Evidence-Based Social Skills Interventions for Children with Autism… · Evidence-Based Social...
Transcript of Evidence-Based Social Skills Interventions for Children with Autism… · Evidence-Based Social...
Evidence-Based Social Skills Interventions for Children withAutism: A Meta-analysis
Peishi WangQueens College, City University of New York
Anne SpillaneNational University
Abstract: The purpose of this study was to provide a synthesis of research studies published in the last ten yearson interventions to increase social skills for children and adolescents with ASD, examine the outcomes of thesestudies and evaluate whether a given intervention meets the criteria for evidence-based practice. Thirty-eightstudies were included in this review, of which 36 were single subject research studies and 2 group experimentalstudies. Results varied widely both between intervention types, and with the different studies within eachintervention type. While Social Stories, Peer-Mediated, and Video-Modeling all met the criteria for evidence-based, a closer look at percentage of nonoverlapping data points (PND) shows that only Video-Modeling meetscriteria for being evidence-based as well as demonstrating high effectiveness as an intervention strategy.
Interacting with one’s peers can have a signif-icant positive impact on the lives of individualswith disabilities, allowing them to build andparticipate more fully in their communities.Numerous interventions to teach social skillshave been developed over the years (Carter &Hughes, 2005, Vaughn, et al., 2003, White,Keonig, & Scahill, 2007). However, many ofthese methods do not meet the requirementsfor evidence-based practice. New regulationsin the reauthorization of IDEA in 2004 re-quire that evidence-based practices be used toensure individuals with disabilities receive thehighest quality instruction.
Autism is a developmental disorder whoseprevalence rate has been increasing dramati-cally over the past decade. One in 150 chil-dren in America today have an autism spec-trum disorder (Centers for Disease Controland Prevention, 2007). The Autism Society ofAmerica (ASA) estimates that 1.5 millionAmericans and their families are now affected.
In fact, autism is growing at a startling rate of10-17 percent per year, and has become anational health crisis, costing the U.S. at least$35 billion annually (Autism Society of Amer-ica, 2007).
Deficits in social skills are one of the corefeatures of autism spectrum disorders (ASD),and are a major source of impairment regard-less of the intellectual or language ability ofpersons with ASD (Carter, Davis, Klin, & Volk-mar, 2005). Individuals having better socialskills are more likely to be accepted in inte-grated settings, live more independently, andwork in integrated settings (Scheuermann &Webber, 2002). However, treating the socialdeficits of individuals with ASD remains achallenge (Weiss & Harris, 2001).
There have been many interventions usedto teach social skills to individuals with ASD.These include social stories (e.g. Delano &Snell, 2006), peer-mediated strategies, (e.g.Laushey & Heflin, 2000), video modeling(e.g. Paterson & Arco, 2007), cognitive behav-ioral training (e.g. Bock, 2007), pivotal re-sponse training (e.g. Jones & Freely, 2007),Theory of Mind (e.g. Chin, Bernard-Opitz,2000), among others. Additionally, a numberof meta-analyses have looked at social skillstraining for individuals with ASD (Bellini &Akullian, 2007; Carter & Hughes, 2005; Cook,
Correspondence concerning this article shouldbe addressed to Peishi Wang, Graduate Programs inSpecial Education, Department of Educational andCommunity Programs, Powdermaker Hall 032J,Queens College, City University of New York, 65-30Kissena Blvd, Flushing, NY 11367. Email: [email protected]
Education and Training in Developmental Disabilities, 2009, 44(3), 318–342© Division on Developmental Disabilities
318 / Education and Training in Developmental Disabilities-September 2009
Gresham, Kern, Barreras, Thornton, & Crews,2008; Hwang & Hughes, 2000; Vaughn et al.,2003; White et al., 2007). None of this re-search has discussed whether the studies metcriteria for being evidence-based practice.
Defining Evidence-Based Practices
National policies, such as No Child LeftBehind (NCLB) require that teachers useevidence-based practices in their classrooms.Also, new regulations in the reauthorizationof IDEA in 2004 require that evidence-basedpractices be used to ensure individuals withdisabilities receive the highest quality instruc-tion. However, there has never been a cleardefinition of what evidence-based practice is.Therefore, in January 2003, the Council forExceptional Children (CEC) Division for Re-search established a task force to address theissue of evidence-based practices. A specialissue of Exceptional Children (2005) was ded-icated to establishing criteria for evidence-based practice in special education.
First, let’s clarify what a practice is. Accord-ing to Horner, Carr, Halle, McGee, and Wol-ery (2005), a “practice refers to a curriculum,behavioral intervention, systems change, oreducational approach designed for use byfamilies, educators, or students with the ex-press expectation that implementation will re-sult in measurable, educational, social, behav-ioral, or physical benefit.” (p. 175)
In the 2005 special issue of ExceptionalChildren, Odom et al. set the context for thedevelopment of research quality indicatorsand guidelines for evidence of effective prac-tices provided by different methodologies inspecial education, including group experi-mental or quasi-experimental research, singlesubject research, correlational research andqualitative research. For the purpose of thisarticle, we will focus on two types of researchmethodologies: group experimental or quasi-experimental and single subject research.These two methodologies are largely used toidentify cause-effect relationships between in-terventions and target behaviors, therefore,they are more appropriate for identifyingevidence-based practices.
Specifically, for group experimental andquasi-experimental research articles and re-ports, Gersten et al. (2005) presented the fol-
lowing quality indicators: (1) participants in agiven study are sufficiently discussed and theirdisability conditions are confirmed; (2) ran-dom assignment to study conditions are at-tempted and when randomization is not fea-sible, other alternatives are used to ensureparticipants are comparable across condi-tions; (3) sufficient information is providedregarding the interventionists and proceduresimplemented to ensure they are comparableacross conditions; (4) intervention strategiesare implemented with fidelity, (5) multipleoutcome measures are used to capture theintervention’s effect, (6) data analysis includeeffect size calculations in addition to inferen-tial statistics (p. 152).
Furthermore, the panel suggested that apractice is considered evidence-based “whenthere are at least four acceptable quality stud-ies or two high quality studies that support thepractice and the weighted effect size is signif-icantly greater than zero.” (Gersten et. al.,2005, p. 162)
When evaluating research studies usingthe single subject methodology, Horner et al.(2005) stated that “single-subject researchdocuments a practice as evidence based when(a) the practice is operationally defined,(b) the context in which the practice is to beused is defined; (c) the practice is imple-mented with fidelity; (d) results from singlesubject research document the practice to befunctionally related to change in dependentmeasures, and (e) the experimental effectsare replicated across a sufficient number ofstudies, researchers, and participants to allowconfidence in the findings” (p. 175-176).
Additionally, documentation of an evidence-based practice typically requires multiple sin-gle subject studies. “A practice may be consid-ered evidence-based when (a) minimum offive single subject studies that meet minimallyacceptable methodological criteria and docu-ment experimental control have been pub-lished in peer-reviewed journals, (b) the stud-ies are conducted by at least three differentresearchers across at least three different geo-graphical locations, and (c) the five or morestudies include a total of at least 20 partici-pants” (Horner et al., 2005, p.176).
Although there have been a few review ar-ticles published on this topic in recent years(e.g. Matson, Matson, & Rivet, 2007; McCon-
Evidence-Based Social Skills Interventions / 319
nell, 2002; Rogers, 2000; Weiss & Harris,2001), they tend to be more descriptive of thevarious interventions and lack quantitativeevaluations of treatment effectiveness, that is,the researchers relied on the conclusionsdrawn by the studies’ authors. In addition,these qualitative reviews do not compare treat-ment effectiveness across different interven-tion strategies. Furthermore, they fail to ad-dress the critical issue of evidence-basedpractices. The purpose of this study was toprovide a synthesis of research studies pub-lished in the last ten years on interventions toincrease social skills for children and adoles-cents with ASD, examine the outcomes ofthese studies and evaluate whether a givenintervention meets the criteria for evidence-based practice.
Method
A comprehensive review of the literature wasconducted using the following procedures.First, an electronic search was conducted forstudies published between 1997 and 2008August using the Educational Resources Infor-mation Center (ERIC) and PsycINFO data-bases. Searches were carried out using a com-bination of the following descriptors: autism,autism spectrum disorder, ASD, social skills, socialbehavior, social development, conversational skills,play skills, social initiations, requesting, social re-sponses, social interactions, social relationships,joint attention, eye contact, video modeling, peer-mediated interventions, videotape modeling, pivotalresponse training, theory of mind, cognitive behav-ioral training, incidental teaching, social stories,perspective taking, and naturalistic teaching. Sec-ond, a manual search was conducted with thefollowing peer-reviewed journals: Research andPractice for Persons with Severe Disabilities, Journalof Applied Behavior Analysis, Exceptional Children,Education and Training in Developmental Disabil-ities, American Journal on Mental Retardation,and Focus on Autism and Other DevelopmentalDisabilities. In all, 104 studies were located inthis initial search of journal articles.
Studies were selected for review based onthe following criteria. First, participants musthave been identified as having ASD between theage of birth and 21. Second, study participantswere students receiving special education ser-vices either at home or in school settings. Stud-
ies conducted exclusively in community-basedsettings, employment settings and other settingsthat were not clearly described were excludedfrom this synthesis. Third, the study must haveused outcome measures that targeted socialskills. Studies that measured functional skillssuch as daily living skills, reduction of problembehaviors, or non-social communication skillswere not included. Fourth, the study must haveassessed the effectiveness of social skill inter-ventions. Studies that used pharmacologicalinterventions were excluded from this anal-ysis. Fifth, the review comprised an empirical,intervention-based investigation and was pub-lished in a peer-reviewed journal between 1997and 2008. Dissertation studies were not includedin this synthesis. Sixth, the study must meet thecriteria for evaluating evidence-based inter-vention strategies outlined by the Council forExceptional Children Division for Research(2005). For the purpose of this review, onlythose studies that utilized group experimentalor quasi-experimental and single subject re-search were evaluated and analyzed. For groupdesigns, presentation of effect sizes alongwith inferential statistics is recommended. How-ever, some studies included in this meta-analysisdid not report the effect size of the interventionin the original study, they were included onlywhen such calculation could be inferred basedon available statistics reported. Effect sizes areexpressed positively when change occurred inthe predicted direction and negatively whenchanges were opposite to those predicted. Aneffect size of .20 is small, .50 moderate, and .80large. The usually accepted minimum clinicallyacceptable effect size for educational interven-tions is 0.33 (McCartney & Rosenthal, 2000).
If a study uses single subject research de-sign, the study must demonstrate experimen-tal control through the use of multiple base-line, reversal or alternating treatment designsas outlined by the Council for ExceptionalChildren Division for Research (2005). Addi-tionally, the study must present data in graph-ical displays that depicted individual datapoints as these graphical displays were criticalfor the calculation of PND (percentage ofnon-overlapping data points), the metric anal-ysis employed in this meta-analysis. Scruggs,Mastropieri, and Castro (1987) suggested that“PND is the only major evaluative criterionthat can consistently be applied in the largest
320 / Education and Training in Developmental Disabilities-September 2009
number of cases of single subject studies”(p. 27). PND is usually computed by dividingthe number of treatment data points that ex-ceeds the highest baseline data point in anexpected direction by the total number ofdata points in the treatment phase. A PNDbetween 91 and 100 is considered a highlyeffective intervention, between 71 and 90moderately effective, between 51 and 70mildly effective, and between 0 and 50, non-effective (Scruggs & Mastropieri, 1998).
