Therapies for Children With Autism Spectrum Disorders

Strength of evidence. The strength of evidence for the effect of social skills interventions on
social outcomes is insufficient (Table 28). Of 8 RCTs, four were fair in quality and none was
good. All studies did demonstrate benefit on at least one outcome measure but a lack of
consistency in the interventions or outcome measures makes it impossible to assess consistency
or precision. Most studies relied on report of intermediate outcomes.
Table 28. Summary of results of social skills interventions
Intervention Study design/Quality Study results and overall strength of evidence
Group-format 6 RCTs / 3 fair 135,139,141 , 3
poor 143,146,149
1 Retrospective cohort / 1 poor 148
5 Prospective case
series 136,138,140,142,144
Individual-format 2 RCTs / 1 fair, 145 1 poor 152
2 Prospective case series 137,147
ASDs=autism spectrum disorders; RCT=randomized controlled trial
103
• High functioning children with ASDs improved on
various social outcomes in individual studies, however
the specific social skills in which benefits were
observed and reported (such as emotion recognition,
theory of mind, and observed peer interactions) varied
depending on the study.
• Strength of evidence on social outcomes is insufficient
given variations in the interventions and outcomes
assessed.
• Improvements were seen in targeted social skills for
treated participants but interventions and outcomes
varied substantially across studies.
• Strength of evidence for social outcomes is insufficient
given variations in the interventions assessed.
Play- and Interaction-Based Interventions
Summary. Fifteen papers (13 unique study populations) assessed play-/interaction-based
approaches. 153-167 Parent training in play-based interventions shows some promise for reducing
challenging behavior and encouraging early social communication skills (e.g., joint attention and
symbolic play). Joint attention and symbolic play interventions also promoted expressive
language growth. 155,156 No studies reported harms of intervention.
Strength of evidence. Although there were at least two RCTs available for most categories of
play interventions (parent-focused, relationship-based, imitation, joint attention and symbolic
play), none was of good quality and the diversity of specific interventions and outcomes
prohibits drawing conclusions about specific approaches (Table 29).