Effectiveness of Sensory and Social Group Interventions to Improve the Participation of Children With Autism Spectrum Disorder via Goal Attainment Scaling

PURPOSE: Children clinically diagnosed with autism spectrum disorder (ASD) experience “persistent deficits in social communication and social interaction across multiple contexts” (American Psychiatric Association, 2013, p. 27). Occupational therapists (OTs) are currently searching for effective interventions to improve social participation in children with autism through evidence-based research. Sensory integration (SI) activities and social skills training have been used as independent variables to determine the effects on social behaviors in children with ASD (Koegel, Vernon, & Koegel, 2009; Schaaf et al., 2015). However, few programs aim to integrate both social skills and SI to promote awareness, self-regulation, and social competence.

ASD includes a broad spectrum of symptoms and characteristics that are expressed differently by each child; therefore, a measure that is sensitive to such differences should be used. Pfeiffer, Koenig, Kinnealey, Sheppard, and Henderson (2011) found that compared with other commonly used assessments, goal attainment scaling (GAS) was able to detect minute and individualized changes in these children and provided a more client-centered approach (Schaaf et al., 2015). This study looked at the effectiveness of combining social skills training and SI simultaneously during intervention through the individualized measure of goal attainment scaling.

DESIGN: A quasi-experimental, single-subject AB design was used. Data were collected through 16 OT group treatment sessions over a 4-wk period. Six children were selected via convenience sampling to participate following an interview. The inclusion criteria were diagnosis of ASD, age 6–12 yr, and sensory processing and social deficits. Exclusion criteria included secondary diagnoses of cerebral palsy, other neurological or genetic disorder, severe visual or hearing impairment, history of severe behavioral disorder, and aggressive behaviors. The severity of ASD of each participant ranged from Level 2 to 3 according to the Gilliam Autism Rating Scale, third edition (GARS–3), and all participants were male. The Sensory Processing Measure and the Social Responsiveness Scale were completed by the parent to identify areas of sensory and social deficits. The GARS–3 was completed to determine the level of severity of ASD. The Social Skills Rating Form (SSRF) was completed for each child at each session. The SSRF was developed by the lead researcher to document daily observable behaviors based on the social participation principles of initiating and responding behaviors, emotional regulation, temperament, and peer interactions (Kramer & Hinojosa, 2010).

Based on the pretest measures and an interview with parents, goals were set for the child to be used in a goal attainment scaling process. An independent evaluator completed assessment of the goals during the final session. Data analysis of the GAS scores included computation of the raw GAS score for each individual, sum of the differences between initial level and level attained, and mean of the raw scores by level of ASD. The means of the data sets were determined per the DSM (American Psychiatric Association, 2013) levels of ASD severity, as indicated by the GARS–3. Daily summary scores from the SSRF were plotted to create trend line graphs for visual analysis.

RESULTS: The mean GAS raw score for Level 2 participants was 4.75 and for Level 3 participants was 4.00. Since the average scaled scores indicate the child’s attainment level, it was determined that the group of participants with Level 2 ASD severity increased an average of 1.58 and the group with Level 3 severity increased an average of 1.33 in the scaled goals. The visual graph of each participant’s scores on the SSRF indicates an upward trend line from baseline through the intervention phase. Use of the individualized measure of the GAS indicated that all participants achieved their expected levels, at a minimum of at least 1.0 attainment level. Results of the daily data tracking of social behaviors via the SSRF also indicated consistent improvement in social skills for participants at both levels of ASD.

CONCLUSION: Based on these results, implementing both SI and social skills training simultaneously in a group setting can improve the social behaviors of children with ASD. This evidence provides insight for OTs working on the social behaviors of clients with ASD and also indicates how goal attainment scaling can determine subtle changes in participants. Using this tool in practice can help OTs provide more client-centered therapy while assessing changes in behavior in members of the ASD population.

References

American Psychiatric Association. (2013). Desk reference to the diagnostic criteria from DSM. Arlington, VA: American Psychiatric Association.

Koegel, R., Vernon, T., & Koegel, L. (2009). Improving social initiations in young children with autism using reinforcers with embedded social interactions. Journal of Autism and Developmental Disorders, 39, 1240–1251. https://doi.org/10.1007/s1080300907325

Kramer, P., & Hinojosa, J. (2010). Frames of reference for pediatric occupational therapy (3rd ed.). Baltimore: Lippincott.

Pfeiffer, B., Koenig, K., Kinnealey, M., Sheppard, M., & Henderson, L. (2011). Effectiveness of sensory integration interventions in children with autism spectrum disorders: A pilot study. American Journal of Occupational Therapy, 65, 76–85. https://doi.org/10.5014/ajot.2011.09205

Schaaf, R., Cohn, E. S., Burke, J., Dumont, R., Miller, A., & Mailloux, Z. (2015). Linking sensory factors to participation: Establishing intervention goals with parents for children with autism spectrum disorder. American Journal of Occupational Therapy, 69, 6905185005. https://doi.org/10.5014/ajot.2015.018036