Autism and ASD : Face Processing, Social Skills, and Direct Training

 

These review notes begin with a summary of work on eye tracking during face processing in which children with ASD differed from controls in their gaze patterns in response to particular forms of stimuli … thus highlighting more specifically the nature of face processing impairments.

The next section concerns the inferring of mental states from faces, where the stimuli are presented as static or dynamic images, with the finding that children with ASD do appear able to make judgements from information conveyed in the eyes.

There follows a report of work in which brain activity in the region concerned with the processing of social information can show normal activation when the participating children with ASD are given specific instructions to attend to facial expression and tone of voice.

The final summaries describe work on social skill programmes for children with autism, highlighting those features which appear significant for effectiveness, including direct teaching.

 

M.J.Connor                                                                                          September 2007

 

 

Face Processing and Different Forms of Stimuli

 

The report of the study by Speer et al (2007) is introduced by reference to existing evidence for normal recognition among children with autism and ASD for non-social stimuli, such as buildings and objects, but for impairments in recognising social stimuli, such as faces.

 

The children have difficulty in distinguishing between familiar and unfamiliar faces, particularly when there is a dependence upon the eyes as the cue to recognition. It is noted (see, for example, Klin et al 2002) that they tend not to fixate upon the eyes but upon the mouth or some other part of the face.

This autism-specific impairment appears not to be a matter of any problem with overall cognitive ability or with visual discrimination skills per se.  Rather, it has been suggested that individuals with autism seek to process faces by activating that part of the brain typically involved in the processing of objects.

 

Further, any processing impairments are more evident when the task in question requires the identification of emotion or mental state, especially when an appreciation of the stimuli is dependent upon an understanding of the social or environmental context.  Accordingly, individuals with autism are likely to find it difficult to recognise an emotion such as surprise …. and the tendency remains  to fixate less upon the eyes than upon the mouth or the body (or upon some object if present).

 

However, it is reported that the evidence is not fully consistent.

For example, it has been shown by van der Geest et al (2002) that samples of children with autism could be as competent as age and IQ matched controls in face or emotion processing when viewing cartoon scenes including a human figure.  It was also found that samples of children with and without autism were not differentiable in terms of their gaze behaviours when presented with still photographs of human faces displaying emotional states. 

Their hypothesis was that any impairments that do separate children with autism from controls are less concerned with the complexity of the (facial) stimuli themselves than with the social context.

 

In seeking to understand these different findings, Speer et al note that the Klin and van der Geest studies involved not only different samples of participants but also different methodology especially the use of dynamic social scenes in the one case and static shots of individuals in the other. 

Therefore, the study by Speer et al themselves set out to replicate and extend existing findings by comparing the gaze patterns of children with autism and comparison groups for 4 types of stimuli … social dynamic, social static, isolated dynamic, and isolated static.  By combining the image type (static or dynamic) and image content

(isolated or social), there would be the opportunity to assess whether face processing impairments in autism are dependent on the contents, or the type of stimuli, or a combination of both elements.

 

The hypothesis was that children with autism would fixate on the eyes less, and on other regions more, than comparison peer groups. 

If the face-processing deficit arises only with naturalistic (moving/dynamic) stimuli, then the predicted group difference would be observed only in the isolated-dynamic and social-dynamic conditions.  If the deficit is concerned with social stimuli, then the group differences would be expected only in the social-static and social-dynamic conditions. If the deficit is a matter of a failure to process the combination of naturalistic and social elements of the stimuli, the group differences would be observed in the social-dynamic condition.

 

Meanwhile, the authors recognise the significance of work in this field for wider social skills and social understanding.  In particular, Klin et al are cited once again in their reporting of an association between longer fixation upon the mouth region and increased social competence (and between longer fixation upon objects within the stimulus content and decreased social competence). 

 

The participants comprised 12 children and young people (all male) between the ages of 9 and 18 years all diagnosed with ASD according to DSM criteria and the use of structured interview and observation schedules. 

Cognitive ability was recorded, and the parents of the participants completed the Social Responsiveness Scale (Constantino and Gruber 2005) which measures the severity of social symptoms … with the hypothesis that higher rated levels of social responsiveness would be associated with longer fixation upon the eye region of the stimulus and shorter fixation upon other parts of the stimulus.

A control group matched for age and measured IQ was recruited. 

