Research in Developmental Disabilities 28 (2007) 423–436

Peer-mediated social skills training program for

young children with high-functioning autism
Kyong-Mee Chung a,*, Shaye Reavis b, Matt Mosconi b,
Josiah Drewry b, Todd Matthews b, Marc J. Tassé c
a
Department of Psychology, College of Arts and Science, Yonsei University,
134 Shinchon-dong, Seodaemoon-ku, Seoul, South Korea 120-749
b
Department of Psychology, University of North Carolina at Chapel Hill, USA
c
Center for Development and Learning, University of North Carolina at Chapel Hill, USA
Received 17 April 2006; received in revised form 12 May 2006; accepted 22 May 2006

Abstract
One of the most prevailing characteristics of children with autism is their deficit in social communication
skills. The purpose of this study was to evaluate the effectiveness of a peer-mediated social skills training
(SST) program combined with video feedback, positive reinforcement and token system in increasing social
communication skills in young children with high-functioning autism. Four boys with high-functioning
autism, ages 6–7 years, participated in the study. The social skills training, lasting 12 weeks, targeted six
communication skills, selected after parent interviews and behavioral observation during a pre-training
assessment period. One SST session was conducted each week, each session lasted 90 min and had six
structured activities. The training effectiveness was evaluated through direct observation of a structured
interaction period, using an observational coding system. Improvement was observed in three out of four
children, although individual differences among children were seen for changes in two global scales as well
as subscales. These results suggest that the social skills training was effective in improving social
communication skills for some children with high-functioning autism. Clinical and research implications
and future directions for social skills training as well as this study’s limitations are discussed.
# 2006 Elsevier Ltd. All rights reserved.

Keywords: Social skills training; High-functioning autism; Video feedback; Peer-mediated; Social communication

Autism is a neurodevelopmental disorder characterized by deficits in communication and

social relatedness and a restricted repertoire of activities and interests (American Psychological
Association, 1994). Although individuals with autism vary in the degree to which they are

* Corresponding author. Tel.: +82 2 2123 2448(O); fax: +82 2 365 4354.
E-mail address: kmchung@yonsei.ac.kr (K.M. Chung).

0891-4222/$ – see front matter # 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ridd.2006.05.002
424 K.-M. Chung et al. / Research in Developmental Disabilities 28 (2007) 423–436

impaired on each of these dimensions, the social problems of autism are undoubtedly the most
troubling, pervasive, and difficult (Kanner, 1943). Previous research has documented that mere
exposure to peers and social interaction settings is not sufficient to help children with autism to
develop age-appropriate social skills (Elliot & Gresham, 1993; Hauck, Fein, Waterhouse, &
Feinsten, 1995; Pollard, 1998; Strain & Kohler, 1995). As a result, numerous researchers have
attempted to develop empirically supported social skills interventions for people with autism
(e.g., Koegel, Koegel, Harrower, Carter, & Marie, 1999; McGee, Morrier, & Daly, 1999; Odom &
Strain, 1986). Data obtained from these interventions suggest that children with autism may show
significant improvements when trained facilitators implement a highly structured training
strategy with systematic procedures (Kohler et al., 1995; Odom & Watts, 1991; Shabani et al.,
2002; Thiemann & Goldstein, 2001).
The literature regarding social skills training for children with autism also indicates that
several factors must be considered when designing an effective program. First, consideration of
individual characteristics, including the child’s age, cognitive level, behavior problems, and pre-
treatment social interaction skills, is crucial for all social skills training programs, but particularly
for those targeting children with autism (Elliot & Gresham, 1993; LaGreca, 1993; Taylor, 2001).
Second, social skill interventions should consider the most suitable behavior management system
to promote each child’s independence and increase the likelihood that he or she will generalize
acquired skills over time and across settings (Koegel & Koegel, 1995; Kohler et al., 1995; Strain
& Kohler, 1999; Taylor, 2001; Weiss & Harris, 2001). Third, the relationship of the person
administering the treatment to the target child is a critical factor. Although many traditional
teaching strategies for people with autism have been implemented by teachers and other
professionals, several more recent programs have also included typically developing peers to
assist in the intervention. Fourth, the teaching modality of social skills training has also been
shown to be a critical factor. Children with autism demonstrate difficulty with communication
and comprehending verbal instruction, and they appear to benefit from visual cues. Several
studies have indicated that social skills training with visual aids, such as social stories, picture
cards, video modeling and video feedback, may result in increased understanding and
generalization of targeted skills for children with autism (Charlop-Christy, Le, & Freeman, 2000;
Krantz & McClannahan, 1998; Thiemann & Goldstein, 2001; Wert & Neisworth, 2003).
Thiemann and Goldstein (2001) considered each of these factors when they designed a social
skills training program for five children with autism between ages 6 and 12 years. The authors
reported that social stories and video feedback combined with a peer-mediated strategy were
effective tools for teaching social and communication skills. Each participant in their study
showed an increase in appropriate communication (e.g., making comments, staying on topic)
while showing a decrease in inappropriate social behaviors (e.g., changing topics and not
responding). Children improved on non-targeted social skills and were able to generalize these
skills to their respective classrooms.
The purpose of this study was to examine the effectiveness of a modified version of the social
skills program developed by Thiemann and Goldstein (2001) to train communication skills in
children with autism spectrum disorder. The current program differed from Thiemann and
Goldstein’s program in the following ways: (1) this study involved homogeneous participants in
terms of level of functioning and chronological age; (2) the target skills involved exclusively
verbal communication skills; (3) the training program was slightly shorter in duration (12 weeks
instead of 15 weeks); (4) training was conducted in a large conference room; (5) social stories
were not included as a treatment component. These variations were made to examine whether a
shorter and less intensive social skills training was effective in increasing appropriate
 K.-M. Chung et al. / Research in Developmental Disabilities 28 (2007) 423–436 425