Using these methods and criteria, we iden-tified 38 studies for inclusion in this review, ofwhich 36 were single subject research studiesand 2 group experimental studies.
Classification
For the 36 single subject research studies,we used a coding system established by Mas-tropieri and Scruggs (1985-1986) and mademodifications based on the criteria outlinedby Horner et al. (2005). Each study was ana-lyzed across the following categories: (1) par-ticipant characteristics, including the numberof participants, diagnosis, settings, age andfunctional levels; (2) description of target be-haviors and skills; (3) description of interven-tion; (4) research design; (5) intervention re-sults including intervention, maintenance andfollow-up, and generalization effects as mea-sured by PND; and (6) confirmation ofwhether the study measured treatment integ-rity and social validity.
Interrater Agreement
To establish interrater reliability for the cod-ing procedure and the PND analysis, the firstauthor coded all the single subject studies andcalculated the PND while the second authorrandomly selected 30% (12) of single subjectstudies, independently coded and calculatedthe PND for those studies. Interrater agree-ment was obtained by dividing the total num-ber of agreements by the total number ofagreements plus disagreements and multiply-ing by 100. The mean interrater agreementbetween the two authors was 97% (range 78%-100%).
Results
A summary of the participants, target behav-iors, intervention strategies, and research de-
sign was constructed and presented in Table1. Table 2 provides descriptive information onintervention results, study effect size or PND,maintenance, follow-up and generalization re-sults, treatment integrity and social validitymeasures.
Overall Findings
Single subject designs were used to evaluateintervention effects in 36 studies and groupdesigns were used in 2 studies. Five categoriesof different interventions emerged from these38 studies, including Social Stories (n � 6),Peer Mediated (n � 9), Video Modeling (n �11), Cognitive Behavior Training (n � 3), andOthers (n � 9).
A total of 147 participants were included.Thirty-one studies used a variation of a multi-ple baseline or probe design, five studies useda reversal design, and two studies used pretestand posttest with a control group design.Treatment integrity was reported in 14 stud-ies, of which 11 reported agreement percent-age, ranging from 77% to 100%. Social valid-ity was measured in 16 studies.
Participants and Settings
Of the 147 participants with ASD, among thestudies that reported on gender, 73 partici-pants were boys, and 6 were girls. Additionally,seven studies reported participation of a totalof 68 typical peers. Participants with ASDranged in age from 2 to 17 years old. The vastmajority of participants were between the agesof 6-12 (82 participants), with thirty partici-pants being five years or younger, and threeparticipants being over 12 years of age. Not allstudies reported ages of participants.
The studies primarily took place in inte-grated settings at public schools. Some studieswere conducted across more than one setting.Ten studies reported being conducted in in-tegrated public school settings not otherwisespecified, 9 in specialized class settings at apublic school. Six studies reported lunch, hall-way, or other integrated school settings, threestudies took place in general education class-room settings. Four studies took place inhome or community settings, three studiestook place in private segregated settings, andone study took place in a private integratedsetting.
Evidence-Based Social Skills Interventions / 321
TA
BL
E1
Evi
denc
e-ba
sed
Soci
alSk
ills
Inte
rven
tion
s:M
etho
dan
dR
esea
rch
Des
ign
Stud
yPa
rtic
ipan
ts/S
ettin
gsT
arge
tB
ehav
ior
Inte
rven
tions
Res
earc
hD
esig
n
Soci
alSt
orie
s(n
�6)
San
sost
i&
Pow
ell-S
mit
h(2
006)
3bo
ysw
ith
Asp
erge
rSy
ndr
ome
(Age
s9,
10,
11yr
s)2
boys
inin
tegr
ated
priv
ate
sch
ools
1in
priv
ate
sch
ool
for
child
ren
wit
hL
DA
llth
ree
boys
hav
eav
erag
eor
abov
e-av
erag
eIQ
Spor
tsm
ansh
ipM
ain
tain
ing
con
vers
atio
nJo
inin
gin
Soci
alSt
ory
was
read
twic
ea
day
Mul
tipl
e-ba
selin
eac
ross
part
icip
ants
Del
ano
&Sn
ell
(200
6)3
boys
with
autis
m(A
ges
6,6,
&9)
Inte
grat
edse
ttin
gs6
typi
calp
eers
(3bo
ys&
3gi
rls)
serv
edas
trai
ning
peer
san
dpl
aypa
rtne
rs
Dur
atio
nof
appr
opri
ate
soci
alen
gage
men
tbe
hav
ior
Freq
uen
cyof
4so
cial
skill
s:Se
ekin
gat
ten
tion
,in
itia
tin
gco
mm
ents
,in
itia
tin
gre
ques
ts,
con
tin
gen
tre
spon
ses
Soci
alSt
ory
was
read
once
ada
yM
ulti
ple-
prob
e-ac
ross
part
icip
ants
Th
iem
ann
&G
olds
tein
(200
1)5
boys
wit
hau
tism
(Age
s6-
12yr
s)3
boys
wer
efu
llyin
tegr
ated
,2
wer
ein
tegr
ated
for
30%
ofth
eda
y10
typi
cal
peer
s
4ta
rget
beh
avio
rs:
con
tin
gen
tre
spon
ses,
secu
rin
gat
ten
tion
,in
itia
tin
gco
mm
ents
,in
itia
tin
gre
ques
ts
Soci
alst
orie
s,pi
ctor
ial
wri
tten
text
cues
,vi
deo
feed
back
Mul
tipl
eba
selin
ede
sign
acro
sstw
oor
thre
ebe
hav
iors
Bar
ry&
Bur
lew
(200
4)1
7-yr
-old
girl
&1
8-yr
-old
boy
wit
hse
vere
auti
smin
self
-con
tain
edse
ttin
g
Prom
ptin
gn
eede
dfo
rch
oice
mak
ing;
appr
opri
ate
play
(wit
hpe
ers
&m
ater
ials
)
Soci
alst
orie
s*A
BC
Dm
ulti
ple-
base
line
desi
gnac
ross
two
subj
ects
Scat
ton
e,T
ings
trom
,&
Wilc
zyn
ski
(200
6)3
boys
8-13
wit
hA
SDfr
eeti
me
acti
viti
esac
ross
the
sch
ool
day
App
ropr
iate
soci
alin
tera
ctio
ns
Soci
alSt
orie
sw
ritt
ento
addr
ess
init
iati
ons
and
resp
onse
sfo
rap
prop
riat
eso
cial
inte
ract
ion
sfo
rta
rget
stud
ents
duri
ng
free
tim
eac
tivi
ties
Mul
tipl
eba
selin
eac
ross
part
icip
ants
Dod
d,H
upp,
Jew
ell,
&K
roh
n(2
008)
2bo
ys,
9&
12yr
sol
dw
ith
PDD
-NO
Sbo
thin
incl
usiv
ese
ttin
gsA
vera
geIQ
Dec
reas
eex
cess
ive
dire
ctio
ns
tosi
blin
gs,
incr
ease
com
plim
ents
tosi
blin
gs
Soci
alSt
ory
Mul
tipl
eba
selin
eac
ross
beh
avio
rs&
mul
tipl
eba
selin
eac
ross
part
icip
ants
(con
tinue
d)
322 / Education and Training in Developmental Disabilities-September 2009
TA
BL
E1
Con
tinu
ed
Stud
yPa
rtic
ipan
ts/S
ettin
gsT
arge
tB
ehav
ior
Inte
rven
tions
Res
earc
hD
esig
n
Peer
Med
iate
d(n
�9)
Lau
shey
&H
eflin
(200
0)2
boys
,5
yrs
1w
ith
seve
reA
utis
m;
1w
ith
mild
PDD
-NO
SIn
clus
ive
sett
ing
Ask
ing
&re
spon
din
gG
etti
ng
atte
nti
onW
aiti
ng
for
turn
Eye
con
tact
Bud
dySy
stem
-Mul
tipl
epe
ers
astu
tors
AB
AB
Pier
ce&
Sch
reib
man
(199
7)T
wo
boys
wit
hau
tism
;m
oder
ate
and
prof
oun
dM
RM
ain
tain
sin
tera
ctio
ns;
Init
iate
sco
nve
rsat
ion
;In
itia
tes
play
Mul
tipl
epe
erus
eof
pivo
tal
resp
onse
trai
nin
gM
ulti
ple
base
line
desi
gnac
ross
peer
trai
ner
san
dac
ross
2pa
rtic
ipan
tsH
wan
g&
Hug
hes
(200
0)3
pres
choo
lbo
ysw
ith
auti
sm(3
2-43
mon
ths)
play
area
inan
earl
yin
terv
enti
onpr
ogra
mcl
assr
oom
Freq
uen
cyof
eye
con
tact
;fr
eque
ncy
ofjo
int
atte
nti
on;
freq
uen
cyof
mot
orim
itat
ion
Soci
alin
tera
ctiv
etr
ain
ing
stra
tegi
es(p
eer-
med
iate
d):
con
tin
gen
tim
itat
ion
;n
atur
ally
occu
rrin
gre
info
rcem
ent;
expe
ctan
tlo
ok;
&en
viro
nm
enta
lar
ran
gem
ent
Mul
tipl
eba
selin
eac
ross
part
icip
ant
Petu
rsdo
ttir
,M
cCom
as,
McM
aste
r,&
Hor
ner
(200
7)
On
efi
ve-y
ear
old
boy
wit
hA
SD&
DD
;h
igh
fun
ctio
nin
g;St
udy
took
plac
ein
the
spec
ial
edcl
assr
oom
Soci
alin
tera
ctio
nPe
er-A
ssis
ted
Lea
rnin
gSt
rate
gies
;co
mm
onst
imul
iac
tivi
ties
;pe
ertu
tori
ng
AB
Aw
ith
draw
alan
dm
ulti
ple
base
line
acro
sspe
ers
Lon
cola
&C
raig
-U
nke
fer
(200
5)5
boys
&1
girl
wit
hm
ild/m
oder
ate
auti
sm(a
ges
6-8)
stud
yto
okpl
ace
ina
sect
ion
edof
far
eaof
ala
rge
hal
lway
ina
publ
icsc
hoo
lw
ith
hig
h%
ofch
ildre
nw
ith
auti
sm
Peer
dire
cted
com
men
tin
g;la
ngu
age
dive
rsit
y&
com
plex
ity
Tw
och
ildre
nw
ith
auti
smw
ere
pair
edan
dre
ceiv
edth
epl
an-
play
-rep
ort
trea
tmen
tsi
mul
tan
eous
ly
Mul
tipl
eba
selin
eac
ross
thre
edy
ads
Gar
riso
n-H
arre
ll,K
amps
,&
Kra
vits
(199
7)
3pr
imar
ygr
ade
stud
ents
wit
hau
tism
and
15ty
pica
lpe
ers
stud
yto
okpl
ace
duri
ng
sch
edul
edpl
ayan
dac
adem
icti
mes
inre
gula
red
ucat
ion
sett
ings
Soci
alin
tera
ctio
nbe
twee
nta
rget
stud
ents
and
thei
rpe
ers,
use
ofau
gmen
tati
veco
mm
unic
atio
nsy
stem
sC
olla
tera
lbe
hav
iors
:ex
pres
sive
verb
aliz
atio
ns,
redu
ctio
nof
inap
prop
riat
ebe
hav
iors
,n
on-ta
rget
peer
sus
eof
com
mun
icat
ion
syst
em,
peer
acce
ptan
ce
Aug
men
tati
veco
mm
unic
atio
ntr
ain
ing,
peer
trai
nin
g,im
plem
enti
ng
peer
net
wor
ks(c
oope
rati
vegr
oup
acti
viti
esw
ith
augm
enta
tive
com
mun
icat
ion
syst
em)
Mul
tipl
eba
selin
epr
obe
desi
gnac
ross
sett
ings
,n
este
dw
ith
mul
tipl
eba
selin
eac
ross
stud
ents
wit
hau
tism
(con
tinue
d)
Evidence-Based Social Skills Interventions / 323
TA
BL
E1
Con
tinu
ed
Stud
yPa
rtic
ipan
ts/S
ettin
gsT
arge
tB
ehav
ior
Inte
rven
tions
Res
earc
hD
esig
n
Car
ter,
Cus
hin
g,C
lark
,&
Ken
ned
y(2
005)
3st
uden
ts(2
with
autis
m)
ages
12,1
3,&
176
gene
rale
duca
tion
stud
ents
incl
asse
sw
ithta
rget
stud
ents
ina
mid
dle
and
high
scho
olE
nglis
han
dsc
ienc
ecl
ass.
