1) personalizing, (2) contextualizing, and (3) immersion in social settings.Greater attention to aligning the nature of intervention with desired outcomes is needed to more effectively measure and promote relational outcomes.

Social Skills Group Training for Students with Neurodevelopmental Disabilities in Senior High School-A Qualitative Multi-Perspective Study of Social Validity

Including students with neurodevelopmental disabilities (NDDs) in regular classrooms has become a law-enforced common practice in many high- and middle-income countries. Still, without appropriate actions supporting the implementation of inclusive pedagogical practice, students with NDDs remain at increased risk for absenteeism, bullying and underachievement. There is limited knowledge on the feasibility of social skills group training (SSGT) in naturalistic settings. Using a qualitative approach, the objective of this study was to explore the lived experiences of (i) students diagnosed with autism or attention-deficit hyperactivity disorder and those showing subclinical social difficulties receiving either SSGT or active social control activities in a regular senior high school setting, (ii) teachers providing SSGT or the active control activity and (iii) school leaders facilitating the implementation of these actions. Due to the impact of the COVID-19 pandemic, comparison between real life versus digital administration of SSGT was also examined. Within a randomized controlled pilot trial of the school-tailored SSGT SKOLKONTAKT^®, the primary perspectives of 20 students, teachers and school leaders on SSGT or the social control activities were explored. All groups perceived SSGT to enhance school attendance and academic achievement of students, as well as teacher inclusion skills and the social school climate. Findings indicate that SSGT is largely feasible and socially valid, and broader implementation of SSGT in school settings appears meaningful.