communications skills for children with similar social skills deficit. The second purpose of this
study was to develop a manual for the social skills training program to facilitate future research
and ease of dissemination.

1. Methods

1.1. Subjects

Four children with autism spectrum disorders (ASD) were recruited using community
advertisements in local service agencies, including NC mental health and the UNC-based autism
program, Division Treatment and Education of Autistic and Communication-Handicapped
Children (TEACCH). Children were selected if they met the following criteria: (a) were between
the ages of 6 and 7 years; (b) met criteria for the DSM-IV diagnosis of ASD; (c) did not meet
criteria for mental retardation; (4) were able to engage in at least two turns of back and forth
verbal communication with basic listening skills. Four children were recruited to participate in
the intervention program. All four were boys and ranged in age at the program’s start from 6
years, 8 months to 7 years, 7 months. The following provides a description of each child.1

1.1.1. Michael
Michael was 6 years, 8 months at the beginning of the intervention and was diagnosed with
autism. He was receiving special education services. Michael struggled with anxiety reactions and
frustration, particularly around transitions. Michael’s strengths included his ability to learn new
concepts quickly and his visual–perceptual skills. Michael was able to engage in conversation with
adults for at least two turns back and forth but demonstrated difficulty staying on topic.

1.1.2. Steven
Steven was 7 years, 1 month at the beginning of the intervention and was diagnosed with
autism spectrum disorder. Steven attended a self-contained autistic classroom but also spend time
in a mainstreamed kindergarten setting. Because his speech was quiet and slow and he often
mumbled, Steven required frequent prompts during conversation, especially with peers. In
addition, he had difficulty staying on topic and perseverated on certain topics.

1.1.3. Joshua
Joshua was 7 years, 7 months at the start of the intervention and was diagnosed with pervasive
developmental disorder-NOS. He received special education services. Joshua’s weaknesses were
in speech and language, but his strengths included reading, writing, and general academic ability.
Joshua’s speech was loud and monotonous. He did not have a problem initiating conversation
with others but had difficulty carrying on conversation more than two turns, mainly due to his
perseveration on certain issues and topics.