 

The stimuli comprised 20 digitized video-clips drawn from a film (“Who’s afraid of Virginia Woolf ?”) chosen originally by Klin et al for depicting interactions with strong emotional content.  The clips showed highly charged interactions among two or more characters.  5 additional stimuli were equally dynamic but portrayed only one character (isolated-dynamic condition) speaking to him- or herself or to another character not visible on the screen.

10 static images were also used … 5 with two or more individuals (social-static condition) and 5 with one character (isolated-static condition).

The participants’ gaze was monitored and recorded by a head-mounted tracking device.

 

The assessment of outcomes indicated that the target and control groups differed in their performance only in the social-dynamic condition.

The individuals with autism spent significantly less time looking at the eyes than did the typically-developing peers.  They also spent marginally more time looking at the body.

These results are supportive of those of Klin et al who noted that individuals with autism fixated less upon eyes and more on mouths, bodies, and objects than did controls when looking at social-dynamic stimuli.

The lack of difference in the isolated-static condition is also consistent with the results produced by van der Geest et al who found no differences in gaze behaviour when groups with and without autism looked at still photographs of isolated individuals. 

 

The overall implication drawn by Speer et al is that the face processing deficit associated with autism appears to be at least partially dependent on stimuli being realistic (ie moving) and social in their nature.  When one or other of these elements is missing, the participants with autism perform similarly to typically-developing controls. Individuals with autism can identify emotions but this is increasingly challenging when an understanding of the social setting is also required.

It is speculated that emotions/ interactions portrayed by a single individual and in a static picture are not as difficult to process as those portrayed by several interacting individuals in a moving scene.

 

(In other words, the present writer – MJC – would suggest, the impairment among individuals with autism in this respect become more evident as the stimuli and context become more complex.  When dealing with a “one-dimensional” situation, the autistic individuals can cope as well as peers; but when the situation is complex and decisions are to be made about precisely where to focus attention/gaze, the disadvantage among the autistic individuals becomes more disabling.  This might be thought analogous to the reported difficulties among children with autism in a relatively free and unstructured situation where they may feel overwhelmed by the amount and range of stimuli [ compared to the more structured and predictable context of a classroom ], and may react by symptoms of stress or by withdrawing themselves physically or psychologically.)

 

This current set of results also shows that autism-related deficits in face processing are indeed linked to more general impairments in social functioning.  With lower social responsiveness (as indicated by the parental ratings), there is a greater tendency to fixate upon the body and less upon the eyes. 

The implication is that there is a relationship between the amount of fixation upon the eyes during interactions and the degree to which children are able to process and understand social information and cues conveyed via faces.

 

The authors acknowledge that this study involved high functioning participants with autism, and that further study is required to determine whether similar results would apply to the wider autistic population.

Nevertheless, the results are seen as promising, and the authors conclude by highlighting the possibility that children’s social responsiveness may be enhanced by direct training to focus their gaze upon a person’s eyes and not so much upon the body during interactions.  

 

Inferring Mental States      

 

The work of Back et al (2007) may be thought complementary to the findings reported above in that it was concerned with the relative capacity of individuals with autism to infer mental states from moving or static images of faces, and from the eyes when presented in isolation or in the context of a whole face.

 

Their introduction emphasises the significance of the ability to recognise mental states from facial expressions in (developing) social interaction and interpersonal communication … such as the regulation of truly two-way conversation.

The lack of such ability has been considered potentially crucial in respect of the social difficulties commonly reported among individuals with ASD. 

Existing evidence (such as that of Baron-Cohen et al 1997) indicates that such individuals can recognise basic emotions, such as happiness or sadness or anger, but are less successful when it comes to recognising more complex emotions such as admiration or interest.  It has been suggested that being able to interpret information from the eyes is significant for recognising these complex mental states rather than the more basic emotions … with support for such a view emerging from studies demonstrating greater difficulty in inferring mental states when the eye region alone, and not the whole face, is available for observation. 

 

A review of research findings completed by Back et al supports the concept of atypical processing of the eye region among individuals with ASD when dealing with face recognition … for example, the focus of such individuals tends to be upon the mouth or generally lower part of the face rather than upon the eyes, unlike those without ASD who prefer to attend to the eye region.

 

However, the findings are not conclusive since some research has failed to replicate this kind of evidence. 

Ponnet et al (2004) reported on one such study where it was found that adults with ASD perform as proficiently as control adults when attributing mental states to the eye region of photographed people.