Soci
alin
tera
ctio
ns(a
ckno
wle
dgem
ent
ofan
othe
rst
uden
tus
ing
verb
alor
nonv
erba
lbeh
avio
rs),
code
dfo
rw
hoth
eyoc
curr
edw
ith,a
ndth
equ
ality
ofin
tera
ctio
n;C
onta
ctan
dco
nsis
tenc
yw
ithge
nera
ledu
catio
ncu
rric
ulum
Peer
trai
ning
toad
apt
clas
sac
tiviti
es,p
rovi
dein
stru
ctio
n,im
plem
ent
beha
vior
plan
s,pr
ovid
efr
eque
ntfe
edba
ck,
prom
ote
com
mun
icat
ion
for
the
part
icip
atin
gst
uden
tsw
ithdi
sabi
litie
s
AB
AB
,an
dB
AB
A:
wor
kin
gw
ith
1or
2pe
ers
Koe
gel,
Wer
ner
,V
ism
ara,
&K
oege
l(2
005)
2pr
imar
ygr
ade
child
ren
with
autis
m14
typi
cally
deve
lopi
ngpe
ers
play
date
soc
curr
ing
inna
tura
lset
tings
Sync
hron
ous
reci
proc
alin
tera
ctio
ns,c
hild
affe
ctC
onte
xtua
llysu
ppor
ted
play
date
s:ac
tiviti
esse
lect
edto
bem
utua
llyre
info
rcin
gfo
rbo
thch
ildw
ithau
tism
and
typi
cally
deve
lopi
ngpe
er,c
oope
rativ
ear
rang
emen
tsse
tup
byad
ults
with
inac
tiviti
es(p
artic
ipat
ion
ofbo
thcr
itica
lto
the
activ
ity)
Mul
tipl
eba
selin
eac
ross
part
icip
ants
Har
per,
Sym
on,
&Fr
ea(2
008)
2bo
ys,8
and
9yr
sol
dw
ithau
tism
inin
clus
ive
sett
ings
Gai
ning
atte
ntio
n,#
oftu
rnta
king
exch
ange
s,#
ofin
itiat
ions
topl
ay
Tri
ads
wer
ede
velo
ped—
with
two
peer
san
don
eta
rget
child
with
autis
mdu
ring
rece
ss;
natu
ralis
ticin
terv
entio
n
Con
curr
ent
mul
tipl
eba
selin
eac
ross
part
icip
ants
Vid
eoM
odel
ing
(n�
11)
Pate
rson
&A
rco
(200
7)2
boys
with
autis
m(A
ges
6&
7yr
s)hi
ghfu
nctio
ning
play
room
inth
esc
hool
’ssp
ecia
ledu
catio
nce
nter
App
ropr
iate
verb
alpl
aybe
havi
or&
mot
orpl
aybe
havi
or;r
epet
itive
verb
alpl
ayan
dm
otor
play
beha
vior
Vid
eom
odel
ing
(by
mal
ead
ult)
;so
cial
prai
seM
ulti
ple
base
line
acro
sspl
aybe
hav
ior
wit
ha
wit
hdr
awal
phas
e
Nik
opou
los
&K
een
an(2
007)
Exp
erim
ent
I:3
boys
with
autis
m(A
ges
6.5;
6.5;
&7)
ina
sem
i-na
tura
listic
room
ofa
spec
ials
choo
l
Exp
erim
ente
rI:
Soci
alin
itiat
ion;
reci
proc
alpl
ay;
imita
tive
resp
onse
;obj
ect
enga
gem
ent;
othe
rbe
havi
ors
Vid
eom
odel
ing
(by
a10
-yr
old
boy
with
LD
&av
erag
eso
cial
skill
s);V
erba
lins
truc
tions
;m
odel
ing
invi
vo;B
ehav
ior
rehe
arsa
l
Mul
tipl
eba
selin
eac
ross
subj
ect
(con
tinue
d)
324 / Education and Training in Developmental Disabilities-September 2009
TA
BL
E1
Con
tinu
ed
Stud
yPa
rtic
ipan
ts/S
ettin
gsT
arge
tB
ehav
ior
Inte
rven
tions
Res
earc
hD
esig
n
Nik
opou
los
&K
een
an(2
004)
3bo
ysw
ith
auti
sm(b
twn
7-9
yr)
sett
ing
unsp
ecifi
edSo
cial
init
iati
on;
reci
proc
alpl
aybe
hav
ior
Vid
eom
odel
ing
(by
ape
er)
Mul
tipl
eba
selin
eac
ross
subj
ects
Gen
a,C
oulo
ura,
&K
ymis
sis
(200
5)3
pres
choo
lbo
ysw
ith
auti
sm(A
ges
5,4,
3yr
)M
ildto
mod
erat
em
enta
lre
tard
atio
n;
Hom
ese
ttin
gfo
rea
chpa
rtic
ipan
t
Aff
ecti
vere
spon
ses:
show
ing
sym
path
y;sh
owin
gap
prec
iati
on;
show
ing
disa
ppro
val
Vid
eom
odel
ing
(by
ape
erof
the
sam
eag
ean
dse
x);
In-v
ivo
mod
elin
g
Mul
tipl
eba
selin
eac
ross
subj
ects
wit
ha
retu
rnto
base
line
Hin
e&
Wol
ery
(200
6)2
girl
sw
ith
auti
sm(A
ges
30,
43m
onth
s)in
clus
ive
sett
ing
Dif
fere
nt
type
sof
pret
end
play
acti
ons
perf
orm
edV
ideo
mod
elin
g(w
ith
adul
tsh
ands
only
)M
ulti
ple
base
line
acro
ssbe
hav
iors
(gar
den
ing
&co
okin
gta
sks)
acro
sstw
opa
rtic
ipan
tsW
ert
&N
eisw
orth
(200
3)4
boys
wit
hau
tism
(Age
s5.
5;4.
5;4;
5yr
s)un
spec
ified
sch
ool
sett
ing
Spon
tan
eous
requ
ests
Vid
eose
lfm
odel
ing
Mul
tipl
eba
selin
eac
ross
subj
ects
Sim
pson
,L
ango
ne,
&A
yres
(200
4)2
boys
and
2gi
rls
wit
hau
tism
(Age
s5,
5,6,
&6)
All
part
icip
ants
wer
ein
clud
edin
gen
eral
edcl
assr
oom
for
part
ofth
eda
y
Com
plyi
ng
wit
hte
ach
erdi
rect
ion
s;gr
eeti
ng
oth
ers;
shar
ing
mat
eria
ls
Em
bedd
edvi
deo
mod
elin
g(b
yty
pica
lpe
ers)
and
com
pute
rba
sed
inst
ruct
ion
*
Mul
tipl
epr
obe
acro
sspa
rtic
ipan
ts
Ch
arlo
p-C
hri
sty,
Le,
&Fr
eem
an(2
000)
5bo
ysan
d1
girl
wit
hau
tism
(Age
s8,
7,10
,11
,&
7)af
ter-
sch
ool
beh
avio
rth
erap
ypr
ogra
mth
erap
yro
om
Subj
ect
1:E
xpre
ssiv
ela
belin
gof
emot
ion
sSu
bjec
t2:
Inde
pen
den
tpl
aySu
bjec
t3:
Spon
tan
eous
gree
tin
gs;
oral
com
preh
ensi
ons
Subj
ect
4:C
onve
rsat
ion
alsp
eech
;co
oper
ativ
epl
aySu
bjec
t5:
Soci
alpl
ay
Invi
voan
dvi
deo
mod
elin
g(b
yfa
mili
arad
ults
)M
ulti
ple
base
line
acro
sssu
bjec
ts;
mul
tipl
eba
selin
ew
ith
child
acro
sstw
om
odel
ing
con
diti
ons
and
wit
hin
each
mod
elin
gco
ndi
tion
acro
sstw
ota
sks
App
le,
Bill
ings
ley,
&Sc
hw
artz
(200
5)E
xper
imen
tI:
2bo
ysw
ith
Asp
erge
r’s
Syn
drom
e(b
oth
5yr
s)St
udy
took
plac
ein
inte
grat
edpr
esch
ool
clas
sroo
mdu
rin
gfr
eepl
ayti
me
Com
plim
ent-g
ivin
gbe
hav
iors
Exp
erim
ent
I:1)
Vid
eom
odel
ing
2)V
M�
rein
forc
emen
t3)
rein
forc
emen
ton
ly
Exp
erim
ent
II:
Self
-man
agem
ent
Mul
tipl
eba
selin
eac
ross
subj
ects
(con
tinue
d)
Evidence-Based Social Skills Interventions / 325
TA
BL
E1
Con
tinu
ed
Stud
yPa
rtic
ipan
ts/S
ettin
gsT
arge
tB
ehav
ior
Inte
rven
tions
Res
earc
hD
esig
n
Bug
gy(2
005)
2st
uden
tsw
ithau
tism
duri
nglu
nch,
rece
ss,a
ndfr
eetim
ein
asm
all
incl
usiv
esc
hool
Soci
alin
itiat
ions
Vid
eota
ped
self-
mod
elin
g,3-
min
ute
vide
osh
owin
gpa
rtic
ipan
tsen
gagi
ngin
typi
cal
posi
tive
soci
alin
tera
ctio
ns
Mul
tiple
base
line
acro
sspa
rtic
ipan
ts
Cha
rlop
-Chr
isty
&D
anes
hvar
(200
3)3
boys
with
autis
m,a
ges
of6,
6an
d9
yrs
low
func
tioni
ngPe
rspe
ctiv
eta
king
Vid
eom
odel
ing
of5
first
-ord
erpe
rspe
ctiv
eta
king
task
sM
ultip
leba
selin
eac
ross
child
ren
and
with
inch
ildac
ross
task
sPi
vota
lRes
pons
eT
rain
ing
(n�
1)Jo
nes
&Fe
ely
(200
7)3
pres
choo
lage
child
ren
with
autis
mJo
int
Att
entio
n:re
spon
ding
and
initi
atin
gPR
T,d
iscr
ete
tria
lfor
mat
*M
ultip
lepr
obe
desi
gnac
ross
two
join
tat
tent
ion
skill
s
The
ory
ofM
ind
(n�
1)C
hin,
Ber
nard
-Opi
tz(2
000)
3hi
gh-fu
nctio
ning
child
ren
with
autis
m,5
-7ye
ars
old,
prim
ary
care
give
rs,o
nepe
erw
hopa
rtic
ipat
edin
the
gene
raliz
atio
nse
ssio
ns,p
artic
ipan
ts’
hom
es
Con
vers
atio
nals
kills
,sha
red
inte
rest
,con
text
ually
appr
opri
ate
resp
onse
s,fa
lse
belie
fs(T
oM)
Initi
atin
gco
nver
satio
ns,T
urn-
taki
ngin
conv
ersa
tion,
liste
ning
,mai
ntai
ning
conv
ersa
tion
topi
c,ch
angi
ngto
pic
appr
opri
atel
y
Mul
tiple
base
line
acro
sspa
rtic
ipan
ts
Cog
nitiv
eB
ehav
iora
lTra
inin
g(n
�3)
Lop
ata,
Tho
mee
r,V
olke
r,&
Nid
a(2
006)
21bo
ysw
ithA
D6-
13ye
ars
old
6-w
eek
sum
mer
trea
tmen
tpr
ogra
mto
enha
nce
soci
albe
havi
ors
Soci
alSk
ills,
Ada
ptab
ility
,and
Aty
pica
lity
from
the
BA
SC,
pare
ntra
ting
scal
es(P
RS)
and
teac
her
ratin
gsc
ales
(TR
S)
6w
eeks
ofth
etr
eatm
ent
prog
ram
6hr
s/da
y,5
days
/w
eek.