1.1.4. Richard
Richard was 6 years, 11 months at the start of the intervention and was diagnosed with autism.
He received special education services. Richard was diagnosed with a chromosomal abnormality,
an inverted duplication 15, which is generally expressed with non-specific symptoms that include

1
Names have been changed to protect confidentiality of the participants.
426 K.-M. Chung et al. / Research in Developmental Disabilities 28 (2007) 423–436

developmental delays, learning disabilities, and autistic features. Richard demonstrated specific
weaknesses in language-related skills, social communication, and perseverative behaviors, such
as asking a question repeatedly until receiving an answer. Attempts to stop his perseveration often
triggered a temper tantrum. His volume was within the conversational level but monotonous.
The children who served as typically developing peers were recruited in via email messages
sent to faculty and staff at the University of North Carolina at Chapel Hill through both the
Department of Psychology and the Center for Development and Learning; typically developing
peers’ ages were 6 years, 6 months; 7 years, 6 months; 9 years, 4 months (all children of faculty
and staff); 10 years, 1 month (the sibling). All four peers were not available for every session
because of other commitments. Each week, however, we were able to arrange for three typically
developing peers to participate. With three peers each week, the entire group consisted of seven
children (four target children and three peers).

1.2. Trainers

The first three authors took turns leading the group. Each group leader had previous
experience running and/or participating in social skills groups for children with autism. Two
undergraduate students were responsible for videotaping and coding the sessions.

1.3. Peer training

Peer training was conducted at baseline and immediately before each session. The purpose of
this training was to orient the peers to the target skill of the day, demonstrate how to prompt the
target children to use the skill of the day, how to encourage target children to ask questions, and
praise the target children for working hard. A group leader went over the target skill of the week
and conducted role-plays with the peers to assess their understanding of the target skill and
answer questions.

1.4. Procedure

The entire intervention lasted 12 weeks, including baseline assessment, skills training, and
wrap-up session.

1.4.1. Baseline
During baseline sessions, each child was videotaped twice at two different moments; both
videotaped segments were used as baseline data for each child’s social skills. The first baseline
data was collected during a 10-min play session in which a peer was assigned to interact with
each child in a separate room. Baseline data was collected during the first 5 min of the 10-min
play session by coding each child’s social behaviors on videotape after the interactions took
place. The second set of baseline data was gathered 1 week later before the intervention was
implemented. The second baseline data was collected by observing each child interacting with a
peer for 5 min on videotape and coding the same social behaviors.

1.4.2. Social skills training

Following the baseline sessions, children participated in 11 weeks of social skills training. (At
session 2, observational data were collected twice: baseline data-2 before the beginning of social
skills training and treatment data-1 at the end of the social skills training session.) Each session
 K.-M. Chung et al. / Research in Developmental Disabilities 28 (2007) 423–436 427

followed the same structure: welcome, explanation of skill of the day, teaching/didactic Time,
practice time, snack time, video time, and wrap-up. Details of specific training sessions are
available upon request to the first author.

1.5. Design

A basic comparison design was used for each child to evaluate treatment effectiveness.

1.6. Measures

1.6.1. Coding system

A social interaction coding system was developed to analyze the children’s social behaviors.
The codes used for this study were adapted from an observational system reported by Thiemann
and Goldstein (2001). In order to allow the coding system to reflect target behaviors focusing on
verbal communication skills, one of Thiemann and Goldstein (2001)’s coding criterion, correct
response (CR), was divided into four parts: acknowledged correct response (ACR), short correct
response (SCR), elaborated correct response (ECR) and asking questions (AQ) (see Table 1). A
direct observational coding system was used to code the frequency of the appropriate and
inappropriate social communication measures for target children. A data recording sheet,
corresponding to the coding system and divided into intervals of 15 s, was also developed.
All 5-min experimental sessions were videotaped. Each session was divided into 15-s
intervals. Two trained undergraduate students coded the frequency of the social communication
behaviors. If a child’s response started in one segment but continued into another, then the
scoring was completed for the first segment only. Both coders were aware the purpose of the
study and not blind to the treatment.

1.6.2. Outcome measures

Two measures for social communication skills were selected as primary dependent measures;
percentage of appropriate talking and percentage of inappropriate talking, each consisting of four
subscales (Table 1). Percentage of appropriate talking was calculated based on the percent of
intervals each target child engaged in any of four appropriate social communication behaviors
during each 5-min experimental session. Percentage of inappropriate talking was calculated
based on the percent of intervals each target child engaged in any of four inappropriate social
communications during each 5-min experimental session. Percentages for the eight subscales
were calculated to evaluate changes in communication over time and calculated based on the
percent of intervals each target child engaged in each subscale communication during each 5-min
experimental session.