The difference has been speculated to reflect differences in methodology or sampling in that the participants in these latter studies tended to have higher IQ scores than those in the Baron-Cohen research; or the task may have been easier in the latter studies because of the use of forced-choice responses. 

 

However, as set out in the previous section, there is also the matter of static versus  dynamic images, with growing support for the view that the use of dynamic (and more complex) stimuli provides a more discriminating challenge.  Typically developing individuals will be able to take advantage of the greater amount of information contained in the dynamic stimuli .. such as changes in facial expression … whereas those with ASD may find it easier to deal with the simple information contained in static stimuli and be intimidated or otherwise fail to cope with more complex and changing information.

 

It could be argued that the relative disability in processing moving stimuli is a matter of some general deficit within lower levels of visual-motion integration, but an alternative argument holds that the disability is specific to the processing of emotional states. 

 

The studies by Back et al used a technique that animated either the whole of a face or particular parts of a face thus to be able to compare the accuracy of processing dynamic and static stimuli, and to determine whether certain facial features are more significant than others in identifying mental states.

 

In the first task, the target participants were aged between 10 and 14 years, and were all subject to a formal diagnosis of ASD. A control group with no autistic features included some normally developing children and some with a developmental delay.

The stimuli were 8 mental states as portrayed by an actress (eg worried, surprised, not interested, etc.) and trialled in pilot studies to check their validity. 

The stimuli were of 5 types … a whole moving face, whole static face, eyes static, mouth static, and nose static. (In the latter 3, the rest of the face was dynamic.)

At the start, the participants were read brief statements to illustrate the 8 mental states (eg. “ When her cat went missing, the girl was very worried ”).

Subsequently, they were shown a series of faces on a screen and invited to select from a list of four words the one which seemed best to fit what the person shown was thinking or feeling.

 

The results indicated that the participants with ASD were generally poorer than controls at attributing mental states to facial expressions.  They were less competent at emotional recognition when there was no relevant information available from the eyes or mouth.

This was acknowledged to be explicable in terms of deficits in attention or in a particular focus of attention …. but the authors held that the results were compatible with the view that group differences in performance is not a matter of an inability per se among individuals with ASD to utilise information from the eyes. 

 

In the second task, the hypothesis under scrutiny was that individuals with ASD are hampered to a greater degree than controls when the information available is from eyes somehow separated from the rest of the face.  Such information is “unnatural” and perhaps particularly daunting to an ASD sample.

In this task, therefore, the participants were asked to recognise mental states either from the eyes alone or from the eyes in the context of the whole face.

 

The results here produced no evidence that the ASD group were inferior to controls in interpreting mental states from the eyes, whether presented in isolation or in the context of a whole face.

 

This might have seemed to be somewhat contradictory to the outcome of task 1 which had suggested an ASD inferiority in inferring mental states from whole faces; but the 2 tasks differed in a significant way.

In task 1, the information about the mental state was conveyed by the whole face; but, in task 2, information was conveyed only by the eyes.  This indicates that the individuals with and without ASD are comparable in their capacity to infer mental states from the eyes, whether in context or in isolation.

 

In their general discussion, the authors restate the finding that participants with ASD can use information from the eyes to attribute mental states … a finding that is at odds with the Baron-Cohen et al (2001) view that children with ASD have an impairment in reading information from the eyes.

Reasons for the failure to replicate this earlier finding were held to include the use of a female model only with the possibility that females are more expressive via their eyes; and the somewhat lower ages and IQs of their sample compared to the earlier sample. 

However, the use of male or female models did not impact upon accuracy in previous studies reported, and lower age and IQ might have been thought predictive of poorer rather than better performance at mind reading via the eyes.  

 

An alternative approach concerns possible deficits in other domains, so, for example, whatever the accuracy of recognising the mental state of another person, the individual with ASD may still not know how to respond or how to make use of the information … ie a deficit exists in executive functioning and/or communication. 

 

Meanwhile, other questions are worthy of investigation, such as whether the findings would generalise to different actors/actresses modelling the facial expressions representing mental states; or whether different results would emerge if responses were not confined to a choice of 4 alternatives. Could the correct interpretation be generated without this kind of cue ?

