Profound impairment in social interaction is a hallmark of autism spectrum disorders (ASD). Although improvement in social functioning is widely considered to be a crucial target for intervention, social skills treatments for school-age children have been the subject of few controlled investigations. The available literature suggests that cognitive behavioral (CBT) techniques are commonly used and may improve targeted social skills in the short term in individuals with ASD. However, drawing firm conclusions about the efficacy of CBT social skills training remains difficult, particularly with respect to maintenance of skills and generalization to natural settings, owing to methodological limitations of extant studies (e.g., lack of random assignment to groups, small sample size, lack of manual-based curricula, minimal assessment of generalization or maintenance). Several neuroimaging studies have found that individuals with ASD underactivate key brain regions involved in social cognition. However, there is also evidence to suggest that activity in normative neural networks can be increased significantly by providing high-functioning children with ASD with explicit instructions to pay attention to important social cues, such as a speaker's facial expression and tone of voice. This suggests that a cognitive behavioral approach to social skills treatment may increase social responsiveness at both the behavioral and neural levels. The purpose of this investigation is to examine the acute and sustained effects of a CBT-based social skills treatment on social cognition and the neural architecture that supports it. High-functioning children with ASD (8-11 years old) will be randomly assigned to a 12-week cognitive behavioral social skills group or a social play comparison group to control for non-specific therapeutic effects. Functional MRI scans as well as behavioral assessments of social cognition, adaptive functioning, and symptom severity will be acquired at baseline, immediately following treatment, and at a 3- month follow-up. We hypothesize that children in the CBT group will show greater improvement in social functioning and increased activation of key brain regions, relative to children in the social play comparison group, both post-treatment and at follow-up. This study aims to address some of the earlier methodological limitations to provide much needed information about the short-term efficacy and durability of a CBT approach to social skills treatment, as well as the neural events that accompany and/or predict response to treatment.

Public Health Relevance

Cognitive behavioral therapy (CBT) social skills groups are commonly used with high functioning children with ASDs;however, the efficacy and durability of these treatments are unknown. With the economic burden of ASD estimated in the range of $30 billion annually in the U.S alone, evaluation of efficacious treatments targeting core deficits in social skills is imperative. Toward this effort, the proposed study is a randomized controlled investigation designed to evaluate short-term effects and maintenance of skills taught in CBT-based social skills groups, at both the behavioral and neural levels.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZMH1-ERB-B (A1))
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Gilotty, Lisa
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Icahn School of Medicine at Mount Sinai
Schools of Medicine
New York
United States
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Soorya, Latha V; Siper, Paige M; Beck, Todd et al. (2015) Randomized comparative trial of a social cognitive skills group for children with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry 54:208-216.e1