1.7. Inter-observer agreement

Each 5-min videotaped segment was scored by two independent observers. Prior to scoring
data for this study, the observers were required to achieve greater than 80% agreement with
master test videos on each subscale. Both observers coded 82% of all experimental sessions
independently. An agreement was recorded if both observers coded the occurrence of the same
social communication behavior within the same interval in the same manner. Disagreements
were recorded if the observers did not agree on the type of social behavior or if one coder did not
observe the behavior. Percent of inter-observer agreement was computed by dividing the number
428 K.-M. Chung et al. / Research in Developmental Disabilities 28 (2007) 423–436
Table 1
Behavioral observation system
Social skills
Appropriate
Contingent response (CR)
Securing attention (SA)
Initiating comments (IC)
Initiating requests (IR)
Inappropriate
topic change (TC)
Unintelligible (UN)
Other (OT)
No response (NR)
Description
Coded if the focus child’s utterance is contingent on a peer’s immediate prior
utterance, within a 2-s interval following the peer’s utterance. Four subcategories
of CR include (a) acknowledged contingent response (ACR): a response to a
peer’s comment in which the child makes any non-verbal gesture (i.e. shakes
head) or a non-word response (i.e. yea, mm-hmm, etc.); (b) short contingent
response (SCR): a one word acknowledgment to the peer’s question or
comment (i.e. yes, okay, etc.); (c) elaborate contingent response (ECR):
answering peer’s question, and/or responding with a related comment about
observable objects or events within the ongoing activity, peer’s previous
question or comment; (d) asking questions (AQ): confirming or clarifying a
question or comment from the peer (e.g., ‘‘What did you say?’’).
Coded if the focus child (a) requests attention or acknowledgment from peers
(e.g., ‘‘Hey!’’ ‘‘See this?’’ or ‘‘Look.’’), (b) calls the peer’s name to gain
attention, or (c) uses gestures or vocalizations to establish joint attention with
the peer (e.g., taps on shoulder, holds an object up to show peers)
Descriptive comments that are related to the ongoing topic or event, but not
contingent on a peer’s prior utterance and not used to request information, and
the focus child (a) provides a comment following a 3-s interval after a peer’s
last utterance, (b) initiates a new idea or topic that relates to the ongoing joint
activity or topic but is not a request, (c) compliments the peer (e.g., ‘‘You did it!’’)
or himself, (d) reinforces the peer for winning, (e) expresses enjoyment to the peer
regarding their interaction together (e.g., ‘‘This is fun!’’). The child’s utterance was
coded as IC if it met the criteria of (b–e) within the 3-s interval
Coded if focus child’s utterance is related to the ongoing topic or event, but not
contingent on a peer’s prior utterance and not used to clarify something the peer
said (would be CR), and the focus child requests information or actions
following a 3-s interval after a peer’s last utterance
Coded with or without a change in materials or games if the focus child (a)
interrupts (definite overlap of words) a peer to introduce a new topic that has
not been discussed previously or to reintroduce a previous topic, (b) changes
the topic to something unrelated to and non-contingent on the peer’s prior
utterance, (c) comments tangential to some aspect of the peer’s previous
utterance but there is an ambiguous semantic referent not immediately
recognizable. Verbal turns that follow a TC are coded as CR, IC, IR or SA if
the conversation follows the changed or shifted topic
Utterances that are not interpretable or are unintelligible to the coder after
listening to the audiotape a minimum of three times
Any (a) animal noises or other vocalizations, (b) stereotypic or perseverative
utterances (considered perseverative on the third utterance); if another child
speaks or the child continues the perseveration at a later time, start over and
code the first two utterances as they are defined, (c) delayed echolalia that
is non-interactive
Child does not respond verbally or non-verbally within 3-s to (a) a peer’s request
for information, requests for actions, or protests; (b) if the child is performing an
action requested by the peer that takes longer than 3-s, wait to see if he completes
the task and give him credit if he does, or (c) if the peer asks the same question
again within the 3-s interval, the utterance is not coded, and the time frame starts
at 0 after the peer’s second question. If the child does not respond after the peer
repeats himself two or more times, coded as NR
 K.-M. Chung et al. / Research in Developmental Disabilities 28 (2007) 423–436 429

of agreements by the number of agreements plus disagreements and multiplying by 100. The
inter-observer agreement across all sessions and participants had a mean rate of agreement of
86% with a range of 80–100% agreement across participants.

