Abstract
There is a dearth of research that focuses on social intervention efforts for adults on the autism spectrum with intellectual disability and limited conversational language. Using a multiple baseline experimental design, this pilot investigation of the Socialization Knowledge for Individuals with Limited Language (SKILL) program evaluated a novel peer-facilitated group program specifically designed to target social interaction skills for this population. Findings from five pilot participants yielded evidence of social improvements across specific verbal skills (on-topic conversational contributions and responses) and nonverbal behaviors (eye-contact, active listening), as evidenced by coded social conversation probes and parent-report measures. These findings demonstrate the promise of a socialization intervention for a population that has historically been neglected in the social intervention research literature.
![](https://cdn.statically.io/img/media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs10803-020-04659-1/MediaObjects/10803_2020_4659_Fig1_HTML.png)
![](https://cdn.statically.io/img/media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs10803-020-04659-1/MediaObjects/10803_2020_4659_Fig2_HTML.png)
![](https://cdn.statically.io/img/media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs10803-020-04659-1/MediaObjects/10803_2020_4659_Fig3_HTML.png)
![](https://cdn.statically.io/img/media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs10803-020-04659-1/MediaObjects/10803_2020_4659_Fig4_HTML.png)
Similar content being viewed by others
Notes
This manuscript uses both Identity-first and Person-first language, consistent with practices among autistic-self advocates and community stakeholders (Kenny et al. 2016).
References
Bal, V. H., Maye, M., Salzman, E., Huerta, M., Pepa, L., Risi, S., et al. (2020). The Adapted ADOS: A new module set for the assessment of minimally verbal adolescents and adults. Journal of Autism and Developmental Disorders, 50(3), 719–729.
Bandura, A. (1979). Self-referent mechanisms in social learning theory. American Psychologist, 34(5), 439–441. https://doi.org/10.1037/0003-066X.34.5.439.b.
Barry, T. D., Klinger, L. G., Lee, J. M., Palardy, N., Gilmore, T., & Bodin, S. D. (2003). Examining the effectiveness of an outpatient clinic-based social skills group for high-functioning children with autism. Journal of Autism and Developmental Disorders, 33(6), 685–701. https://doi.org/10.1023/B:JADD.0000006004.86556.e0.
Chang, Y.-C., & Locke, J. (2016). A systematic review of peer-mediated interventions for children with autism spectrum disorder. Research in Autism Spectrum Disorders, 27, 1–10. https://doi.org/10.1016/j.rasd.2016.03.010.
Cicchetti, D. V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6(4), 284–290. https://doi.org/10.1037/1040-3590.6.4.284.
Conner, C. M., White, S. W., Beck, K. B., Golt, J., Smith, I. C., Mazefsky, C. A. (2018). Improving emotion regulation ability in autism: The Emotional Awareness and Skills Enhancement (EASE) program. Autism: The International Journal of Research and Practice, 1362361318810709. https://doi.org/10.1177/1362361318810709
Corbett, B. A., & Abdullah, M. (2005). Video modeling: Why does it work for children with autism? Journal of Early and Intensive Behavior Intervention, 2(1), 2–8. https://doi.org/10.1037/h0100294.
Constantino, J. N., & Gruber, C. P. (2012). Social responsiveness scale: SRS-2. Torrance, CA: Western Psychological Services.
DiStefano, C., Shih, W., Kaiser, A., Landa, R., & Kasari, C. (2016). Communication growth in minimally verbal children with ASD: The importance of interaction. Autism Research: Official Journal of the International Society for Autism Research, 9(10), 1093–1102. https://doi.org/10.1002/aur.1594.
Dudley, K. M., Klinger, M. R., Meyer, A., Powell, P., & Klinger, L. G. (2019). Understanding service usage and needs for adults with asd: the importance of living situation. Journal of Autism and Developmental Disorders, 49(2), 556–568. https://doi.org/10.1007/s10803-018-3729-0.
