Using Single–Subject Design and Goal Attainment Scaling to Measure Improvement in Social Participation in Children With Autism Spectrum Disorder

PURPOSE: Deficits in social participation and sensory processing are limiting factors in functional performance of children with autism spectrum disorder (ASD). Both sensory integration and group social skills instruction have been shown to be effective intervention strategies for children with ASD, but limited research is available that shows the effectiveness of pairing these interventions to improve social participation. The research question for this study was, Is the pairing of sensory–based activities with group social skills instruction effective in improving social participation in children with ASD?

METHOD: This study used an AB single–subject design and goal attainment scaling (GAS). Participants were recruited through posted advertisements. Exclusion criteria were other neurological, genetic, or severe behavior disorder and severe visual or hearing impairment. Interested caregivers completed a screening questionnaire and interview with the lead researcher. Participants were five children aged 6–12 with a physician diagnosis of ASD. Informed consent and child assent were obtained.

A semistructured interview with the lead researcher and caregiver was completed along with three assessments. Deficits in sensory processing were assessed using the Sensory Processing Measure, deficits in social participation were assessed using the Social Responsiveness Scale, and ASD symptoms were assessed using the Gilliam Autism Rating Scale. Target goal areas were identified with caregivers on the basis of the areas assessed on the Social Skills Rating Form (SSRF): initiating behaviors, responding behaviors, self–regulation, emotional regulation, and peer interaction. The lead researcher used the GAS 5–point rating system to write three goals per child. At final sessions, an independent evaluator assigned a GAS score for each goal. Researchers tracked each participant’s daily social participation status via the SSRF.

Final GAS scores were calculated for each participant, and an average scaled score was derived. The SSRF results were plotted on a visual graph with a celeration line. Split middle line test was used to determine statistical significance.

RESULTS: GAS results indicate that three of the five participants achieved the expected level of progress toward goal attainment, with one participant achieving much more than expected progress. The other two participants progressed less than expected. Visual analysis revealed that four of the five participants displayed accelerating trends for their data. Using a celeration line and the split middle line test of statistical significance, it was determined that three participants showed significant changes.

CONCLUSION: GAS results from the three participants reaching at least the expected level of progress support the hypothesis that pairing sensory–based activities with group–based social skills training is an effective method to enhance the social participation of children with ASD. The lack of improvement in the other two participants may be explained by confounding variables. The visual results indicated that the SSRF was indeed able to track improvement in social participation, making it an effective tool to use in single–subject design studies. These findings help support the use of sensory–based activities to enhance the learning of social skills.

IMPACT STATEMENT: This research can influence the approach occupational therapy practitioners use to address occupational performance in social participation. The results allow practitioners to better understand the link between sensory components and the ability to be alert and focused to learn social skills in children with ASD. Social skills is a category in all tiers of the American Occupational Therapy Association’s table of research priorities in mental health for children and youth and is an area in need of further research.

References

Kiresuk, T. J., Smith, A., & Cardillo, J. E. (1994). Goal attainment scaling: Applications, theory, and measurement. Hillsdale, NJ: Erlbaum.

Schaaf, R. C., Hunt, J., & Benevides, T. (2012). Occupational therapy using sensory integration to improve participation of a child with autism: A case report. American Journal of Occupational Therapy, 66, 547–555. https://doi.org/10.5014/ajot.2012.004473

Tanner, K., Hand, B. N., O’Toole, G., & Lane, A. E. (2015). Effectiveness of interventions to improve social participation, play, leisure, and restricted and repetitive behaviors in people with autism spectrum disorder: A systematic review. American Journal of Occupational Therapy, 69, 6905180010. https://doi.org/10.5014/ajot.2015.017806