2. Results

2.1. Data analysis

Pre- and post-test scores were compared to examine the effectiveness of this social skills
training on the participants’ social communication skills. Figs. 1–4 present the percent of

Fig. 1. Intervals (%) engaged in social communical skills during baseline and treatment for Michael during 5-min
sessions.
430 K.-M. Chung et al. / Research in Developmental Disabilities 28 (2007) 423–436

Fig. 2. Intervals (%) engaged in social communical skills during baseline and treatment for Steven during 5-min sessions.

intervals in which each child engaged in both appropriate and inappropriate talking during
the 5-min experimental sessions. Also, Figs. 1–4 revealed changes in three additional
social communication subscales across sessions and were added in order to illustrate treatment
gains.

2.2. Michael

Michael increased his appropriate talking (Fig. 1) as his mean frequencies for appropriate
talking increased from 17.8% at baseline to 24.1% post social skills training. Michael’s mean
scores for inappropriate talking slightly decreased from baseline (7.5%) to treatment phases
(5.3%). In addition, when each skill was examined, significant progress in initiating comments
 K.-M. Chung et al. / Research in Developmental Disabilities 28 (2007) 423–436 431

Fig. 3. Intervals (%) engaged in social communical skills during baseline and treatment for Joshua during 5-min sessions.

(IC) was clearly noted. Frequency of IC changed from 36.3% (baseline) to 70.0% (the last four
sessions), with a gradually increasing trend, suggesting Michael steadily improved over time. His
engagement in elaborated contingent response (ECR) improved prior to session 10, but dropped
during the following two sessions. However, the graph demonstrates that Michael initiated a
greater number of ECRs during training than at baseline.

2.3. Steven

Steven’s progress is shown in Fig. 2. It suggests that Steven showed an increased use of
appropriate phrases, while presenting no change in his rate of inappropriate talking. His mean
432 K.-M. Chung et al. / Research in Developmental Disabilities 28 (2007) 423–436

Fig. 4. Intervals (%) engaged in social communical skills during baseline and treatment for Richard during 5-min
sessions.

score for appropriate talking at baseline was 9.0%, while his mean score during treatment was
16.9%. In addition, Steven demonstrated a 43.0% increase in appropriate talking during the
final three treatment sessions from baseline. A decrease in Steven’s inappropriate talking was
observed during treatment (mean scores: baseline = 11.8%; treatment = 4.6%), although
this decrease might be due to one high score on the second baseline point, since his
inappropriate talking was relatively low throughout the treatment except for one session.
Steven’s engagement in ECR and IC changed over time from baseline to treatment, from
14.5% to 39.0% and from 0% to 23.7%, respectively. The graphs of these sub-skills indicate
gradual increases over time. Steven’s NR decreased over time. His average NR during
baseline was 42.0% and dropped to 1.7% at the end of treatment (average for the last three
sessions).
 K.-M. Chung et al. / Research in Developmental Disabilities 28 (2007) 423–436 433

2.4. Joshua

Joshua’s appropriate talking increased from 16.4% during baseline to 25.4% to the post-
intervention phase. Although Joshua’s inappropriate talking during baseline was not high
(average 7.5%), his score on inappropriate talking decreased further during treatment (average
1.5%). In fact, he rarely engaged in inappropriate behaviors after session 6. No ECR was noted
during baseline, whereas variable but steady ECR were observed during treatment (average
18.7%). Forty percent improvement in IC from baseline (18.5%) to treatment (44.5%) was
observed. Joshua’s TC was low at baseline (average 7.5%) and he did not engage in any TC after
session 6, except during the last session (Fig. 3).