Duncan, D., Matson, J. L., Bamburg, J. W., Cherry, K. E., & Buckley, T. (1999). The relationship of self-injurious behavior and aggression to social skills in persons with severe and profound learning disability. Research in Developmental Disabilities, 20(6), 441–448. https://doi.org/10.1016/S0891-4222(99)00024-4.
Dunn, L. M., & Dunn, D. M. (2007). Peabody Picture Vocabulary Test—Fourth Edition PPVT4. Bloomington, MN: NCS Pearson.
Dijkhuis, R. R., Ziermans, T., van Rijn, S., Staal, W., & Swaab, H. (2019). Emotional arousal during social stress in young adults with autism: Insights from heart rate, heart rate variability and self-report. Journal of autism and developmental disorders, 49(6), 2524–2535.
Dyson, M. W., Chlebowski, C., & Brookman-Frazee, L. (2019). Therapists’ adaptations to an intervention to reduce challenging behaviors in children with autism spectrum disorder in publicly funded mental health services. Journal of autism and developmental disorders, 49(3), 924–934.
Fletcher-Watson, S., Adams, J., Brook, K., Charman, T., Crane, L., Cusack, J., et al. (2019). Making the future together: Shaping autism research through meaningful participation. Autism, 23(4), 943–953. https://doi.org/10.1177/1362361318786721.
Carminati, G., Gerber, F., Baud, M. A., & Baud, O. (2007). Evaluating the effects of a structured program for adults with autism spectrum disorders and intellectual disabilities. Research in Autism Spectrum Disorders, 1(3), 256–265. https://doi.org/10.1016/j.rasd.2006.11.001.
Gates, J. A., Kang, E., & Lerner, M. D. (2017). Efficacy of group social skills interventions for youth with autism spectrum disorder: A systematic review and meta-analysis. Clinical Psychology Review, 52, 164–181. https://doi.org/10.1016/j.cpr.2017.01.006.
Gotham, K., Marvin, A. R., Taylor, J. L., Warren, Z., Anderson, C. M., Law, P. A., et al. (2015). Characterizing the daily life, needs, and priorities of adults with autism spectrum disorder from Interactive Autism Network data. Autism, 19(7), 794–804. https://doi.org/10.1177/1362361315583818.
Harrop, C., Amsbary, J., Towner-Wright, S., Reichow, B., & Boyd, B. A. (2019). That’s what I like: The use of circumscribed interests within interventions for individuals with autism spectrum disorder. A systematic review. Research in Autism Spectrum Disorders, 57, 63–86. https://doi.org/10.1016/j.rasd.2018.09.008.
Howlin, P., Goode, S., Hutton, J., & Rutter, M. (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry, 45(2), 212–229. https://doi.org/10.1111/j.1469-7610.2004.00215.x.
Hume, K., Loftin, R., & Lantz, J. (2009). Increasing independence in autism spectrum disorders: A review of three focused interventions. Journal of Autism and Developmental Disorders, 39(9), 1329–1338. https://doi.org/10.1007/s10803-009-0751-2.
Ingersoll, B., & Wainer, A. (2013). Initial efficacy of project ImPACT: A parent-mediated social communication intervention for young children with ASD. Journal of Autism and Developmental Disorders, 43(12), 2943–2952. https://doi.org/10.1007/s10803-013-1840-9.
Kasari, C., Alexandra, S., & Wendy, S. (2018). SMARTer approach to personalizing intervention for children with autism spectrum disorder. Journal of Speech, Language, and Hearing Research, 61(11), 2629–2640. https://doi.org/10.1044/2018_JSLHR-L-RSAUT-18-0029.
Ko, J. A., Miller, A. R., & Vernon, T. W. (2019). Social conversation skill improvements associated with the Social Tools And Rules for Teens program for adolescents with autism spectrum disorder: Results of a randomized controlled trial. Autism, 23(5), 1224–1235. https://doi.org/10.1177/1362361318808781.
Krasileva, K. E., Sanders, S. J., & Bal, V. H. (2017). Peabody picture vocabulary test: Proxy for verbal iq in genetic studies of autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(4), 1073–1085. https://doi.org/10.1007/s10803-017-3030-7.