470
-min
ute
trea
tmen
tcy
cles
daily
One
grou
pha
da
beha
vior
alm
anag
emen
tpo
int
syst
emw
ithre
spon
seco
st
Pre
and
post
test
desi
gn.2
grou
ps:S
ocia
lSki
llsin
stru
ctio
non
ly(S
S)an
dSo
cial
Skill
sin
stru
ctio
nan
dB
ehav
iora
lTre
atm
ent
(SS�
BT
)
Bau
mri
nger
(200
2)15
high
-func
tioni
ngch
ildre
nw
ithau
tism
Soci
alco
gniti
onan
dem
otio
nal
unde
rsta
ndin
g,ov
ert
soci
alfu
nctio
ning
Ada
pted
soci
alsk
ills
curr
icul
umta
ught
3ho
urs/
wee
kov
era
7m
onth
peri
od*
Pre-
post
test
desi
gn:P
robl
emso
lvin
gm
easu
re,E
mot
ion
inve
ntor
y,O
bser
vatio
nsof
Soci
alIn
tera
ctio
n,an
dSo
cial
Skill
sR
atin
g(S
SRS-
T)
Boc
k(2
007)
4bo
ys9-
10ye
ars
old
elem
enta
rysc
hool
whe
rest
uden
tsat
tend
ed:
soci
alst
udie
sco
oper
ativ
egr
oup
activ
ities
,noo
nre
cess
,and
lunc
h
Part
icip
ate
inco
oper
ativ
ele
arni
ngac
tiviti
es,p
lay
orga
nize
dsp
ort
gam
es,a
ndvi
sit
with
peer
sdu
ring
lunc
h
Soci
al-b
ehav
iora
llea
rnin
gst
rate
gyin
terv
entio
n(S
OD
A)*
Mul
tiple
base
line
acro
ssse
ttin
gs
(con
tinue
d)
326 / Education and Training in Developmental Disabilities-September 2009
TA
BL
E1
Con
tinu
ed
Stud
yPa
rtic
ipan
ts/
Setti
ngs
Tar
get
Beh
avio
rIn
terv
entio
nsR
esea
rch
Des
ign
Oth
ers
(n�
7)K
ran
tz&
McC
lan
nah
an(1
998)
3bo
ysw
ith
auti
sm(a
ges
4-5)
smal
lcl
assr
oom
atth
epa
rtic
ipan
ts’
sch
ool
Scri
pted
inte
ract
ion
;el
abor
atio
ns,
unsc
ript
edin
tera
ctio
n
Tex
tual
cues
wer
eem
bedd
edin
the
child
’sac
tivi
tysc
hed
ules
;sc
ript
fadi
ng
Mul
tipl
eba
selin
eac
ross
part
icip
ants
Nel
son
,M
cDon
nel
l,Jo
hn
ston
,C
rom
pton
,N
elso
n(2
007)
4pr
esch
ool
child
ren
wit
hau
tism
(age
s3-
4)Pl
ayin
itia
tion
;en
gage
men
tti
me;
play
repe
rtoi
reK
eys
toPl
ayM
ulti
ple
base
line
prob
e
McG
ee&
Dal
y(2
007)
3pr
esch
ool
boys
wit
hau
tism
univ
ersi
tyba
sed
pres
choo
l,w
ith
maj
orit
yof
typi
cally
deve
lopi
ng
child
ren
Tw
oso
cial
phra
ses:
“all
righ
t”an
d“y
oukn
oww
hat
?”In
cide
nta
lte
ach
ing
Mul
tipl
eba
selin
eac
ross
part
icip
ants
Ch
arlo
p-C
hri
sty,
Car
pen
ter,
Le,
LeB
lan
c,&
Kel
let
(200
2)
3bo
ysw
ith
auti
sm3-
12ye
ars
old
Sess
ion
sw
ere
con
duct
edin
empt
ytr
ain
ing
room
s,th
ech
ild’s
clas
sroo
m,
and
the
child
’sh
ome
Spee
ch:
spon
tan
eous
spee
chan
dim
itat
ion
Soci
alco
mm
unic
ativ
e:co
oper
ativ
epl
ay,
join
tat
ten
tion
,re
ques
tin
g,in
itia
tion
PEC
Str
ain
ing
Mul
tipl
eba
selin
eac
ross
part
icip
ants
Shab
ani
etal
.(2
002)
3ki
nde
rgar
ten
boys
wit
hau
tism
,ty
pica
llyde
velo
pin
gpe
ers
atsc
hoo
lan
dh
ome
Ver
bal
init
iati
ons,
and
verb
alre
spon
ses
tope
erin
itia
tion
s
Tac
tile
prom
ptin
gde
vice
for
init
iati
ng
AB
AB
Gon
zale
z-L
opez
&K
amps
(199
7)4
child
ren
wit
hau
tism
,ag
es5-
7ye
ars
old,
12ty
pica
lki
nde
rgar
ten
and
firs
tgr
ade
child
ren
inth
esa
me
elem
enta
rysc
hoo
lsp
ecia
led
ucat
ion
clas
sroo
m
Beh
avio
rm
anag
emen
tsk
ills
for
typi
cal
peer
sG
reet
ings
,us
ing
nam
esan
dco
nve
rsat
ion
s,im
itat
ion
and
follo
win
gin
stru
ctio
ns,
shar
ing
and
turn
-taki
ng,
aski
ng
for
hel
p
Soci
alsk
ills
trai
nin
gus
ing
trai
nin
gsc
rips
,so
cial
skill
str
ain
ing
plus
rein
forc
emen
t
Rev
ersa
lde
sign
wit
htw
oin
terv
enti
onco
ndi
tion
s
Ch
arlo
p-C
hri
sty
&K
elso
(200
3)3
boys
wit
hau
tism
,ag
es8,
8,an
d11
verb
al,
liter
ate
Con
vers
atio
nal
spee
chC
onve
rsat
ion
alSc
ript
s,cu
eca
rds
Mul
tipl
eba
selin
eac
ross
subj
ects
wit
hem
bedd
edm
ulti
ple
prob
esw
ith
inea
chch
ildac
ross
con
vers
atio
ns
*In
terv
enti
ons
wer
eim
plem
ente
dby
clas
sroo
mte
ach
ers,
para
prof
essi
onal
sor
pare
nts
.
Evidence-Based Social Skills Interventions / 327
TA
BL
E2
Evi
denc
e-B
ased
Soci
alSk
ills
Inte
rven
tion
s:R
esul
ts,
Eff
ects
,T
reat
men
tIn
tegr
ity
Stud
yR
esul
tsM
aint
enan
ce/F
ollo
wup
/G
ener
aliz
atio
nT
reat
men
tIn
tegr
itySo
cial
Valid
ityM
easu
res
Soci
alSt
orie
s(n
�6)
San
sost
i&
Pow
ell-S
mit
h(2
006)
Incr
ease
dta
rget
beha
vior
(2/3
)PN
D�
59.5
7%Fo
llow
-up
data
wer
eco
llect
edtw
ow
eeks
afte
rth
etr
eatm
ent
FPN
D�
50%
Mai
nte
nan
cere
sult
sn
otre
port
ed
Tw
opa
rtic
ipan
tsda
taw
ere
repo
rted
,88
%&
92%
3rdch
ild’s
fam
ilyfa
iled
topr
ovid
en
eede
din
fo
Yes
Del
ano
&Sn
ell
(200
6)Im
prov
edpe
rfor
man
ceon
all
targ
etbe
havi
ors
acro
ssal
lth
ree
part
icip
ants
(3/3
)PN
D�
90%
Inte
rven
tion
was
grad
ually
fade
d(2
phas
es)
2pa
rtic
ipan
tsde
mon
stra
ted
gain
sin
thei
rge
ner
aled
clas
sroo
mse
ttin
gsM
PND
�81
.57%
Mea
n�
93%
(78%
-100
%)
Yes
Th
iem
ann
&G
olds
tein
(200
1)3/
4ta
rget
beha
vior
sw
ere
obta
ined
by3
boys
;2/4
targ
etbe
havi
ors
wer
eob
tain
edby
2bo
ysPN
D�
47%
2bo
ysge
ner
aliz
edto
untr
ain
edso
cial
beh
avio
rs;
1ge
ner
aliz
edw
ith
incl
assr
oom
MPN
D�
37.9
7%
Not
repo
rted
Yes.
7ge
ned
teac
her
san
d6
SLP
grad
uate
stud
ents
wh
oar
ebl
ind
toth
est
udy
rate
dpa
rtic
ipan
ts’
perf
orm
ance
pre-
and
post
-trea
tmen
tvi
a2-
min
vide
ovi
gnet
tes.