 

In any event, the authors conclude by holding that the results confirm that individuals with ASD can use information from the eyes to infer mental states.  This concurs to an extent with the conclusion of the previously summarised research (of Speer et al) and may offer some support to the view that such individuals may indeed have this capacity, but may not use this capacity (and require direct prompting, or focusing of attention, to do so). 

 

Theory of Mind and Direct Instruction     

   

A study specifically concerned with the effect of direct teaching upon the ability or willingness of children with ASD to attend to facial expressions or tone of voice has been reported by Wang et al (2007).

 

Their findings have shown that when children with autism or ASD were given explicit instructions to pay attention to the facial expression and the tone of voice of the stimulus person, there was increased activation in the medial prefrontal cortex … the brain area implicated in processing social information including the intentions of other people.

 

The implication cited by the authors is that it appears possible to achieve more normal functioning of activity in that social part of the brain simply by providing more specific instructions to focus upon significant social cues.

Therefore, there is support for the view that there is nothing inherently wrong with the brain area or that its appropriate functioning is not possible among individuals with ASD, but that there is a tendency not to focus in this way, and thus not to take advantage of the capacity to recognise social cues.  What matters is that this tendency is countered through direct instructions. 

 

Wang et al note that individuals with ASD can demonstrate good or superior cognitive functioning on formal assessments, but still show impairments in understanding the context of a conversation or the meaning behind humour or irony.

 

Their study, accordingly, set out to examine the underlying neural circuits which are activated when children with ASD are asked to decide if a given statement made during a conversation is sincere or ironic; and to explore whether a more typical pattern of brain activity would be observed when the children are given direct instructions about attending to social cues. 

The participants were 18 boys with ASD aged between 7 and 17 years, and a similar number of typically developing controls, all with a full scale IQ above 70.  They listened to conversations and viewed corresponding cartoon drawings of the scenario and were asked whether the concluding comment was sincere or meant the opposite of what was said.

 

When given neutral instructions, the control group but not the ASD group showed activity in the medial prefrontal cortex of the brain.  However, when given direct instructions to pay close attention to the facial expression and the tone of voice, the boys with ASD also showed activation in this brain area.

 

It was concluded that it appears possible to “train” the brains of children and young people with ASD to use social cues as a means of interpreting the intentions of other people and thus to become involved in more successful social interactions.

 

(It could be argued – MJC – that this is further support for the concept of poor or absent incidental learning among individuals with ASD, and for the corresponding need to take nothing for granted [ in terms, for example, of an awareness of context or an ability to follow communication, verbal and non-verbal, of any complexity ] when working and talking with individuals identified with ASD.)

 

The Effectiveness of Social Skill Programmes for Children with ASD

 

Following the above references to basic components of social and communicative skill and to the way in which they may be enhanced, one turns to “organised” interventions designed to increase the social interactions of children with autism and ASD. 

 

The comparison of two existing programmes is introduced by the authors (Kroeger et al 2007)  with a reference to deficits in socialisation and communication as core markers of autism or ASD, with social dysfunction commonly regarded as both the most debilitating to the child’s quality of life and a primary defining characteristic.

The dysfunction may take the form of limitations in social reciprocity, joint attention, and imaginative play, all of which will limit the opportunity to participate in social activities and to become accepted as a member of a group.

 

It is generally recognised that children with ASD require help in respect of developing and using social skills, but there is little consistent evidence concerning the most effective means.

Further, studies typically involve observational methods or relate to single cases, so that there is an absence of statistical analysis by which to highlight significantly beneficial strategies.  The children involved are usually from the higher-functioning end of the spectrum so that there is little information available about children with more severe needs, including poor verbal and non-verbal communication skills, especially in the case of young children of pre-school or reception-class age. 

 

It is noted by these present authors that peer-oriented studies appear most frequently in the published literature, but some questions or doubts persist about their nature and outcomes. 

For example, it may be that the emphasis in the social-skill training is upon the peers, helping them to determine how to interact with the children who have ASD, and any benefits will not be maintained when the groupings are changed.

It remains unclear whether any actual behavioural changes occur in the children with ASD, especially if the settings are unstructured and there is a dependence upon incidental learning. 

 

Correspondingly few studies have attempted directly to teach this target group to initiate and to maintain social interaction, although the available evidence (eg Krasny et al 2003) does suggest that teaching the children in a structured and predictable setting can produce effective results.

