Intervention Summary

Social Skills Group Intervention--High Functioning Autism (S.S.GRIN-HFA)

Social Skills Group Intervention--High Functioning Autism (S.S.GRIN-HFA) is designed to improve social behaviors in children with high functioning autism spectrum disorders (HFASDs) by building basic behavioral and cognitive social skills, reinforcing prosocial attitudes and behaviors, and building adaptive coping strategies for social problems, such as teasing or isolation. The intervention is designed for children in grades 3-5 (ages 8-12) who have a diagnosis of HFA, Asperger's disorder, or pervasive developmental disorder-not otherwise specified and who are experiencing peer difficulties, such as having immature social skills relative to peers, including impulse control problems; having few, if any, close friends and/or being rejected and teased by peers; and being socially anxious and awkward with peers. S.S.GRIN-HFA primarily reflects social learning and cognitive behavioral theoretical perspectives.

Mental health professionals (i.e., school counselors, psychologists, social workers) use highly detailed session scripts to implement S.S.GRIN-HFA as a 15-week curriculum (one 60-minute session per week). The sessions, which are presented through a combination of didactic instruction and role-playing, modeling, and hands-on activities, are organized into three modules, which cover the following topics: (1) communication, including verbal and nonverbal communication and listening skills; (2) working with others, including understanding the consequences of actions, taking other perspectives, cooperating, and compromising; and (3) friendship skills, including making and keeping friends, solving social problems, and coping with bullying and teasing. Parents participate in selected sessions of S.S.GRIN-HFA, receive weekly handouts, and are involved in community exercises. By supporting and reinforcing positive changes, enhancing communication, and modeling positive attitudes toward treatment, parents can enhance treatment efficacy.

In the study reviewed for this summary, the population of children was made up almost entirely of boys. Other S.S.GRIN programs have been developed for use with children in other age groups, and S.S.GRIN-HFA was adapted from S.S.GRIN 3-5, a program for children in grades 3-5 who are highly disliked by peers, bullied or victimized by peers, and/or highly socially anxious. S.S.GRIN 3-5 was reviewed separately by NREPP.

Descriptive Information

Areas of Interest	Mental health promotion Mental health treatment
Outcomes	1: Children's social skills 2: Parent's perceived self-efficacy for helping her or his child
Outcome Categories	Family/relationships Social functioning
Ages	6-12 (Childhood) 26-55 (Adult)
Genders	Male Female
Races/Ethnicities	American Indian or Alaska Native Asian Black or African American White
Settings	Outpatient
Geographic Locations	Suburban
Implementation History	S.S.GRIN-HFA has been implemented in an estimated 80 sites across 13 States (California, Connecticut, Florida, Georgia, Illinois, Indiana, Massachusetts, Minnesota, North Carolina, Oregon, Pennsylvania, Tennessee, and Texas) and the District of Columbia. an estimated 1,500 children with HFA have participated in S.S.GRIN-HFA. Outside the United States, S.S.GRIN-HFA has been implemented in Australia, Canada, the Cayman Islands, England, Greece, and the United Arab Emirates.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: Yes
Adaptations	No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	Indicated

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

DeRosier, M. E., Swick, D. C., Davis, N. O., McMillen, J. S., & Matthews, R. The efficacy of a social skills group intervention for improving social behaviors in children with high functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 41(8), 1033-1043.

SELmedia. Final report: Adapting evidence-based social skills training for high-functioning autism. Cary, NC: Author.

Supplementary Materials

Constantino, J. N., & Gruber, C. P. Psychometric properties and validation studies. In Social Responsiveness Scale (SRS) manual (pp. 31-40). Torrance, CA: Western Psychological Services.

Ollendick, T. H., & Schmidt, C. R.. Social learning constructs in the prediction of peer interaction. Journal of Clinical Child Psychology, 16(1), 80-87.

Validity information on the Self-Efficacy Scale, the Social Responsiveness Scale, and the Achieved Learning Questionnaire

Outcomes

Outcome 1: Children's social skills
Description of Measures	Children's social skills were assessed using two measures: Social Responsiveness Scale (SRS). The 65-item SRS is a parent-report measure that assesses children's social skill level in five domains: Social Awareness, Social Cognition, Social Communication, Social Motivation, and Autistic Mannerisms. Using a 4-point scale ranging from "not true" to "almost always true," the parent rates her or his child's social skill level for each item. Achieved Learning Questionnaire (ALQ). The ALQ is a parent-report measure that assesses children's attainment of social skills learned through S.S.GRIN-HFA. The measure includes 21 items that describe specific age-appropriate social skills (e.g., "takes turns listening and talking in a conversation," "takes initiative to invite others to play or work with him or her"). Using a 5-point Likert scale ranging from 0 (extremely poor) to 4 (excellent), the parent rates her or his child's ability to perform each skill over the past month.
Key Findings	A study was conducted with parent-child dyads. Each child had a prior diagnosis of an HFASD and ranged in age from 8 to 12. Participants were randomly assigned to the treatment group, which received S.S.GRIN-HFA, or the comparison group, which received S.S.GRIN, an intervention developed for children experiencing rejection or bullying at school. Assessments were completed 2 weeks before the intervention (pretest) and within 2 weeks after the intervention (posttest). Results indicated the following: From pre- to posttest, children in the treatment group had an improvement in social skills, as measured by the SRS, whereas children in the comparison group had a decline (p < .05). Specifically, children in the treatment group had an improvement in four of the five SRS domains: Social Awareness (p < .05), Social Communication (p < .01), Social Motivation (p < .05), and Autistic Mannerisms (p < .05). From pre- to posttest, children in the treatment group had an improvement in social skills, as measured by the ALQ, whereas children in the comparison group had a decline (p < .05).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	3.0 (0.0-4.0 scale)