Bar
ry&
Bur
lew
(200
4)B
oth
part
icip
ants
mad
ega
ins
inm
akin
gin
depe
nden
tch
oice
san
dpl
ayap
prop
riat
ely
duri
ngfr
eepl
aytim
ein
the
self-
cont
aine
dse
ttin
gPN
D�
100%
Gen
eral
izat
ion
effe
cts
wer
ere
port
edvi
aan
ecdo
tal
evid
ence
—th
egi
rltr
ansi
tion
edto
age
ner
aled
clas
sroo
mdu
eto
the
sign
ifica
nt
gain
sin
her
soci
alsk
ills
Not
repo
rted
Not
repo
rted
Scat
ton
e,T
ings
trom
,&
Wilc
zyn
ski
(200
6)In
crea
sein
appr
opri
ate
soci
alin
tera
ctio
nsfo
r2/
3pa
rtic
ipan
tsPN
D�
46.7
%
Non
e10
0%fo
r2
stud
ents
,86
%fo
r1
stud
ent
IRP-
15sc
ores
all
inth
eac
cept
able
ran
ge
Dod
d,H
upp,
Jew
ell,
&K
roh
n(2
008)
Incr
ease
dta
rget
beha
vior
sfo
rbo
thbo
ysPN
D�
60%
(zer
oba
selin
e)
Rep
orte
dfo
ron
ly1
subj
ect
MPN
D�
100%
Part
icip
ant
1�10
0%;
Part
icip
ant
2�97
.1%
Yes
(con
tinue
d)
328 / Education and Training in Developmental Disabilities-September 2009
TA
BL
E2
Con
tinu
ed
Stud
yR
esul
tsM
aint
enan
ce/F
ollo
wup
/G
ener
aliz
atio
nT
reat
men
tIn
tegr
itySo
cial
Valid
ityM
easu
res
Peer
Med
iate
d(n
�9)
Lau
shey
&H
eflin
(200
0)Si
gnifi
can
tim
prov
emen
tin
soci
alsk
ills
for
both
child
ren
PND
�10
0%
On
ly1
part
icip
ant
repo
rted
follo
wup
data
inge
ner
aled
clas
sroo
man
dh
em
ain
tain
edth
ega
ins
FPN
D�
100%
(1ch
ildon
ly)
Yes
Focu
sgr
oup
was
used
tova
lidat
eth
eD
V&
IV
Pier
ce&
Sch
reib
man
(199
7)B
oth
part
icip
ants
mad
esi
gnifi
can
tga
ins
inth
eir
soci
alsk
ills
PND
�71
.01%
Bot
hpa
rtic
ipan
tsge
ner
aliz
edth
eir
gain
sin
toot
her
sett
ings
wit
hn
ovel
peop
leas
wel
lM
PND
�66
.67%
FPN
D�
71.0
5%
Not
repo
rted
Not
repo
rted
Hw
ang
&H
ugh
es(2
000)
3/3
part
icip
ants
incr
ease
dta
rget
beh
avio
r;PN
D�
72.2
2%
Gen
eral
izat
ion
ofey
eco
nta
ctan
dm
otor
imit
atio
nw
ere
foun
dac
ross
new
sett
ing
and
diff
eren
tpa
rtn
er;
join
tat
ten
tion
rare
lyge
ner
aliz
ed
Yes
Yes
Petu
rsdo
ttir
,M
cCom
as,
McM
aste
r,&
Hor
ner
(200
7)
No
effe
cts
ofpe
ertu
tori
ng
alon
eon
soci
alin
tera
ctio
ns.
Add
ing
play
-rel
ated
com
mon
stim
uli
toth
epe
er-tu
tori
ng
acti
vity
incr
ease
dso
cial
inte
ract
ion
sdu
rin
gfr
eepl
ay.
PND
�36
.17%
Not
repo
rted
81%
(ran
ge56
%-9
2%)
for
the
K-P
AL
S;91
%(r
ange
86-9
6%)
for
com
mon
stim
uli
acti
viti
es
Yes
Lon
cola
&C
raig
-U
nke
fer
(200
5)A
llde
pen
den
tva
riab
les
impr
oved
acro
ssal
lsu
bjec
tsPN
D�
56.7
2%
Not
repo
rted
98%
(80%
-100
%)
Not
repo
rted
(con
tinue
d)
Evidence-Based Social Skills Interventions / 329
TA
BL
E2
Con
tinu
ed
Stud
yR
esul
tsM
aint
enan
ce/F
ollo
wup
/G
ener
aliz
atio
nT
reat
men
tIn
tegr
itySo
cial
Valid
ityM
easu
res
Gar
riso
n-H
arre
ll,K
amps
&K
ravi
ts(1
997)
Incr
ease
ddu
rati
onof
peer
inte
ract
ion
sac
ross
sett
ings
,in
crea
sed
use
ofau
gmen
tati
veco
mm
unic
atio
nsy
stem
,so
me
incr
ease
inve
rbal
izat
ion
s,in
crea
sein
peer
acce
ptan
ceFr
eque
ncy
ofin
tera
ctio
ns
PND
�48
%D
urat
ion
ofin
tera
ctio
ns
PND
�95
%
Non
eN
otre
port
edN
otre
port
ed
Car
ter,
Cus
hin
g,C
lark
,&
Ken
ned
y(2
005)
Hig
her
leve
lof
soci
alin
tera
ctio
ns,
and
con
tact
wit
hth
ege
ner
alcu
rric
ulum
wh
ensu
ppor
ted
by2
peer
sPN
D�
35.0
9%
Non
eN
otre
port
edN
otre
port
ed
Koe
gel,
Wer
ner
,V
ism
ara,
&K
oege
l(2
005)
Sign
ifica
nt
incr
ease
sin
unpr
ompt
edsy
nch
ron
ous
reci
proc
alin
tera
ctio
ns
PND
�10
0%
Non
eN
otre
port
edFr
eque
ncy
ofre
cipr
ocal
invi
tati
ons—
mor
ein
vita
tion
sex
ten
ded
bype
ers
afte
rtr
eatm
ent
Har
per,
Sym
on,
&Fr
ea(2
008)
Bot
hpa
rtic
ipan
tsim
prov
edth
eir
soci
alpe
erin
tera
ctio
ns
duri
ng
rece
ssPN
D�
75%
(zer
oba
selin
e)
Yes
GPN
D�
100%
Yes
Dat
aw
ere
repo
rted
ina
tabl
e,ra
ngi
ng
from
78%
-100
%
Yes
but
thro
ugh
anec
dota
lre
port
s
(con
tinue
d)
330 / Education and Training in Developmental Disabilities-September 2009
TA
BL
E2
Con
tinu
ed
Stud
yR
esul
tsM
aint
enan
ce/F
ollo
wup
/G
ener
aliz
atio
nT
reat
men
tIn
tegr
itySo
cial
Valid
ityM
easu
res
Vid
eoM
odel
ing
(n�
11)
Pate
rson
&A
rco
(200
7)B
oth
part
icip
ants
incr
ease
dth
eir
appr
opri
ate
verb
alan
dm
otor
play
beh
avio
rac
ross
toys
;th
eir
repe
titi
veve
rbal
and
mot
orpl
aybe
hav
ior
decr
ease
d;PN
D�
100%
1bo
yge
ner
aliz
edm
otor
play
wit
hth
ree
rela
ted
toys
;fo
llow
upda
taw
ere
reco
rded
1w
eek
afte
rtr
eatm
ent
was
wit
hdr
awn
for
both
boys
FPN
D�
100%
Not
repo
rted
Not
repo
rted
Nik
opou
los
&K
een
an(2
007)
Exp
erim
ent
I:m
ixed
resu
lts
acro
sssu
bjec
tsan
dbe
hav
iors
PND
�90
.57%
Gen
eral
izat
ion
toa
nov
elpe
erw
asm
easu
red
for
all
thre
epa
rtic
ipan
ts;
Follo
wup
data
wer
eta
ken
at1-
and
2-m
onth
s.FP
ND
�10
0%
Not
repo
rted
Th
eso
cial
valid
atio
nof
the
trea
tmen
tou
tcom
esw
asas
sess
edby
ten
mot
her
sof
sch
ool-a
ged
child
ren
.
Nik
opou
los
&K
een
an(2
004)
All
part
icip
ants
incr
ease
dth
edu
rati
onof
reci
proc
alpl
ay;
soci
alin
itia
tion
impr
ovem
ent
resu
lts
wer
em
ixed
PND
�72
.41%
Follo
w-u
pte
sts
con
duct
edat
1an
d3
mon
ths
afte
rth
est
udy
FPN
D�
100%
Not
repo
rted
Not
repo
rted
Gen
a,C
oulo
ura,
&K
ymis
sis
(200
5)A
ll3
part
icip
ants
incr
ease
dth
eir
affe
ctiv
eca
tego
ries
Invi
vom
odel
ing
PND
�88
%V
ideo
mod
elin
gPN
D�
79%
Follo
w-u
pat
1-an
d3-
mon
ths
GPN
D�
100%
FPN
D�
100%
Not
repo
rted
Not
repo
rted
Hin
e&
Wol
ery
(200
6)B
oth
part
icip
ants
show
edim
prov
emen
tin
both
pret
end
play
beh
avio
rsPN
D�
70.4
5%
Gen
eral
izat
ion
acro
ssm
ater
ials
and
acro
ssse
ttin
gsw
ere
mea
sure
dM
PND
�10
0%
M�
95%
(83.
3%to
100%
)Ye
s
(con
tinue
d)
Evidence-Based Social Skills Interventions / 331
TA
BL
E2
Con
tinu
ed
Stud
yR
esul
tsM
aint
enan
ce/F
ollo
wup
/G
ener
aliz
atio
nT
reat
men
tIn
tegr
itySo
cial
Valid
ityM
easu
res
Wer
t&
Nei
swor
th(2
003)
All
4pa
rtic
ipan
tssh
owed
sign
ifica
nt
impr
ovem
ent
PND
�97
%
Yes
MPN
D�
100%
Not
repo
rted
Not
repo
rted
Sim
pson
,L
ango
ne,
&A
yres
(200
4)A
ll4
part
icip
ants
show
edsi
gnifi
can
tim
prov
emen
tPN
D�
97.3
0%
Not
repo
rted
Not
repo
rted
Not
repo
rted
Ch
arlo
p-C
hri
sty,
Le,
&Fr
eem
an(2
000)
Ove
rall,
vide
om
odel
ing
led
toqu
icke
rac
quis
itio
nof
skill
sth
anin
vivo
mod
elin
g.In
vivo
mod
elin
gPN
D�
72.8
8%V
ideo
mod
elin
gPN
D�
76.9
2%
Gen
eral
izat
ion
prob
esac
ross
diff
eren
tst
imul
i,pe
rson
s,an
dse
ttin
gw
ere
con
duct
eddu
rin
gba
selin
ean
dal
so3
to5
days
afte
rcr
iter
ion
perf
orm
ance
was
dem
onst
rate
din
trea
tmen
t.In
vivo
GPN
D�
58.8
2%V
ideo
GPN
D�
84.6
2%
Yes.
For
the
invi
voco
ndi
tion
,th
em
odel
ing
sess
ion
sw
ere
vide
otap
edan
dra
ted
at99
%.