A group setting is important not only in permitting a number of children to be supported but also in ensuring the availability of partners with whom the target children can interact. (The corollary is that individual sessions, especially away from the natural setting, will be of limited usefulness.)

 

The study of Kroeger et al themselves investigated the effectiveness of group-delivered social skill programmes for young children with autism.  Direct instruction of play and social skills was the format by which to seek an increase in pro-social behaviours.

This was compared against a second type of group approach where the general structure was similar but there was not the element of direct instruction; instead, unstructured play time was provided during the period when the first group of children were receiving the direct instruction. 
Video modelling was the main element of the direct teaching strategy given evidence for its value among children with autism, the use of other children as models, and the opportunity afforded the supervisors to concentrate on prompting responses rather than having to be both model and prompter.

 

The participating children were aged between 4 and 6 years, all diagnosed with ASD, and allocated either to the direct instruction group (N=13) or the control group (N=12).  However, it is acknowledged that the allocation was not random but was a matter of family preferences for the time-slots available. 

The sessions were of 1 hour, and were held 3 times a week over a 5 week period.

The main author acted as general supervisor supported by facilitators who had been received training.

The sessions involved “hello” circle time, and “goodbye” circle time; with the middle section used either for the direct instruction work or for supervised free play.

The direct instruction, using the video modelling and direct teaching/prompting, targeted simple and complex motor imitation, parallel play, ball play, taking turns, seeking play partners, pretend play with partners, and use of play stations.  Half the time was used to model/teach the given behaviour, and the other half to prompt the use of the behaviour in the play part of the session.

“Social” reinforcement was used for both groups with eye contact, smiling, and interactive play encouraged by means of verbal praise;  and tangible rewards, such as biscuits, sweets, and crisps, were used in the direct instruction group. 

 

The results, in terms of video-recorded and rated behaviours, indicated improvement in pro-social behaviour across all the children, thus offering evidence in support of the effectiveness of group intervention among children with autism. 

 

It was also found that group intervention appears even more beneficial when there is an element of direct instruction.

Children in the direct teaching group made greater pro-social behaviour gains than did children in the play activity group, with support accruing for the view that repetition and intensity within a structured setting are critical components for the teaching and learning of social skills.

 

The social gains achieved in both groups were attributed to the low child to adult ratio, the structure, and the high level of training of the facilitators … with the implication that these elements would have to be repeated if similar progress were achieved in a classroom setting. 

It was also considered likely that the availability of same age peers as models and as interaction partners, alongside the adults who provided the direct teaching and prompting, provided a further positive impetus for initiating and maintaining social behaviours.  Meanwhile, the video modelling provides a consistent format for teaching a range of skills.

 

While the programme was directed towards social behaviours, the authors gathered anecdotal reports from a number of parents that the children had also made advances in their language and communication skills, including substantial increases in verbal output.  It was speculated that such benefits reflected the enhancement of “pivotal responses ” which are individual and socially-communicative behaviours, such as eye contact and the use of gestures, leading to positive changes in a broader range of social sills. 

 

In their conclusion, the authors recognise that the programme was quite short when compared to other behavioural programmes for children with autism, and it remains possible that greater gains are achievable when the programmes covers a longer period or involves more frequent sessions.  There is also the question whether the gains observed are maintained over time and generalise to different settings.  Accordingly, the authors suggest that the significant and initial findings of the programme should be followed up by ensuring that the direct teaching element becomes part of the repertoire of available strategies, albeit stressing that the child-adult ratio and the high level of training for the staff appear to be critical for success.

 

A review (meta-analysis) of school-based social skill interventions was completed by Bellini et al (2007) and their report was introduced, too, with a reference to impairments in social functioning as central to ASD.  They describe social skills as critical for successful emotional and cognitive development with the implication that effective social skill programmes should be a standard element of educational provision. 

 

Their initial literature review indicated that social skill programmes do indeed show promise for increasing the social and communicative skills of children with ASD. 

For example, they cite Rogers (2000) who noted a potential responsiveness in this target population to a variety of social skill intervention strategies to facilitate adult-child and child-child interactions.  These included pivotal response training, adult prompting, environmental modification, social skill groups, social stories, video modelling, and peer-mediated instruction. 

 

(One might put this another way and suggest the apparent significance of focusing attention in the first place, ensuring a clear structure and predictability in the setting, targeting a particular skill or situation, video-modelling to allow for repetition and the use of other children as models, adult cues and encouragement, and availability of peers for the practice and reinforcement of the skills in question.)