Kaufman, A. S. (1990). Kaufman brief intelligence test: KBIT. Circle Pines, MN: AGS, American Guidance Service.
Leaf, J. B., Townley-Cochran, D., Taubman, M., Cihon, J. H., Oppenheim-Leaf, M. L., Kassardjian, A., et al. (2015). The Teaching interaction procedure and behavioral skills training for individuals diagnosed with autism spectrum disorder: A review and commentary. Review Journal of Autism and Developmental Disorders, 2(4), 402–413. https://doi.org/10.1007/s40489-015-0060-y.
Maenner, M. J. (2020). Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016 (p. 69). Surveillance Summaries: MMWR.
Matson, J. L., & Shoemaker, M. (2009). Intellectual disability and its relationship to autism spectrum disorders. Research in Developmental Disabilities, 30(6), 1107–1114. https://doi.org/10.1016/j.ridd.2009.06.003.
Mazefsky, C. A., Day, T. N., Siegel, M., White, S. W., Yu, L., Pilkonis, P. A., et al. (2018). Development of the Emotion Dysregulation Inventory: A PROMIS®ing Method for Creating Sensitive and Unbiased Questionnaires for Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 48(11), 3736–3746. https://doi.org/10.1007/s10803-016-2907-1.
Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., et al. (2013). The Role of Emotion Regulation In Autism Spectrum Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(7), 679–688. https://doi.org/10.1016/j.jaac.2013.05.006.
Mazefsky, C. A., & White, S. W. (2014). Emotion Regulation: Concepts & Practice in Autism Spectrum Disorder. Child and Adolescent Psychiatric Clinics of North America, 23(1). https://doi.org/10.1016/j.chc.2013.07.002
Murphy, C., Barnes-Holmes, P. M. D. (2017). Teaching important relational skills for children with Autism spectrum disorder and intellectual disability using freely available (GO-IRAP) software. Austin Journal of Autism & Related Disabilities, 3(2).
National Research Council (US) and Institute of Medicine (US) Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities (M. E. O’Connell, T. Boat, & K. E. Warner, Eds.). National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK32775/
Neuhaus, E., Webb, S. J., & Bernier, R. A. (2019). Linking social motivation with social skill: The role of emotion dysregulation in autism spectrum disorder. Development and psychopathology, 31(3), 931–943.
Nicolaidis, C., Raymaker, D., McDonald, K., Dern, S., Ashkenazy, E., Boisclair, C., et al. (2011). Collaboration strategies in nontraditional community-based participatory research partnerships: lessons from an academic-community partnership with autistic self-advocates. Progress in Community Health Partnerships, 5(2), 143–150. https://doi.org/10.1353/cpr.2011.0022.
Pallathra, A. A., Calkins, M. E., Parish-Morris, J., Maddox, B. B., Perez, L. S., Miller, J., et al. (2018). Defining behavioral components of social functioning in adults with autism spectrum disorder as targets for treatment. Autism Research, 11(3), 488–502. https://doi.org/10.1002/aur.1910.
Pallathra, A. A., Cordero, L., Wong, K., & Brodkin, E. S. (2019). Psychosocial interventions targeting social functioning in adults on the autism spectrum: A literature review. Current Psychiatry Reports. https://doi.org/10.1007/s11920-019-0989-0.
Parish-Morris, J., Sariyanidi, E., Zampella, C., Bartley, G. K., Ferguson, E., Pallathra, A. A., Bateman, L., Plate, S., Cola, M., Pandey, J., Brodkin, E. S., Schultz, R. T., Tunç, B. (2018). Oral-Motor and Lexical Diversity During Naturalistic Conversations in Adults with Autism Spectrum Disorder. Proceedings of the Fifth Workshop on Computational Linguistics and Clinical Psychology: From Keyboard to Clinic, 147–157. https://doi.org/10.18653/v1/W18-0616
Phillips, J. M., Uljarević, M., Schuck, R. K., Schapp, S., Solomon, E. M., Salzman, E., et al. (2019). Development of the Stanford Social Dimensions Scale: initial validation in autism spectrum disorder and in neurotypicals. Molecular autism, 10(1), 1–16.
