A new study suggests training peers can help children with autism spectrum disorder improve their social skills, even more than a direct adult-led intervention.
Researchers led by Connie Kasari, Ph.D., discovered children with ASD who attend regular education classes are more likely to improve their social skills if their typically developing peers are taught how to interact with them.
Notably, the indirect educational method appears to improve skills better than if the ASD children are directly taught such skills. The National Institutes of Health-funded study suggests a shift away from more commonly used interventions that focus on training children with ASD directly may provide greater social benefits for children with ASD.
The study was published online ahead of print in the Journal of Child Psychology and Psychiatry.
“Real life doesn’t happen in a lab, but few research studies reflect that,” said Thomas R. Insel, director of the National Institute of Mental Health, a part of NIH. “As this study shows, taking into account a person’s typical environment may improve treatment outcomes.”
Traditional training of social skills for children with ASD involves intervention for a group of children with social challenges. This educational focus has had mixed results as each child may have a different disorder and may be from different classes or schools.
Moreover, the intervention is usually delivered at a clinic, but may also be school-based and offered in a one-on-one format.
Other types of intervention focus on training peers how to interact with classmates who have difficulty with social skills. Both types of intervention have shown positive results in studies, but neither has been shown to be as effective in community settings.
In the current study, Kasari, of the University of California, Los Angeles, and colleagues compared different interventions among 60 children, ages 6-11, with ASD. All of the children were mainstreamed in regular education classrooms for at least 80 percent of the school day.
These children were randomly assigned to either receive one-on-one training with an intervention provider or to receive no one-on-one intervention. The children were also randomized to receive a peer-mediated intervention or no peer-mediated intervention.
Researchers discovered children with ASD whose peers received training—including those who may also have received the child-focused intervention—spent less time alone on playgrounds and had more classmates naming them as a friend, compared to participants who received the child-focused interventions.
Teachers also reported that students with ASD in the peer-mediated groups showed significantly better social skills following the intervention. However, among all intervention groups, children with ASD showed no changes in the number of peers they indicated as their friends.
At follow-up, children with ASD from the peer-mediated groups continued to show increased social connections despite some of the children having changed classrooms due to a new school year and having new, different peers.
According to the researchers, the findings suggest that peer-mediated interventions can provide better and more persistent outcomes than child-focused strategies. Furthermore, child-focused interventions may only be effective when paired with peer-mediated intervention.
In a recent interview with the Autism Science Foundation on this “peer-modeling” research, Kasari said, “Anytime we involved typical peers with the children with autism we found out that more children in the classroom nominated that child or selected that child as a friend, played with them on the playground more often, and connected with the child. The other model, where we just had an adult work with a child, wasn’t as effective.”
In addition to the benefits of peer-mediated interventions, the researchers noted several areas for improvement.
For example, peer engagement especially helped children with ASD to be less isolated on the playground, but it did not result in improvement across all areas of playground behavior, such as taking turns in games or engaging in conversations and other joint activities.
Also, despite greater inclusion in social circles and more frequent engagement by their peers, children with ASD continued to cite few friendships.
Further studies are needed to explore these factors as well as other possible mediators of treatment effects.
Source: National Institutes of Health