 

Reference is also made to the work of McConnell (2002) who divided interventions into 5 categories … environmental modification, child-specific intervention, collateral skill intervention, peer-mediated intervention, and comprehensive intervention. 

The environmental modification involves changes to the setting, (and one infers, for example, the establishment of routine and structure, small size of groups, etc.).  Child-specific strategies refer to direct instruction of social behaviours.  Collateral skill intervention refers to strategies to enhance social interaction via training in related skills such as play behaviours and language.  Peer-mediated intervention involves training other children to prompt and to respond to the social behaviours of the target children.  Comprehensive intervention involves any combination of the above elements.

 

However, Bellini et al continue, even with the benefit of this categorisation, a problem with existing literature reviews is their lack of quantitative data by which to gain a clear indication of effectiveness.  Qualitative studies do not highlight precisely what it is about the setting or the participants or the procedures which are significant for the most beneficial outcomes; nor do they allow for direct comparison of effectiveness across different initiatives.

 

The quantitative studies that are available have demonstrated that “traditional” social skill training has not been very effective in developing social skills among children and adolescents with ASD. Further, no significant outcome differences have been observed in respect of the duration of interventions, participant ages, or the means used to measure the targeted social skills.

The general implication has been that any social skill programme must be designed to fit the individual needs of the child as opposed to trying to fit the child into some existing social skill “package”.  It has also been deemed necessary to clarify the type of skill deficit …. does the child lack a particular skill so that the task involves teaching that skill, or is it a matter of failing to perform a skill that the child does possess ?

 

The analysis completed by Gresham et al (2001) led to a number of recommendations for promoting effective social skill interventions :

• The training should be of longer duration and greater intensity than what is typically implemented … 30 hours of instruction spread over 10-12 weeks are not sufficient
• Attention must be directed towards maintenance and generalisation of effects so that, for example, the training will not be effective if it is given in some separate and contrived setting rather than in a more natural context with opportunities to practise and consolidate the skills among different peers and different situations
• The type of social impairment must be clarified so that, for example, if it involves an actual skill deficit, the goal should be the direct teaching of the skill in question
• Reports of any intervention should include data about the intervention thus to ensure “treatment fidelity” and to reduce the risk of “therapy drift” (and to enable replication).

 

The school setting is the obvious choice for a “natural context” given the opportunities for peer interactions and for modelling/teaching a range of skills.

However, Bellini et al note the practical difficulties in setting up programmes, such as the lack of time available to the staff, or limited training and resources … and they note, too, the lack of studies reporting on in-school programmes for children with ASD.

 

The purpose of the authors’ own study was to gather quantitative data from existing research studies, albeit involving single cases, in respect of social skill interventions. 

Their analysis involved scanning papers appearing in the research literature during the period 1980-2005, with a focus upon reported and measured differences between baseline performance and follow-up performance thus to gain a measure of effectiveness.

(The actual method used concerned computing the percentage of non-overlapping data points [PND] between baseline and post-treatment phases.  A PND score above 90 indicates very effective intervention; 70-90 indicates effectiveness; 50-70 indicates low or dubious effectiveness; and below 50 indicates ineffectiveness.)

 

The overall results of this analysis demonstrated that school-based social skill interventions have been of low effectiveness for children with ASD.  Immediate effects and generalisation effects were low across participants, settings, and the play stimuli.  The period of intervention and length of session varied widely; but no significant associations were noted between outcomes and the number or hours or frequency of sessions.    

This picture of low treatment effect is consistent with the outcomes of previous meta-analyses.

 

Some positive indicators were identified … work with individuals appeared more successful than working with a group of children with ASD, and in-school interventions appeared more effective with students of secondary school age (albeit not reaching the level of statistical significance).

 

With regard to implications, the authors noted the clear view presented by Gresham et al about duration and intensity of intervention, even if these present results appeared to show no such effects.

However, the authors reported that their data, and those of previous analyses, often failed to include adequate information concerning length and duration of intervention, hence the need for some caution in dealing with this issue.  The recommendation is to maximise instructional intensity for the ASD children and to ensure that the specific intervention is supported by all school personnel in looking for opportunities to teach and reinforce social skills as often as possible during the school day.

