A social-competence group intervention featuring didactic teaching and practice in play contexts for preschool children with autism spectrum disorders
Relatively few intervention programs of social competence have been specifically designed for preschool children with autism spectrum disorders (ASD).
This randomized controlled trial (RCT) investigated the effectiveness of the social-competence group intervention (SCGI), which features a combination of didactic teaching and practice in play contexts for preschool children with ASD.
Social competence is defined as the ability to interact with others effectively (Rose-Krasnor, 1997). It is multidimensional and consists of three key dimensions: social skill elements, social reciprocity, and social adjustment (Ashton, 2018, Huber et al., 2019, Liu, 2021). The first dimension, social skill elements, encompasses a series of essential skills to accomplish a social task. The second, social reciprocity, is the ability to maintain interpersonal interactions, and social adjustment is the ability to adjust one’s behaviors in different social contexts for sustaining the quality of the social interaction. Each of these three dimensions represents different aspects of social competence. Given its multifaceted nature, it is crucial to understand how social competence manifests in children who have difficulties in it.
Children with ASD usually show difficulties in social competence (Dakopolos & Jahromi, 2019, Matson & Wilkins, 2007). They often have deviant or delayed development of social skill elements in verbal and non-verbal social behaviors, such as eye contact, gestures, and facial and verbal expression (Claudia and Lucia, 2022, Rahman et al., 2020). Their lack of these elements of essential social skills causes them difficulty in interpreting others’ social cues and expressing their thoughts and feelings. Moreover, they may frequently have poor social reciprocity and thus difficulties in maintaining back-and-forth interactions with others (Rahman et al., 2020). As for their social adjustment, even if they are able to maintain reciprocity during social interaction, they may also encounter difficulties in socially adjusting their behaviors to the needs of others, such as sharing, helping, and showing empathy in the social contexts of real-life settings (Chen & Lai, 2021, Dunfield, Best, Kelley, & Kuhlmeier, 2019). Improving social competence in these dimensions is important for helping children with ASD to build healthy social lives.
To date, few social competence-specific intervention programs have been designed for children with ASD at the preschool age (Kaat & Lecavalier, 2014). Notable examples of these programs include TIP (Teaching Interaction Procedure; Leaf et al., 2012), JASPER (Joint Attention Symbolic Play Engagement and Regulation; Goods, Ishijima, Chang, & Kasari, 2013), and P4P (PEERS® for Preschoolers; Antezana et al., 2022). TIP addresses prompting targeted social skills through the components of label/identify skills, provide rationales, reiterate skill steps, demonstrate the skill, and receive verbal feedback. JASPER is aimed to facilitate joint engagement and targets communication skills within play routines. P4P includes group sessions focusing on developmentally appropriate social skills through play activities and parallel caregiver engagement for social coaching. The positive effectiveness of these programs highlights the benefits of social competence-specific interventions at the critical preschool age in children with ASD.
Specific characteristics can be drawn from these effective social competence-specific intervention programs for preschool children with ASD. First, didactic teaching has been used to directly teach social skills to the children (Odom et al., 2021). In didactic teaching, various teaching methods and positive reinforcement strategies are utilized to provide structured and tailored social skills instruction to preschoolers with ASD for fostering children’s development of target social behaviors (Haring & Lovinger, 1989, Kassardjian et al., 2014, Kirby & Toler, 1970, Leaf et al., 2012). Second, play contexts have been adopted to offer a natural and engaging setting for children to practice social skills in situations analogous to real-life social events, such as conflicts that may arise during play (Schreibman et al., 2015). When practicing in play contexts, children not only have higher motivation to spontaneously interact with their social partners but also better transfer what they have learned to everyday social events. Third, caregiver involvement is effective to facilitate the social competence of preschool children with ASD. Caregivers are involved in discussing children’s social competence, setting collaborative goals, assigning homework, etc. This involvement extends the intervention effects beyond intervention sessions to the home environment. Therefore, didactic teaching, naturalistic play contexts and caregiver involvement are suggested while developing intervention programs for preschool children with ASD to enhance their social competence. Furthermore, an increasing number of studies have incorporated caregivers’ parental stress as an outcome measure in interventions programs for children with ASD (Curley et al., 2023; Osborne et al., 2008; Shine & Perry, 2010). Measurement of parental stress can assist therapists in identifying whether it poses a potential barrier in social competence interventions for children with ASD, as higher levels of parental stress have been linked to decreased intervention effectiveness (Curley et al., 2023, Keen et al., 2010, Strauss et al., 2012). Given the above, caregivers’ parental stress should be taken into consideration when caregivers participate in intervention programs targeting children with ASD.
Therefore, we designed a social-competence group intervention (SCGI) to promote social competence in preschool children with ASD. The SCGI applied didactic teaching by including a set sequence of lessons targeting social competences and employed practicing in play contexts to create naturalistic contexts to promote the generalizability of the social competence learned in the didactic teaching. Strategies of positive reinforcement, caregiver involvement, and homework were also applied in the SCGI to encourage preschool children with ASD to utilize the learned social competence. This study investigated the effectiveness of the SCGI using a randomized controlled trial (RCT) design. We hypothesized that the SCGI would effectively promote social competence in preschool children with ASD.