2.5. Richard

Changes in Richard’s appropriate and inappropriate talking were minimal (Fig. 4). The
average rates of appropriate talking at baseline and during the social skills group were 19.6% and
22.3%, respectively. Inappropriate talking decreased slightly from 6.5% at baseline to 5.0%
during the social skills training. Most subscales of appropriate talking were not changed. For IC,
Richard scored an average of 27.5% at baseline and an average of 52.9% during treatment,
indicating a 50.0% increase in engagement in IC by the end of the training. No noticeable
changes were observed in subscales of inappropriate talking.

3. Discussion

Overall, the results demonstrated that peer-mediated social skills training group combined
with video feedback and behavior management was an effective mode of intervention for
children with high-functioning autism. This indicated that children with autism can improve on
basic communication skills over a relatively short period (11 weeks) of structured group
teaching, role-play practice, feedback, and contingent reinforcement as well as with the
participation of typically developing peers. Although children’s individual strengths and
weaknesses moderated their ability to improve in targeted skills, each child in this study did show
some improvement from baseline. Three out of the four children demonstrated markedly greater
improvement, in both reduction of inappropriate talking and increase in appropriate talking. The
last child, Richard, showed improvement only in one social communication subscale, initiating
comments. More specifically, all children demonstrated improvement in at least one advanced
social communication subscale. Three of the four children demonstrated improvement in both
ECR and IC, skills necessary for effective communication.
One of the interesting findings of our study was the individual differences in improvements.
Compared to Michael and Steven, Joshua’s improvement was less noticeable. This lack of
improvement can possibly be explained by his persevarative behavior, since Joshua’s progress
slowed between sessions 7 and 10, a period corresponding with Joshua’s intense focus on earning
contingent rewards and the repetition of a few ‘‘stock’’ phrases he had previously been rewarded
for but that were not appropriate for new conversations or skills in subsequent sessions. It seemed
to become clear to Joshua, however, that this was no longer effective for earning reinforcement,
and he abandoned this strategy and showed improvement. Joshua was quick to understand that he
needed to participate in a manner appropriate to the present conversation, rather than using rote
phrases. Compared to baseline data, Joshua engaged in significantly more frequent SCR during
each treatment session except session 3. During this session, Joshua showed interest in one of the
434 K.-M. Chung et al. / Research in Developmental Disabilities 28 (2007) 423–436

toys used during the experimental session and was overly focused on and appeared to perseverate
on the toy.
Several factors contributed to Richard’s limited progress. First, Richard missed two sessions
(sessions 2 and 10). Since each session included a review of the previous session and was
intended to build upon previously taught skills, successive sessions were dependent on one
another. The compounded effect of missing sessions was particularly severe for Richard, who
often perseverated on certain topics e.g., asking the same questions repeatedly until they were
fully explained to his satisfaction). When previous skills were discussed, Richard had great
difficulty understanding what other children had learned during the previous session. Second,
Richard’s communications were overly focused on facts and often centered on tangential and
loosely associated information. For example, when Richard’s peer asked him whether he had a
brother, he asked questions regarding whether each group member had a brother until he
exhausted all group members. This scenario was repeated on several occasions. Richard’s
perseveration made it difficult to redirect him in a group setting without compromising the group
activity. The reason for lack of improvement in overall appropriate talking despite significant
increase in IC was due to his lack of reciprocity; Richard asked questions but did not wait to hear
peers’ responses to his questions.
Aside from progress in social communication skills among participants, there were several
additional benefits of this group training. First, specific feedback was provided to the parents of
each child in order to inform them of their child’s strengths and weaknesses. Although children in
this study each demonstrated basic communication and listening skills, we observed significant
individual differences.
Group instruction and training requires the following pre-requisite skills on the part of the
participants: ability to attend and listen to others, turn-taking, and appropriate voice volume.
Without these skills, the effectiveness of the training is diminished. For example, due to his
perseveration and difficulty attending to lessons without having his specific, tangential questions
answered, Richard often interrupted the group and demonstrated less improvement than other
participants. Richard required one-on-one teaching on a regular basis and typically needed
repeated redirection during sessions. This observation indicated he would benefit more from a
one-to-one setting with an adult focusing on his specific needs. At the least, training addressing
these difficulties should be held prior to group-wide didactic/teaching instruction.
As another example, although Steven showed improvement in several skills during training,
Steven’s voice was so soft and monotone that it was difficult for other participants to hear him.
Individualized teaching that focuses on improving his ability to regulate volume, tone and rhythm
would be helpful before entering a social skills training group format. If he had participated in
individual training addressing his specific needs prior to the group, we expect that he would have
shown more dramatic improvement across a range of skills.
Second, parents reported that their children enjoyed participating in the training group. Some
parents reported that they used coming to the session as a reward, although this was an unforeseen
circumstance. Other parents reported that their children repeatedly asked when was the next
training group session. Most participants reported that the play-time at the beginning of each
session was the most enjoyable part of the group. When children came to the session, toys were
made available to them and the participants participated in several different group games. This
planned play was designed to motivate children to participate in the training and allowed them to
feel comfortable with their typically developing peers and other participants. This anecdotal
information suggested that the planned free-play time in fact functioned as a reinforcement and
may have contributed to for the success of the social skills training group.
 K.-M. Chung et al. / Research in Developmental Disabilities 28 (2007) 423–436 435