 

Meanwhile, as far as the precise setting for the intervention is concerned, the present results support the accumulating evidence that “decontextualised” sessions  (ie  those that take place in some separate room and away from the normal classroom) are likely to be of limited effectiveness.  The recommendation is for interventions to be based in the typical classroom setting, with the implication for shared planning among staff and facilitators in respect of identifying the social skill strategies that can be used in that and other “natural” settings. 

This recommendation is based upon the common finding that children with ASD find difficulties in transferring skills from one setting to another.

 

In respect of choice of strategy, there is further emphasis upon the need to differentiate skill deficits (such as a lack of knowledge about how to begin an interaction) from a failure to use a skill that the child does possess. 

 

The authors support, too, the plea for clear information in the reports of interventions concerning the precise methods used over time. This will enable observers to determine if ineffectiveness of an approach is due to some inherent weakness in the strategy or to a failure to implement the strategy in the way that is necessary and agreed. 

 

In their conclusion, the authors acknowledge the relatively small number of research reports included in the analysis (N=55) and the associated limitation in respect of adequate information by which to explore the covariance among participant characteristics, settings, methodology, and outcome measures. 

It is also recognised that their analysis may be influenced by “publication bias” in that authors may only submit, and editors may only print, those reports which have clear and strong findings. There is a risk, therefore, that published papers may tend to inflate the effects of interventions.

 

Nevertheless, and pending the outcomes of further research, Bellini et al felt able to conclude that their results support the view that social skill interventions, as currently practised and reported, are of low effectiveness.  Their results support the position adopted by Gresham who argued that the implications include raising the “dosage” of the intervention, including an element of direct instruction, the use of a natural setting, matching the intervention to the type of deficit, and ensuring that the implementation of the strategies follows the guidelines set down.

 

                                         *          *          *          *          *

 

 

M.J.Connor                                                                                          September 2007

 

                        

 

REFERENCES     

 

Back E., Ropar D., and Mitchell P.  2007   Do the eyes have it ?   Child Development  78(2)  397-411

 

Baron-Cohen S., Wheelwright S., and Joliffe T.  1997   Is there a “ language in the eyes ? ”  Visual Cognition  4  311-331

 

Baron-Cohen S., Wheelwright S., Spong A., Scahill V., and Lawson J.  2001   Are intuitive physics and intuitive psychology independent ?   Journal of Developmental and Learning Disorders  5  47-78

 

Bellini S., Peters J., Benner L., and Hope A.  2007   A meta-analysis of school-based social skills interventions for children with autism spectrum disorders.   Remedial and Special Education  29(3)  153-162  

 

Constantino J. and Gruber C.  2005   Social Responsiveness Scale.   Los Angeles : Western Psychological Services

 

Gresham F., Sugai G., and Horner R.  2001   Interpreting outcomes of social skill training for students with high incidence disabilities.   Teaching Exceptional Children  67  331-344

 

Klin A., Jones W., Schultz R., Volkmar F., and Cohen D.  2002   Visual fixation patterns during viewing of naturalistic social situations as predictors of social competence in individuals with autism.   Archives of General Psychiatry  59  809-816

 

Krasny  L., Williams B., Provencal S., and Ozonoff S.  2003   Social skill interventions for the autism spectrum.   Child and Adolescent Psychiatric Clinics of North America  12  107-122

 

Kroeger K., Schultz J., and Newsom C.  2007   A comparison of two group-delivered social skills programmes for young children with autism.   Journal of Autism and Developmental Disorders  37  808-817

 

McConnell S.  2002   Interventions to facilitate social interaction for young children with autism.   Journal of Autism and Developmental Disorders  32  351-201     

 

Ponnet K., Roeyers H., Buysee A., De Clercq A., and Van der Heyden E.  2004   Advanced mind-reading in adults with Asperger syndrome.   Autism 8  249-266

 

Rogers S.  2000  Interventions that facilitate socialization in children with autism.  Journal of Autism and Developmental Disorders  30  399-409 

 

Speer L., Cook A., McMahon W., and Clark E.  2007   Face processing in children with autism.   Autism  11(3)  265-277

 

Van der Geest J., Kemner C., Cafferman G., Verbaten M., and Van England H.  2002  Looking at images with human figures.   Journal of Autism and Developmental Disorders  32(2)  69-75

 

Wang A., Lee S., Sigman M., and Dapretto M.  2007   Reading affect in the face and voice.   Archives of General Psychiatry  64  698-708