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Question
Question: How effective are social skills groups in improving social outcomes for young people with autism spectrum disorders (ASD)?
Outcomes: Primary outcome: social competence. Secondary outcomes: social communication, quality of life (including loneliness, friendship, child depression, maternal depression), emotion recognition, specific behaviours and adverse effects.
Methods
Design: Systematic review and meta-analysis.
Data sources: CENTRAL (2011, Issue 4), MEDLINE (1948 to November week 3, 2011), EMBASE (1980 to Week 50, 2011), PsycINFO (1887 to December Week 2, 2011), CINAHL (1937 onwards), ERIC (1966 onwards), Sociological Abstracts (1952 onwards), OCLC WorldCat, Social Science Citation Index (1970 to 12 December 2011) and mRCT were searched in December 2011. The reference lists of published papers were hand searched.
Study selection and analysis: Randomised controlled trial (RCTs) comparing social skills groups with no intervention, waitlist or treatment as usual in 6-year-olds to 21-year-olds with ASD (DSM-IV-TR or ICD-10 autistic disorder, Asperger's syndrome, pervasive developmental disorder not otherwise specified, Rett's syndrome or childhood disintegrative disorder). Social skills groups had to be delivered to at least two individuals in any setting, and be of any frequency or duration. Standardised mean differences effect sizes (ES) were calculated and random-effects meta-analysis conducted where possible.
Main results
Five RCTs with 196 participants were included in the review. Four studies included children aged 8–11 years old and one study included adolescents aged 11–17 years old. All the studies included participants with IQs above the cut-off for intellectual disability. Duration of the intervention ranged from five to 20 weeks or 12–25 sessions. All the outcome measures were assessed immediately after treatment and no long-term follow-up data were reported. Compared with waitlist control or no treatment, social skills groups improved overall social competence at the end of treatment (4 RCTs; ES 0.47, 95% CI 0.16 to 0.78; p=0.003). No differences were found between social skills groups and control for emotion recognition or social communication (emotion recognition: 2 RCTs; ES +0.34, 95% CI −0.20 to +0.88; p=0.21; social communication: 1 RCT; ES +0.05, 95% CI −0.63 to +0.72; p=0.89). Two studies found that social skills groups improved self-reported friendship quality compared with control (ES 0.41, 95% CI 0.02 to 0.81; p=0.04). One study found participants reporting themselves less lonely after treatment compared with controls (ES −0.66, 95% CI −1.15 to −0.17; p=0.008). One study measured child and parental depression with no differences found between groups. No overall meta-analysis was carried out for quality of life due to the different measures used across studies. No studies measured specific behaviours and no adverse events were reported in any of the studies.
Conclusions
Social skills groups may improve short-term social competence in children and adolescents with ASD. Further research is needed to determine the generalisability of social skills groups for ASD.
Notes: All studies were carried out in the USA which may affect the generalisability of findings.
Commentary
This paper seeks to systematically examine evidence for the efficacy of social skills groups in improving social competence, social communication, emotion recognition and quality of life for children and adults with Autism Spectrum Disorders (ASD). Given the fact that social skills group interventions are a common method of treatment for individuals with ASD, yet empirical evidence examining the effectiveness of these interventions is mixed, this paper represents an important area of inquiry.
Previous meta-analyses investigating the efficacy of social skills groups for individuals with ASD have been inconclusive, citing too great a lack of evidence to draw conclusions. However, in the current study, Reichow and colleagues have disentangled mixed reviews to illuminate the benefit of social skills groups for youth with ASD, representing the first conclusive meta-analysis of its kind.
The reviewers examined randomised controlled trials (RCTs) of social skills groups for youth with ASD from 6 to 21 years of age by means of a review of electronic databases through December 2011. Five studies met the review criteria, in that they utilised RCT designs, employed group formats to improve social skills, compared treatment with control conditions and targeted youth with ASD. Of those studies included in this review, the participants were all above the cut-off for intellectual disability and ranged in age from 8 to 17 years.
The results of this meta-analysis reveal that among the social skills groups reviewed, modest gains in social competence, friendship quality and decreased loneliness were demonstrated. Weighted mean effect size for social competence (0.47) was even comparable with previous meta-analyses of psychotherapy and child/adolescent group treatments.
While these findings are encouraging and provide the first conclusive meta-analysis supporting the efficacy of social skills groups for children and adolescents with ASD, the small number of studies reviewed, whose quality of evidence was graded as ‘low’ overall, limits the generalisability of the findings. Future research examining emerging evidence in this area might explore cross cultural differences as well as treatment impact among participants within a broader range of age and cognitive functioning.
Footnotes
Sources of funding: Internal sources: Associates of the Yale Child Study Center and Yale University School of Medicine, USA. External sources: no sources of support supplied.
Footnotes
Competing interests EAL is the first author of one of the research studies reviewed in this paper.