Third, it appears necessary to develop a more systematic peer-training program. In this

training, peers were asked to pay attention to target children’s responses and continuously prompt
communication. Verbal praise was provided only intermittently. This was often difficult even for
socially skilled peers. Some peers became bored or frustrated, which impacted target children’s
communication frequency and quality significantly. Because these training situations are not
intrinsically reinforcing for the peers, more intensive peer training should be combined with
systematic reinforcement systems.
One of the goals of this project was to develop a user-friendly and easily adaptable teaching
manual for parents, school personnel, and direct-support staff. A social skills training curriculum
manual would be helpful in consistency in application and establish treatment effectiveness and
dissemination of the intervention protocol.
Four major limitations of this study are the limited number of data points at baseline,
unblinded coders, absence of a control group and the use of comparison design. For practical
reasons, only two baseline data points were collected, although at least three baseline data points
are recommended (Cooper, Heron, & Heward, 1987). Both coders were undergraduate students
who also assisted to run the social skills group in the center. They both were aware that the
purpose of the group was to increase participating children’s social skills. Hence, it was
practically impossible for them to be oblivious to the purpose of this study. Even though we found
coders independent to the training, it is not hard to guess the purpose of the study by just being
familiar with coding system. In our study, children and parents visited the training center only for
the purpose of the group. They often had to endure long commutes, and thus the number of
sessions that could be held was limited. Practical difficulties contributed to a lack of a control
group: (1) difficulty of recruiting participants with similar communication issues, cognitive
levels and ages and (2) unwillingness of parents to be in a wait-list group. Another limitation of
this study is the use of the comparison design. Despite its weakness as an experimental design, it
was selected primarily due to the difficulty of adopting other research designs. Reversal design
was not appropriate for skills acquisition, and multiple baseline design was not used since it was a
group treatment program. More frequent and shorter sessions in a school or day treatment
program would allow using a stronger research design.
This is a multi-component training program including instruction, rehearsal, positive
reinforcement and video feedback. However, it is difficult to determine which components of
training were necessary or contributed which amount of the variance in increased skill. Throughout
the training, children in our study were motivated to receive contingent rewards (i.e., stickers). In
fact, some children repeatedly asked us whether they would receive stickers if they talked to other
children while other children were busy counting the number of stickers at the beginning of the
training. Furthermore, most participants enjoyed seeing themselves on the TV screen. Some of
them were able to monitor their performance without prompts. Now that treatment effectiveness has
been evidenced with several of the children in our group, it is necessary to tease out these
components in order to investigate which procedures moderate or mediate eventual treatment gains.
In summary, this study demonstrated that communication skills among children with high-
functioning autism could improve through a relatively short social skills training program.
Despite the fact that inappropriate or lack of communication skills are the major struggle among
this population, it has not been easy to find an effective social skills program due to limited
resources in practical settings. Hence, it is not hard to predict that there is a tremendous need to
develop an effective social skills training manual for teachers, parents, and paraprofessionals.
Although further studies are necessary to demonstrate its effectiveness and practicality, this study
could be considered as the first step to come close to their need.
436 K.-M. Chung et al. / Research in Developmental Disabilities 28 (2007) 423–436

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