Płatos, M., & Wojaczek, K. (2018). Broadening the scope of peer-mediated intervention for individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 48(3), 747–750. https://doi.org/10.1007/s10803-017-3429-1.
Ratto, A. B., Turner-Brown, L., Rupp, B. M., Mesibov, G. B., & Penn, D. L. (2011). Development of the contextual assessment of social skills (cass): A role play measure of social skill for individuals with high-functioning autism. Journal of Autism and Developmental Disorders, 41(9), 1277–1286. https://doi.org/10.1007/s10803-010-1147-z.
Russell, G., Mandy, W., Elliott, D., White, R., Pittwood, T., & Ford, T. (2019). Selection bias on intellectual ability in autism research: A cross-sectional review and meta-analysis. Molecular Autism, 10(1), 9. https://doi.org/10.1186/s13229-019-0260-x.
Ryan, G., Brady, S., Holloway, J., & Lydon, H. (2019). Increasing appropriate conversation skills using a behavioral skills training package for adults with intellectual disability and autism spectrum disorder. Journal of Intellectual Disabilities, 23(4), 567–580. https://doi.org/10.1177/1744629517750744.
Schalock, R. L., Brown, I., Brown, R., Cummins, R. A., Felce, D., Matikka, L., et al. (2002). Conceptualization, measurement, and application of quality of life for persons with intellectual disabilities: Report of an international panel of experts. Mental Retardation, 40(6), 457–470. https://doi.org/10.1352/0047-6765(2002)040<0457:CMAAOQ>2.0.CO;2.
Sharda, M., Tuerk, C., Chowdhury, R., Jamey, K., Foster, N., Custo-Blanch, M., et al. (2018). Music improves social communication and auditory–motor connectivity in children with autism. Translational Psychiatry, 8(1), 1–13. https://doi.org/10.1038/s41398-018-0287-3.
Shattuck, P. T., Narendorf, S. C., Cooper, B., Sterzing, P. R., Wagner, M., & Taylor, J. L. (2012). Postsecondary Education and Employment Among Youth With an Autism Spectrum Disorder. Pediatrics, 129(6), 1042–1049. https://doi.org/10.1542/peds.2011-2864.
Siaperas, P., & Beadle-Brown, J. (2006). A case study of the use of a structured teaching approach in adults with autism in a residential home in Greece. Autism, 10(4), 330–343. https://doi.org/10.1177/1362361306064433.
Siegel, M. (2018). The severe end of the spectrum: Insights and opportunities from the autism inpatient collection (AIC). Journal of Autism and Developmental Disorders, 48(11), 3641–3646. https://doi.org/10.1007/s10803-018-3731-6.
Sparrow, S. S., Cicchetti, D. V., Saulnier, C. A. (2016). Vineland Adaptive Behavior Scales-Third Edition (Vineland-3).
Spriggs, A. D., Knight, V., & Sherrow, L. (2015). Talking picture schedules: Embedding video models into visual activity schedules to increase independence for students with ASD. Journal of Autism and Developmental Disorders, 45(12), 3846–3861. https://doi.org/10.1007/s10803-014-2315-3.
Stauch, T. A., Plavnick, J. B., Sankar, S., & Gallagher, A. C. (2018). Teaching social perception skills to adolescents with autism and intellectual disabilities using video-based group instruction. Journal of Applied Behavior Analysis, 51(3), 647–666. https://doi.org/10.1002/jaba.473.
Stedman, A., Taylor, B., Erard, M., Peura, C., & Siegel, M. (2019). Are children severely affected by autism spectrum disorder underrepresented in treatment studies? An analysis of the literature. Journal of Autism and Developmental Disorders, 49(4), 1378–1390. https://doi.org/10.1007/s10803-018-3844-y.
Taylor, J. L., Henninger, N. A., & Mailick, M. R. (2015). Longitudinal patterns of employment and postsecondary education for adults with autism and average-range IQ. Autism, 19(7), 785–793. https://doi.org/10.1177/1362361315585643.