Not
repo
rted
App
le,
Bill
ings
ley,
&Sc
hw
artz
(200
5)D
urin
gvi
deo
mod
elin
g,bo
thpa
rtic
ipan
tsw
ere
able
toac
quir
eth
esk
ills
ofco
mpl
imen
t-giv
ing
resp
onse
sE
xper
imen
tII
:Se
lf-m
anag
emen
tin
crea
sed
subj
ects
’in
depe
nde
nce
inm
onit
orin
gth
eir
own
com
plim
ent-g
ivin
gbe
hav
ior
Vid
eoM
odel
ing
Res
pon
dto
oth
ers
PND
�10
0%In
itia
tePN
D�
0%
Exp
erim
ent
IIn
itia
tion
FPN
D�
20%
Res
pon
seFP
ND
�10
0%
M�
90%
(84%
-97%
)Pa
ren
tsan
dte
ach
ers
repo
rts
(con
tinue
d)
332 / Education and Training in Developmental Disabilities-September 2009
TA
BL
E2
Con
tinu
ed
Stud
yR
esul
tsM
aint
enan
ce/F
ollo
wup
/G
ener
aliz
atio
nT
reat
men
tIn
tegr
itySo
cial
Valid
ityM
easu
res
VM
�R
einf
orce
men
tIn
itiat
ion
PND
�10
0%R
espo
nse
PND
�10
0%R
einf
orce
men
tIn
itiat
ion
PND
�10
0%R
espo
nse
PND
�10
0%(Z
ero
base
line)
Exp
erim
ent
#2V
ideo
Mod
elin
gR
espo
ndPN
D�
100%
Initi
ate
PND
�0%
Self
Man
agem
ent
Initi
atio
nPN
D�
100%
Res
pons
ePN
D�
100%
Bug
gy(2
005)
Gai
nsm
ade
infr
eque
ncy
ofso
cial
initi
atio
ns(0
to4.
4;an
d.1
7to
4.25
initi
atio
ns/d
ay)
PND
�90
.91%
(Zer
oba
selin
efo
ron
epa
rtic
ipan
t)
Res
ults
mai
nta
ined
MPN
D�
100%
FPN
D�
100%
Not
repo
rted
Not
repo
rted
Ch
arlo
p-C
hri
sty
&D
anes
hva
r(2
003)
Var
ious
gain
sm
ade
byal
lpa
rtic
ipan
tsPN
D�
52.2
1%(Z
ero
base
line)
Wid
erra
nge
ofge
ner
aliz
atio
ns
wer
ere
port
edG
PND
�40
.35%
MPN
D�
46.6
7%
Not
repo
rted
Not
repo
rted
(con
tinue
d)
Evidence-Based Social Skills Interventions / 333
TA
BL
E2
Con
tinu
ed
Stud
yR
esul
tsM
aint
enan
ce/F
ollo
wup
/G
ener
aliz
atio
nT
reat
men
tIn
tegr
itySo
cial
Valid
ityM
easu
res
Pivo
tal
Res
pon
seT
rain
ing
(n�
1)Jo
nes
&Fe
ely,
(200
7)A
ll3
child
ren
achi
eved
mas
tery
(90%
inde
pend
ent
corr
ect
resp
ondi
ng,a
cros
s2
cons
ecut
ive
sess
ions
and
days
)PN
D�
66.1
1%
Perf
orm
ance
con
tin
ued
duri
ng
6-30
mai
nte
nan
cese
ssio
ns,
and
duri
ng
gen
eral
izat
ion
prob
esG
PND
�10
0%
Vid
eo-ta
ped
reco
rdin
gs:
86-9
7%pr
esen
tati
on80
-100
%pr
ompt
ing
77-9
6%co
nse
quen
ces
Not
repo
rted
Th
eory
ofM
ind
(n�
1)C
hin
,B
ern
ard-
Opi
tz(2
000)
Incr
ease
dtim
esp
ent
insh
ared
inte
rest
inco
nver
satio
nsIn
crea
sed
perc
enta
geof
resp
onse
sap
prop
riat
eto
cont
ext
ofco
nver
satio
nSc
ore
of0
for
alls
tude
nts
onfir
stor
seco
ndor
der
Fals
eB
elie
fta
sks.
PND
�80
.77%
1ch
ildin
crea
sed
shar
edin
tere
stti
me,
perc
enta
geof
con
text
ually
appr
opri
ate
resp
onse
sw
ith
typi
cally
deve
lopi
ng
peer
GPN
D�
100%
Not
repo
rted
Incr
ease
dey
eco
nta
ct,
mai
nta
inin
gto
pic,
and
taki
ng
turn
sac
cord
ing
toso
cial
valid
ity
asse
ssm
ent
ques
tion
nai
re
Cog
nit
ive
Beh
avio
ral
Tra
inin
g(n
�3)
Lop
ata,
Th
omee
r,V
olke
r,&
Nid
a(2
006)
Sign
ifica
ntm
ain
effe
cts
wer
efo
und
from
pare
ntra
tings
for
gene
rali
mpr
ovem
ent
for
soci
alsk
ills,
adap
tabi
lity,
and
atyp
ical
ity.S
taff
ratin
gsha
dsi
gnifi
cant
impr
ovem
ents
for
soci
alsk
ill,b
utno
nsig
nific
ant
ratin
gsfo
rad
apta
bilit
y,an
dsi
gnifi
cant
ratin
gsin
the
oppo
site
dire
ctio
nfo
rat
ypic
ality
Eff
ect
size
soci
alsk
ills:
.24
Eff
ect
size
adap
tabi
lity:
.59
Eff
ect
size
atyp
ical
ity:.
39
Non
eN
otre
port
edN
otre
port
ed
(con
tinue
d)
334 / Education and Training in Developmental Disabilities-September 2009
TA
BL
E2
Con
tinu
ed
Stud
yR
esul
tsM
aint
enan
ce/F
ollo
wup
/G
ener
aliz
atio
nT
reat
men
tIn
tegr
itySo
cial
Valid
ityM
easu
res
Bau
mri
nge
r(2
002)
Post
trea
tmen
tre
sults
indi
cate
dsi
gnifi
cant
lygr
eate
rab
ility
tosu
gges
tre
leva
ntso
lutio
ns,h
ighe
rnu
mbe
rof
soci
also
lutio
ns,f
ewno
n-so
cial
solu
tions
Sign
ifica
ntim
prov
emen
tin
know
ledg
eof
emot
ions
Sign
ifica
ntm
ain
effe
cts
for
initi
atin
gpo
sitiv
ein
tera
ctio
ns,
and
resp
ondi
ngpo
sitiv
ely
tope
ers
Sign
ifica
ntly
high
erpo
st-tr
eatm
ent
scor
eson
coop
erat
ion
and
asse
rtio
non
SSR
S-T
Eff
ect
size
posi
tive
inte
ract
ions
:1.2
4E
ffec
tsi
zeco
oper
atio
n:.4
7E
ffec
tsi
zeas
sert
ion:
.69
Non
eN
otre
port
edN
otre
port
ed
Boc
k(2
007)
Incr
ease
inpa
rtic
ipat
ion
inco
oper
ativ
ele
arni
ngac
tiviti
es,
play
ing
orga
nize
dsp
ort
gam
esat
rece
ss,a
ndvi
sitin
gw
ithpe
ers
atlu
nch
for
alls
tude
nts
PND
�10
0%
Mai
nten
ance
prob
es1/
mon
thfo
r5
mon
ths
indi
cate
dhi
ghpe
rfor
man
cele
vels
mai
ntai
ned
afte
rin
terv
entio
ntr
aini
ngM
PND
�10
0%
Not
repo
rted
Not
repo
rted
Oth
ers
(n�
7)K
ran
tz&
McC
lan
nah
an(1
998)
Ver
bale
labo
ratio
nsan
dun
scri
pted
inte
ract
ion
incr
ease
d;PN
D�
83.5
2%(Z
ero
base
line)
Gai
ns
mai
nta
ined
ton
ewin
tera
ctio
ns/
acti
viti
esG
PND
�10
0%
Not
repo
rted
Not
repo
rted
(con
tinue
d)
Evidence-Based Social Skills Interventions / 335
TA
BL
E2
Con
tinu
ed
Stud
yR
esul
tsM
aint
enan
ce/F
ollo
wup
/G
ener
aliz
atio
nT
reat
men
tIn
tegr
itySo
cial
Valid
ityM
easu
res
Nel
son
,M
cDon
nel
l,Jo
hn
ston
,C
rom
pton
,N
elso
n(2
007)
Incr
ease
din
itiat
ion
&en
gage
men
tdu
ratio
n;im
prov
edso
phis
ticat
ion
PND
�48
.57%
Initi
atio
nsar
ege
nera
lized
with
inth
ecl
assr
oom
MPN
D�
100%
Not
repo
rted
Yes
McG
ee&
Dal
y(2
007)
Chi
ldre
nw
ere
able
toac
quir
eta
rget
soci
alph
rase
s,an
dtr
ansf
erus
eof
thos
eph
rase
sto
situ
atio
nsw
here
ther
ew
ere
nopr
ompt
sor
rein
forc
emen
tfo
rth
eir
use
PND
�36
.78%
(Zer
oba
selin
e)
Gen
eral
izat
ion
prob
esoc
curr
eddu
ring
free
-pla
yac
tiviti
esat
leas
t2
hrs
afte
rte
achi
ngse
ssio
nsG
PND
�44
.44%
Tea
chin
gse
ssio
ns
vide
otap
ed,
mon
itor
edoc
curr
ence
sof
proc
edur
aler
rors
Solic
ited
opin
ion
sfr
omlo
cal
area
pres
choo
lte
ach
ers
usin
gqu
esti
onn
aire
s
Ch
arlo
p-C
hri
sty,
Car
pen
ter,
Le,
LeB
lan
c,&
Kel
let
(200
2)
Incr
ease
sin
spon
tane
ous
spee
chan
dim
itatio
nIn
crea
ses
inin
itiat
ions
,req
uest
s,an
djo
int
atte
ntio
nM
LU
PND
�27
.78%
Coo
pera
tive
Play
,Joi
ntA
tten
tion,
Eye
Con
tact
&C
ombi
ned
Freq
uenc
yof
Initi
atio
nan
dR
eque
sts
PND
�76
.32%
Res
ults
mai
ntai
ned
duri
ngpo
sttr
aini
ngfo
llow
-up
ML
UFP
ND
�10
0%C
oope
rativ
ePl
ay,J
oint
Att
entio
n,E
yeC
onta
ct&
Com
bine
dIn
itiat
ions
and
Req
uest
sFP
ND
�96
.67%
Not
repo
rted
Not
repo
rted
Shab
ani
etal
.(2
002)
Incr
ease
sin
verb
alin
itiat
ions
and
resp
onse
sPN
D�
89.1
3%
Part
ialm
aint
enan
ceof
beha
vior
duri
ngpr
ompt
-fadi
ngM
PND
�10
0%
Not
repo
rted
Not
repo
rted
Gon
zale
z-L
opez
&K
amps
(199
7)In
crea
sed
freq
uenc
yan
ddu
ratio
nof
inte
ract
ions
for
alls
tude
nts
Freq
uenc
yof
inte
ract
ions
PND
�59
%D
urat
ion
ofin
tera
ctio
nsPN
D�
67%
Non
eN
otre
port
edN
otre
port
ed
Ch
arlo
p-C
hri
sty
&K
elso
(200
3)A
llpa
rtic
ipan
tsm
ade
gain
sPN
D�
89.4
7%G
ener
aliz
atio
npr
obes
wer
eta
ken
with
diff
eren
tco
nver
satio
nal
part
ners
,set
tings
and
topi
csG
PND
�72
%
Not
repo
rted
Not
repo
rted
336 / Education and Training in Developmental Disabilities-September 2009
Target Behaviors
A number of social behaviors were targetedacross the studies; many studies targeted morethan one behavior. Maintaining conversationand/or appropriate social behavior was tar-geted in 28 studies, 17 studies targeted initiat-ing conversations or social behavior (includ-ing greetings and requests), 5 studies targetedinitiating play. Eight studies targeted appro-priate play skills (including turn-taking), twostudies targeted eye contact, and two studiestargeted perspective-taking.
