Journal of Autism and Developmental Disorders, Vol. 30, No.

5, 2000

Interventions That Facilitate Socialization in Children

with Autism

Sally J. Rogers1

Social dysfunction is perhaps the most defining and handicapping feature of autism. Improved
social functioning has long been considered one of the most important intervention outcomes.
A variety of social interventions have been designed, empirically examined, and published in
the autism literature. Children with autism have been found to be responsive to a wide varie-
ty of interventions aimed at increasing their social engagement with others, both adults and
peers. Successful strategies employing peer-mediated approaches and peer tutoring have in-
volved typically developing peers. Furthermore, several studies have demonstrated that social
engagement directly affects other important behaviors like language, even when these be-
haviors are not specifically targeted by the teaching program. Thus, while an area of severe
involvement, social behavior is also responsive to intervention.

KEY WORDS: Social dysfunction; autism; social interventions.

INTRODUCTION of the acquisition of the behavior, maintenance of

Social dysfunction is the single most defining fea-
ture of autism (Kanner, 1943) and arguably its most
handicapping as well. From the beginning, improved
social functioning has been considered one of the most
important intervention outcomes. A variety of social
interventions have been designed, empirically exam-
ined, and published in the autism literature. These in-
terventions differ in a variety of ways: the age group
of the people with autism involved, the target behav-
ior of the intervention (initiation, response, mainte-
nance), the kind of social partner involved: peer or
adult, the intervention strategy used, and the charac-
teristics of the intervenor: adult or peer. Almost all of
the published interventions represent a behavioral
methodology, involving careful definition of the target
behaviors to be acquired, increased, or diminished, de-
finition of the antecedents and consequences of the
behavior, the use of task analysis, and measurement
1
University of Colorado Health Sciences Center, JFK Partners, 4200
East 9th Avenue, Campus Box C–234, Denver, Colorado 80262.
399
the behavior under more natural reinforcement condi-
tions, and generalization to other settings, persons, and
behaviors.
While earlier efforts in the field involved adult-
directed teaching, with demonstrated effectiveness, the
field has moved to more careful attention to the ecol-
ogy of children’s social interactions in natural settings,
with a concurrent shift to a greater focus on social
interactions with peers. As Simpson, Myles, Sasso, and
Kamps (1997) have pointed out, adult-directed instruc-
tion in social skills has not been grounded in natural
contexts and use of typical stimuli and reinforcers.
Many current approaches, such as incidental teaching
and various peer-mediated strategies, are built upon
careful prompting and shaping of child behaviors by
typical peers embedded in child-initiated interactions
within natural contexts. Peer interactions may take sev-
eral forms. Peers may be taught to initiate the interac-
tion, or they may be taught to respond to the child with
autism whose initiation is prompted by another person.
Finally, peers may be taught to be tutors for both school-
work and recreational activities.
0162/3257/00/1000-0399$18.00/0 © 2000 Plenum Publishing Corporation
400
This paper reviews some of the social interven-
tions with demonstrated empirical support that have
been described in peer-reviewed journals in order to
identify additional research needs and future directions.
This is not meant as an exhaustive review; rather, the
papers are representative of the peer-reviewed publi-
cations available in the literature, most of which in-
volve single-subject designs. The paper is organized
both by age group and by type of intervention used, be-
ginning with interventions to improve preschoolers’ so-
cial interactions with parents, other adults, and peers,
then moving to school-age children’s interactions with
adults and peers, and closing with three different in-
terventions to build adolescent interactions with peers.
INTERVENTIONS FOR FACILITATING
SOCIAL INTERACTIONS IN PRESCHOOLERS
Interventions That Enhance Parent–Preschooler
Interactions
Two published papers have focused on increasing
interactions of very young children with their parents.
Both of these studies involve noncontrolled group de-
signs without reversals or other methods that unequiv-
ocally demonstrate a causal relationship. Dawson and
Galpert (1990) described a pre–post study of 14 chil-
dren, ages 20 to 66 months, and their mothers. The in-
tervention involved teaching the parent to imitate the
child in play with toys for 20 minutes each day for
2 weeks. Follow-up after 2 weeks demonstrated sig-
nificant increases over baseline in increased gaze to
mother’s face, increased number of toys played with,
and increased number of play schemas used, as well as
generalization to novel toys. Rogers, Herbison, Lewis,
Pantone, and Reis (1986) used a similar pre–post de-
sign to assess changes in child behavior of 13 preschool-
ers following 6 or more months of intensive inter-
vention in a daily preschool program that heavily
emphasized positive adult–child interactions, play, and
communication. Several markers of significantly im-
proved social functioning were found, including im-
provements in the social-communicative play levels
with a familiar adult and increases in child positive af-
fect and social initiations and decreased negative re-
sponses to mother’s initiations during mother–child
play. Maternal behavior was stable across the two sam-
ples; thus changes in child behavior did not appear due
to changes in maternal behaviors, but rather represented
generalization of effects from the day program. Im-
provement in social interactions was demonstrated
across three separate measures and with various part-
Rogers
ners, adding convergent validity to the impact of this
model on social development of young children with
autism.
Interventions That Enhance Preschoolers’
Interactions with Other Adults
Two approaches for increasing interactions with
teachers or other therapists have been demonstrated
using multiple baseline approaches. One approach,
coming from the work of Schreibman using pivotal re-
sponse training (PRT), was described in several publi-
cations by Stahmer, Schreibman, and colleagues. In
pivotal response training, certain behaviors are seen as
central to wide areas of functioning. Changing pivotal
behaviors is thought to affect change in other associ-
ated behaviors without specifically targeting them.
Stahmer (1995) compared two interventions—symbolic
play training and language training—using pivotal re-
sponse techniques, including child choice and rein-
forcing attempts, among others, with seven preschool-
aged children with autism who had some verbal skills.
In addition to demonstrating increases in the targeted
symbolic play skills, the children demonstrated in-
creased positive responses to adult initiations and
smaller increases in initiations to adults in the play
training, but not the language training, intervention.
These results were maintained for 3 months after the end
of treatment and generalized over settings and other
adults, but not peers.
Krantz and McClannahan (1998) used a visual
cuing system involving a script-fading procedure to in-
crease social initiations to a teacher. The technique, pre-
viously found to be effective with older children, in-
volved using a one-word stimulus embedded in a child’s
independent play schedule. The stimulus prompted the
child to approach an adult and initiate a joint attention
request (look, watch me, etc.), to which the adult res-
ponded with various comments about the child’s be-
havior, but without any other reinforcing consequence.
Over time the script was faded. Three preschoolers with
some language learned the procedure, maintained and
increased initiations even after the stimuli were faded,
and demonstrated generalization by using unscripted
and elaborated initiations and by generalizing across
new adults and new activities. One important aspect of
this technique for eliciting social initiations deserves
highlighting. By using a visual cue, potential difficul-
ties seen in adult prompting paradigms (disruptions in
ongoing social interactions, constant presence of cuing
adult, difficulties with fading adult prompts; Oke &
Schreibman, 1990) were avoided.