Team, D. (2014). Datavyu: A video coding tool. Databrary Project, New York University. http://datavyu.org.
Thompson, C., McDonald, J., Kidd, T., Falkmer, T., Bölte, S., Girdler, S. (2020). “I don’t want to be a patient”: Peer mentoring partnership fosters communication for autistic university students. Scandinavian Journal of Occupational Therapy, 1–16.
Totsika, V., Felce, D., Kerr, M., & Hastings, R. P. (2010). Behavior problems, psychiatric symptoms, and quality of life for older adults with intellectual disability with and without autism. Journal of Autism and Developmental Disorders, 40(10), 1171–1178. https://doi.org/10.1007/s10803-010-0975-1.
Vernon, T. W., Holden, A. N., Barrett, A. C., Bradshaw, J., Ko, J. A., McGarry, E. S., et al. (2019). A pilot randomized clinical trial of an enhanced pivotal response treatment approach for young children with autism: The PRISM model. Journal of Autism and Developmental Disorders, 49(6), 2358–2373. https://doi.org/10.1007/s10803-019-03909-1.
Vernon, T. W., Miller, A. R., Ko, J. A., Barrett, A. C., & McGarry, E. S. (2018). A randomized controlled trial of the social tools and rules for teens (START) program: An immersive socialization intervention for adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(3), 892–904. https://doi.org/10.1007/s10803-017-3380-1.
Walsh, E., Holloway, J., & Lydon, H. (2018). An evaluation of a social skills intervention for adults with autism spectrum disorder and intellectual disabilities preparing for employment in ireland: A pilot study. Journal of Autism and Developmental Disorders, 48(5), 1727–1741. https://doi.org/10.1007/s10803-017-3441-5.
Walsh, E., Holloway, J., Lydon, H., McGrath, A., & Cunningham, T. (2019). An exploration of the performance and generalization outcomes of a social skills intervention for adults with autism and intellectual disabilities. Advances in Neurodevelopmental Disorders, 3(4), 372–385. https://doi.org/10.1007/s41252-019-00125-x.
Walton, K. M., & Ingersoll, B. R. (2013). Improving social skills in adolescents and adults with autism and severe to profound intellectual disability: A review of the literature. Journal of Autism and Developmental Disorders, 43(3), 594–615. https://doi.org/10.1007/s10803-012-1601-1.
Williams, K. T., Williams, K. T. (2007). EVT-2: Expressive vocabulary test. Pearson.
Acknowledgements
The authors would like to acknowledge our dedicated team of behavior coders and peer facilitators who made this research possible. We are also grateful for the commitment and input from our participating families.
Funding
University of California Santa Barbara, Academic Senate Grant (PI: Vernon).
Author information
Authors and Affiliations
Contributions
Author Contributions
EF conceived of the study along with TV, facilitated its design and coordination, collected the data, performed the statistical analysis, interpreted the data, and drafted the manuscript. KD contributed to study design and coordination, data collection, and manuscript development. JL assisted with writing scripts perform reliability checks, creating variables for behaviorally-coded data, and analyzing the data. KH contributed to the development of behavior-coding schemes, developing a coding manual, and training new coders. HF assisted with the development of behavior-coding procedures, data interpretation, and the preparation of figures for the manuscript. AM participated in study design, coordination, and data collection. TV participated in the design and coordination of the study, collected data, assisted with interpretation of the data, and revised the manuscript critically. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Consent to Participate
Informed consent was obtained from legal guardians and assent was obtained from all adults included in the study.
Consent to Publish
Participants signed informed consent regarding publishing their data.
Ethics Approval
Approval was obtained from the ethics committee of University of California, Santa Barbara. The authors certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ferguson, E.F., Drapalik, K.N., Liang, J. et al. Social Interaction Skill Intervention for Autistic Adults with Intellectual Disability and Limited Language: A Pilot of the SKILL Program. J Autism Dev Disord 51, 1641–1657 (2021). https://doi.org/10.1007/s10803-020-04659-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10803-020-04659-1