Outcome 2: Parent's perceived self-efficacy for helping her or his child
Description of Measures	Parent's perceived self-efficacy for helping her or his child was assessed using the parent version of the Self-Efficacy Scale. The 10-item scale is a self-report measure that assesses the parent's perceived self-efficacy for helping her or his child with social tasks. Using a 5-point Likert scale ranging from 1 (not sure at all) to 5 (really sure), the parent rates each item to indicate "how sure they are they could help their child perform the task" and "how sure they are that their help would foster a successful outcome for their child."
Key Findings	A study was conducted with parent-child dyads. Each child had a prior diagnosis of an HFASD and ranged in age from 8 to 12. Participants were randomly assigned to the treatment group, which received S.S.GRIN-HFA, or the comparison group, which received S.S.GRIN, an intervention developed for children experiencing rejection or bullying at school. Assessments were completed 2 weeks before the intervention (pretest) and within 2 weeks after the intervention (posttest). Results indicated that from pre- to posttest, parents who participated in S.S.GRIN-HFA had greater perceived self-efficacy for helping their child with social problems, whereas parents in the comparison group had a decline (p < .05).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	3.0 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	6-12 (Childhood) 26-55 (Adult)	98.2% Male 1.8% Female	92.7% White 3.6% Asian 1.8% American Indian or Alaska Native 1.8% Black or African American

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Children's social skills	3.3	3.3	2.5	2.3	3.3	3.8	3.0
2: Parent's perceived self-efficacy for helping her or his child	3.3	3.0	2.5	2.3	3.3	3.8	3.0

Study Strengths

The study used measures that are well established and have good psychometric properties. Cronbach's alpha values for the measures were reported and were at acceptable levels. Information on the face, discriminant, and concurrent validity of the measures also was documented. Potential confounding variables appear to be generally well controlled for (e.g., group difference at baseline). The study used appropriate statistical analyses to address confounding variables and to infer relationships between the intervention and outcomes.

Study Weaknesses

Intervention fidelity was not reviewed by independent investigators; rather it was assessed by the group leaders and coleaders, who provided their opinion regarding their adherence to the treatment manual. A tested fidelity instrument was not included. There was a difference in participant attrition between the treatment group and the comparison group (6% vs. 0%). The treatment group also had a lower mean percentage of sessions completed relative to the comparison group (i.e., 89% vs. 96%). The small sample size, along with the differences in attrition between study groups, raises concerns regarding potential confounds.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

3-C Institute for Social Development. Child workbook: Research-based information and activities for children. Cary, NC: SELmedia.

3-C Institute for Social Development. S.S.GRIN-HFA professional manual: Group exercises for enhancing children's communication, cooperation, and confidence (2nd ed.). Cary, NC: SELmedia.

3-C Institute for Social Development. The S.S.GRIN crew: Comic book. Cary, NC: SELmedia.

Additional program materials:

Activity cards
Animated video series [DVD]
Parent handouts
Rules poster
Visual schedule cards

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
3.3	2.9	2.8	3.0

Dissemination Strengths

The manual for professionals is well organized and easy to read, and it includes lessons with a variety of activities for the children as well as guidance on working with the children's families. The sessions are highly scripted, but the developer encourages implementers to use their knowledge and experience to adapt the materials to the children in the group. The online training, which follows the sequence of the manual, is well designed and offers continuing education credits. There are tools for self-assessment during the training to aid the participant in the final test at the completion of the training. A fidelity checklist, which mirrors session guidelines, is provided to support adherence to the model. The developer encourages the use of quality assurance tools as a part of program implementation.

Dissemination Weaknesses

The audio on the DVD was not always clear, which raises concerns that children with auditory processing challenges might have difficulty understanding what the characters are saying. Training is not required, even though the population for which the program is intended is unique in ways that necessitate specialized training. Sections of the audio track of the online training, particularly the portions when the trainer is speaking, are unclear, and some text subtitles are not timed to match correctly with the video. Although a fidelity checklist is available, there is no standardized protocol or developer support resource to assist implementers in ensuring fidelity to the model.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
S.S.GRIN-HFA Kit (includes professional manual, animated video series [DVD], 10 child workbooks, 10 comic books, rules poster, set of activity cards, visual schedule and cards, and parent handouts)	$265 per electronic copy downloaded from the program Web site; $795 per hard copy	Yes
Online subscription (includes online training)	1- or 3-year subscription is included in the cost of the electronic or hard-copy kit, respectively; $95 for each yearly renewal	No
1-day, on-site training	$2,500 for up to 25 participants, plus travel expenses	No
Phone and email support	Included in the cost of the kit	No
Fidelity checklists for each session and pre- and posttest assessments	Included in the cost of the kit	No