Research Designs
The vast majority of studies (31) utilized amultiple baseline design. Twenty-four studieswere conducted across participants, six studieswere conducted across behaviors, three stud-ies were conducted across settings, three stud-ies were conducted across other individuals,and two studies were conducted across tasks.Some of the studies were conducted acrossmultiple categories within the study.
Of the other seven studies, five utilized theABAB or reversal design, and two studies uti-lized the group experimental design. Both ofthe experimental studies followed a pre-post-test format with a control group.
Outcome Measures across Interventions
Social Stories. Six studies used Social Storiesto teach social skills. The PND scores rangedfrom 46.7% to 100% with a mean of 67.21%,which represents questionable effectiveness asan intervention according to Scruggs and Mas-tropieri (1998). Although Social Stories metthe criteria for evidence-based practice ac-cording to Horner et al. (2005), the effective-ness of Social Stories as an intervention forimproving social skills is questionable due tothe low PND scores.
Peer Mediated. A total of nine studies in thisreview used peer mediated strategies. ThePND scores ranged from 35.09% to 100% witha mean of 60.69%, which represents low toquestionable effectiveness. Twenty-four partic-ipants were included in these studies. Thestudies were conducted by 25 researchersacross nine geographic areas. However, theeffectiveness of peer mediated strategies to
improve social skills in children with autismremains to be questionable due to the lowPND scores.
Video Modeling. There were eleven studiesused video modeling to teach social skills. ThePND scores ranged from 50% to 100% with amean of 84.25%, which represents effectiveintervention. Video Modeling met the criteriafor evidence-based intervention and its PNDscores shows that it is an effective interven-tion for teaching social skills to children withautism.
Cognitive Behavioral Training. Three stud-ies were included in this category to examinethe effects of cognitive behavior training onsocial skills, two of which were group experi-mental designs. We used available data re-ported in the original studies to obtain theeffect size due to the absence of such results inthe original studies. The effect size for Lopataet al (2006) ranged from .59-.24 indicatingmoderate to mild effects, while the effect sizefor Baumringer (2002) ranged from 1.24-.47indicating high to moderate effects. The thirdstudy used a multiple baseline across settingsdesign. The PND for intervention was calcu-lated at 100%, which is very promising. How-ever, more studies are needed to confirm theefficacy of cognitive behavioral training.
Others. In this category, most of the inter-ventions were represented by only one study,i.e. pivotal response training (n � 1), Theoryof Mind (ToM, n � 1), scripts and cue cards(n � 2), Keys to Play (n � 1), incidentalteaching (n � 1), PECS training (n � 1),tactile prompting device (n � 1) and socialskills training with scripts and reinforcement(n � 1). Even though some of the studiesreported fairly promising PND scores, (e.g.ToM PND � 80.77%, indicating an effectiveintervention), more studies are needed withmore participants and by different research-ers to further evaluate their effectiveness asevidence-based and effective interventions.
Intervention Maintenance and GeneralizationEffects
Twelve out of 36 studies reported the mainte-nance effects of the intervention. The PNDscores ranged from 38% to 100%, with a meanof 78.5%. Nine studies reported the generali-zation effects of the intervention. The PND
Evidence-Based Social Skills Interventions / 337
scores ranged from 40% to 100% with a meanof 80.95%. In addition, nine studies reportedthe follow-up data of the intervention. ThePND scores ranged from 60% to 100%, with amean of 92.15%. However, these averageswere obtained across five categories of inter-ventions, making it impossible to concludewhether the impact of individual interven-tions was effectively maintained and general-ized due to limited number of studies in eachcategory reporting such results.
Treatment Integrity
Fourteen studies assessed the extent to whichintervention conditions were implemented asintended; eleven studies actually reportednumerical data on treatment integrity. Re-searchers in 3 studies discussed that treatmentintegrity was monitored but provided no nu-merical data. In studies in which treatmentintegrity was reported, interventions were im-plemented with a high degree of fidelity. Be-cause most studies did not include assessmentof treatment integrity, we find it difficult todraw definite conclusions that the changes inthe target behaviors are the results of the in-terventions. Also because most studies re-viewed in this article were implemented byresearchers, additional research is needed todetermine whether interventions can be im-plemented with high fidelity by teachers, par-ents, or others. Otherwise, the generality ofthese interventions for use in the real schoolsettings remains to be unclear.
Social Validity
Measures of social validity were reported in 16studies. Most studies provided evidence forthe social importance of intervention out-comes. Assessment of social validity was ob-tained either through interviews or question-naires. It is important that parents andclassroom teachers believe that the selectedintervention strategies are effective and ap-propriate. If the intervention lacks social va-lidity, parents and teachers are less likely toexert the necessary effort to implement theintervention, thus diminishing the interven-tion fidelity.
Discussion
Results varied widely both between interven-tion types, and within each intervention type.While Social Stories, Peer-Mediated, andVideo-Modeling interventions all met the cri-teria for evidence-based practices according toHorner et al. (2005), a closer look at PNDscores shows that only Video-Modeling meetscriteria for being evidence-based as well asdemonstrating high effectiveness as an inter-vention strategy. The PND scores of two of thesix Social Stories intervention studies (Barry &Burlew, 2004; Delano & Snell, 2006), andthree of the nine Peer-Mediated interventionstudies (Garrison-Harrell, Kamps, & Kravits,1997; Koegel, Werner, Vismara, & Koegel,2005; Laushey & Heflin, 2000), demonstratedhigh effectiveness. Looking more closely atthose highly effective studies could provideclues to implementing interventions in waysthat will be effective. Cognitive behavioraltraining is another intervention that showsgreat promise; more research is needed inthis area to demonstrate both its status as anevidence-based practice, and its overall effec-tiveness.
Zero Baseline Effects
Seven out of the 36 single subject studies re-ported zero baseline, by which is meant allbaseline data are equal to zero. Such data areproblematic due to the fact that a minor effectcould result in relatively high levels of non-overlapping data. In the case of zero baselines,it is often difficult to believe that “the subjectwas exhibiting no task-relevant behavior at all.It often seems that the observational measurewas not sensitive to relevant levels of behaviorthat were being examined” (Scruggs, et al.,1987, p. 30). Therefore, during final dataanalysis, we need to be more cognizantwhether a specific treatment was effective onlyin the presence of “zero baseline” data. Insuch case, conclusions regarding the effective-ness of a particular treatment should be inter-preted with caution.
Implications for Practice
This review described a variety of interven-tions that have been developed and evaluated
338 / Education and Training in Developmental Disabilities-September 2009
to promote social skills in children with autismspectrum disorders. The results of the presentstudy are consistent with those of previousmeta-analysis indicating that social skills inter-ventions are minimally effective for childrenwith ASD (Bellini et al. 2007; Vaughn et al.,2003). The exception to this is video model-ing; that intervention was shown to meet thecriteria for evidence based practice, as well asbeing highly effective. Practitioners imple-menting video-modeling as a method forteaching social skills can do so with greaterconfidence of its effectiveness. While socialstories and peer-mediated strategies can besaid to be evidence-based practices, practitio-ners should monitor these strategies closelywhen implementing them as they may havelimited effectiveness. Other strategies shouldbe implemented carefully, with the under-standing that they have not met criteria asevidence-based practices, and require contin-uous monitoring for effectiveness.
Most of studies included in this review wereconducted by researchers with a few excep-tions that were implemented by classroomteachers, paraprofessionals or parents. How-ever, social skills training in general is carriedout by teachers and parents in integrated set-tings. If the interventions implemented byprofessional researchers yield mixed results, itwould be a real challenge for classroom teach-ers and parents with limited resources andtime to achieve the same or better outcomes.
Limitations
This synthesis only evaluated social skills inter-ventions for children with ASD published be-tween 1997 and August 2008. Evaluating stud-ies over a longer period of time may haveresulted in more interventions meeting thecriteria for evidence-based practice, or morestudies demonstrating a higher level of effec-tiveness. However, the criteria for evidence-based practices were only recently established;studies done before 1997 would have beeneven more less likely to meet those criteria.We also only looked at studies that were pri-marily implemented in school-based settings;the effectiveness of these interventions on so-cial skills in community settings or for adultswith ASD cannot be determined from thismeta-analysis.
Suggestions for Future Research
Although our initial search of the literaturefound 104 studies that targeted social skills, inthe end only 38 of those met criteria to beevaluated as evidence-based practice, as well asallowing for the calculation of treatment ef-fects. Future research in this area should beplanned and implemented in such a way thatmeets the criteria for evidence-based practice,as well as reports treatment effects.
Most of the studies targeted students be-tween the ages of 5-12; many of the remainingstudies targeted preschool children. Onlythree studies were implemented with individ-uals over 12 years of age. Studies targetingthese older children would be beneficial indetermining if particular interventions aremore effective with this age group.
Generalization of skills is an integral com-ponent of social skills interventions. Futurestudies are needed to examine the generaliza-tion of skills across multiple settings and withmultiple persons. Researchers and teachersshould create an explicit plan for promotinggeneralization when developing a social skillsintervention.
Single subject designs were used to evaluateintervention effects in 36 out of the 38 studiesincluded in this review. Multiple baseline de-signs were utilized in almost all of the studiesto establish the experimental control. Al-though such designs are well-suited to demon-strate analyses, certain limitations do apply—itdoes not allow for comparison of differentinterventions. Future research is needed todetermine which intervention is most effectivefor which students. Compounding this limita-tion is the presence of near or at zero baselineperformance by the participants in many stud-ies. Because most social skills interventions arelikely to boost social interaction above thefloor levels, comparative analysis can assist re-searchers in identifying which interventionachieves this objective most effectively.
References
References marked with an asterisk indicate studiesincluded in the meta-analysis.
*Apple, A. L., Billingsley, F., & Schwartz, I. S.(2005). Effects of video modeling alone and withself-management on compliment-giving behav-
Evidence-Based Social Skills Interventions / 339
iors of children with high-functioning ASD. Jour-nal of Positive Behavior Interventions, 7, 33-46.
Autism Society of America (2008). http://www.autism-society.org/site/PageServer?pagename�about_whatis
*Barry, L. M., & Burlew, S. B. (2004). Using socialstories to teach choice and play skills to childrenwith autism. Focus on Autism and Other Developmen-tal Disabilities, 19(1), 45-51.
*Baumringer, N. (2002). The facilitation of social-emotional understanding and social interactionin high-functioning children with autism: Inter-vention outcomes. Journal of Autism and Develop-mental Disorders, 32, 283-298.
Bellni, S., & Akullian, J. (2007). A meta-analysis ofvideo modeling and video self-modeling interven-tions for children and adolescents with autismspectrum disorders. Exceptional Children, 73, 264-287.
Bellini, S., Peters, J. K., Benner, L., & Hopf, A.(2007). A meta-analysis of school-based socialskills interventions for children with autism spec-trum disorders. Remedial and Special Education, 28,153-162.
*Bock, M. A. (2007). The impact of social-behav-ioral learning strategy on the social interactionskills of four students with asperger syndrome.Focus on Autism and Other Developmental Disorders,22, 88-95.
*Buggy, T. (2005). Video self-modeling applicationswith students with autism spectrum disorder in asmall private school setting. Focus on Autism andOther Developmental Disabilities, 20, 52-63.
*Carter, E. W., Cushing, L. S., Clark, N. M., &Kennedy, C. H. (2005). Effects of peer supportinterventions on students’ access to the generalcurriculum and social interactions. Research andPractice for Persons with Severe Disabilities, 30, 15-25.
Carter, A. S., Davis, N. O., Klin, A., & Volkmar, F. R.(2005). Social development in autism. In F. R.Volkmar, R. Paul, A. Klin, & D. Cohen (Eds,),Handbook of autism and pervasive developmental dis-orders: Vol. 1. Diagnosis, development, neurobiology,and behavior. Hoboken, NJ: John Wiley & Sons.
Carter, E. W., & Hughes, C. (2005). Increasing so-cial interaction among adolescents with intellec-tual disabilities and their general educationpeers: Effective interventions. Research & Practicefor Persons with Severe Disabilities, 30, 179-193.
Centers for Disease Control and Prevention (2007).http://www.cdc.gov/ncbddd/autism/overview.htm
*Charlop-Christy, M. H., Carpenter, M., Le, L.,LeBlanc, L. A., & Kellet, K. (2002). Using thePicture Exchange Communication System (PECS)with children with autism: Assessment of PECSacquisition, speech, social-communicative behav-ior, and problem behavior. Journal of Applied Be-havior Analysis, 35, 213-231.
*Charlop-Christy, M. H., & Daneshvar, S. (2003).Using video modeling to teach perspective takingto children with autism. Journal of Positive BehaviorInterventions, 5, 12-21
*Charlop-Christy, M. H., & Kelso, S. E. (2003).Teaching children with autism conversationalspeech using a cue card/written script program.Education and Treatment of Children, 26, 108-127.
*Charlop-Christy, M. H., Le, L., & Freeman, K. A.(2000). A comparison of video modeling with invivo modeling for teaching children with autism.Journal of Autism and Developmental Disorders, 30,537-552.
*Chin, H. Y. & Bernard-Opitz, V. (2000). Teachingconversational skills to children with autism: Ef-fect of the development of a theory of mind.Journal of Autism and Developmental Disorders, 30,569-583.
Cook, C., Gresham, F., Kern, L., Barreras, R.,Thornton, S., & Crews, S. (2008, September).Social skills training for secondary students withemotional and/or behavioral disorders: A reviewand analysis of the meta-analytic literature. Jour-nal of Emotional and Behavioral Disorders, 16, 131-144.
*Delano, M. E., & Snell, M. E. (2006). The effects ofsocial stories on the social engagement of chil-dren with autism. Journal of Positive Behavior Inter-ventions, 8, 29-42.
*Dodd, S., Hupp, S. D. A., Jewell, J. D., Krohn, E.(2008). Using parents and siblings during a socialstory intervention for two children diagnosedwith PDD-NOS. Journal of Developmental and Physi-cal Disabilities. 20, 217-229.
*Gena, A., Couloura, S., & Kymissis, E. (2005). Mod-ifying the affective behavior of preschoolers withautism using In-Vivo or video modeling and re-inforcement continegies, Journal of Autism andDevelopmental Disorders, 35, 545-556.
*Garrison-Harrell, L., Kamps, D., & Kravits, T.(1997). The effects of peer networks on social-communicative behaviors for students with au-tism. Focus on Autism and Other Developmental Dis-orders, 12, 241-255.
Gersten, R., Fuchs, L., Compton, D., Coyne, M.,Greenwood, C., & Innocenti, M. (2005). Qualityindicators for group experimental and quasi-experimental research in special education. Ex-ceptional Children, 71, 149-164.
*Gonzalez-Lopez, A., & Kamps, D. M. (1997). Socialskills training to increase social interactions be-tween children with autism and their typicalpeers. Focus on Autism and Other Developmental Dis-orders, 12, 2-15.
*Harper, C. B., Symon, J. B. G., Frea, W. D. (2008).Recess is Time-in: using peers to improve socialskills of children with autism. Journal of Autism andDevelopmental Disorders, 38, 815-826.
340 / Education and Training in Developmental Disabilities-September 2009
*Hine, J. F., & Wolery, M. (2006). Using point-of-view video modeling to teach play to preschoolerswith autism. Topics in Early Childhood Special Edu-cation, 26, 83-93.
Horner, R. H., Carr, E. G., Halle, J., McGee, G.,Odom, S., & Wolery, M. (2005). The use of single-subject research to identify evidence-based prac-tices in special education. Exceptional Children, 71,165-179.
*Hwang, B., & Hughes, C. (2000). Increasing earlysocial-communicative skills of preverbal pre-school children with autism through social inter-active training. Journal of Association for Persons withSevere Handicaps, 25, 18-28.
*Jones, E. A. & Feeley, K. M. (2007). Parent imple-mented joint attention intervention for pre-schoolers with autism. SLP-ABA, 2, 253-268.
*Koegel, R. L., Werner, G. A., Vismara, L. A., &Koegel, L. K. (2005). The effectiveness of contex-tually supported play date interactions betweenchildren with autism and typically developingpeers. Research and Practice for Persons with SevereDisabilities, 30, 93-102.
*Krantz, P. J., & McClannahan, L. E. (1998). Socialinteraction skills for children with autism: Ascript-fading procedure for beginning readers.Journal of Applied Behavior Analysis, 31, 191-202.
*Laushey, K. M., & Heflin, L. J. (2000). Enhancingsocial skills of kindergarten children with autismthrough the training of multiple peers as tutors.Journal of Autism and Developmental Disorders, 30,183-193.
*Loncola, J. A., & Craig-Unkefer, L. (2005). Teach-ing social communication skills to young urbanchildren with autism. Education and Training inDevelopmental Disabilities, 40, 243-263.
*Lopreta, C., Thomeer, M. L., Volker, M. A., &Nida, R. E. (2006). Effectiveness of a cognitive-behavioral treatment on the social behaviors ofchildren with asperger disorder. Focus on Autismand Other Developmental Disorders, 21, 237-244.
Mastropieri, M. A., & Scruggs, T. E. (1985-1986).Early intervention for socially withdrawn chil-dren. The Journal of Special Education, 19, 429-442.
Matson, J. L., Matson, M. L., & Rivet, T. T. (2007).Social-skills treatments for children with autismspectrum disorders: An overview. Behavior Modifi-cation, 31, 682-707.
McCartney, K., & Rosenthal, R. (2000). Effect size,practical importance, and social policy for chil-dren. Child Development, 71, 173-180.
McConnell, S. R. (2002). Interventions to facilitatesocial interaction for young children with autism:Review of available research and recommenda-tions for educational intervention and future re-search. Journal of Autism and Developmental Disor-ders, 32, 351-372.
*McGee, G. G., & Daly, T. (2007). Incidental teach-
ing of age-appropriate social phrases to childrenwith autism. Research and Practice for Persons withSevere Disabilities, 32, 112-123.
*Nelson, C., McDonnell, A. P., Johnston, S. S.,Crompton, A., & Nelson, A. R. (2007). Keys toplay: A strategy to increase the social interactionsof young children with autism and their typicallydeveloping peers. Education and Training in Devel-opmental Disabilities, 42, 165-181.
*Nikopoulos, C. K., & Keenan, M. (2004). Effects ofvideo modeling on social interactions by childrenwith autism. Journal of Applied Behavior Analysis, 37,93-96.
*Nikopoulos, C. K., & Keenan, M. (2007). Usingvideo modeling to teach complex and sequencesof children with autism. Journal of Autism andDevelopmental Disorders, 37, 678-693.
Odom, S. L., Brantlinger, E., Gersten, R., Horner,R. H. Thompson, B., & Harris, K. R. (2005).Research in special education: Scientific methodsand evidence-based practices. Exceptional Children,71, 137-148.
*Paterson, C. R., & Arco, L. (2007). Using videomodeling for generalizing toy play in childrenwith autism. Behavior Modification, 31, 660-681.
*Petursdottir, A., McComas, J., McMaster, K., &Horner, K. (2007). The effects of scripted peertutoring and programming common stimuli onsocial interactions of a student with autism spec-trum disorder. Journal of Applied Behavior Analysis,40, 353-357.
*Pierce, K., & Schreibman, L. (1997). Multiple peeruse of pivotal response training to increase socialbehaviors of classmates with autism: Results fromtrained and untrained peers. Journal of AppliedBehavior Analysis, 30, 157-160.
Rogers, S. J. (2000). Interventions that facilitatesocialization in children with autism. Journal ofAutism and Developmental Disorders, 30, 399-409.
*Sansosti, F. J., & Powell-Smith, K. A. (2006). UsingSocial Stories to improve the social behavior ofchildren with Asperger Syndrome. Journal of Posi-tive Behavior Interventions, 8, 43-57.
*Scattone, D., Tingstrom, D. H., & Wilczynski, S. M.(2006). Increasing appropriate social interactionsof children with autism spectrum disorders usingsocial stories. Focus on Autism and Other Develop-mental Disorders, 21, 211-222.
Scheuermann, B., & Webber, J. (2002). Autism:Teaching does make a difference. Toronto: Wads-worth.
Scruggs. T. E., & Mastropieri, M. A. (1998). Sum-marizing single-subject research: Issues and appli-cations. Behavior Modification, 22, 221-242.
Scruggs, T. E., Mastropieri, M. A., & Casto, G.(1987). The quantitative synthesis of single-sub-ject research: Methodology and validation. Reme-dial and Special Education, 8, 24-33.
Evidence-Based Social Skills Interventions / 341
*Shabani, D. B., Katz, R. C., Wilder, D. A.,Beauchamp, K., Taylor, C. R., & Fischer, K. J.(2002). Increasing social initiations in childrenwith autism: Effects of a tactile prompt. Journal ofApplied Behavior Analysis, 35, 79-83.
*Simpson, A., Langone, J., Ayres, K. M. (2004).Embedded video and computer based instructionto improve social skills for students with autism.Education and Training in Developmental Disabilities,39, 240-252.
*Thiemann, K. S., & Goldstein, H. (2001). SocialStories, written text cues, and video feedback:Effects on social communication of children withautism. Journal of Applied Behavior Analysis, 34,425-446.
Vaughn, S., Kim, A. H., Sloan, C. V. M, Hughes,
M. T., Elbaum, B., & Sridhar, D. (2003). So-cial skills interventions for young children withdisabilities. Remedial and Special Education, 24,2-15.
Weiss, M. J., & Harris, S. L. (2001). Teaching socialskills to people with autism. Behavior Modification,25, 785-802.
*Wert, B. Y., & Neisworth, J. T. (2003). Effects ofvideo self-modeling on spontaneous requesting inchildren with autism. Journal of Positive BehaviorInterventions, 5, 30-34.
White, S. W., Keonig, K., & Scahill, L. (2007). Socialskills development in children with autism spec-trum disorders: A review of the intervention re-search. Journal of Autism and Developmental Disor-ders, 37, 1858-1868.
342 / Education and Training in Developmental Disabilities-September 2009