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Emotion-based Social Skills Training
6 month follow-up to a
controlled intervention study in
55 mainstream schools for children with
Autism Spectrum Disorders
Michelle Wong PhD/DCP
Ratcliffe, Wong, Dossetor, Hayes (2014)
Presentation Overview
1. Research Background
2. EBSST
3. Methodology
4. Results
5. Discussion
6. Future Directions
Delays in Social & Emotional
Development
Bernard-Opitz et al, 2001; Bernier et al, 2006;
de Brindley & Frith, 2009; Ziv et al, 2014
• Poor social functioning
• Less aware of others
• Solitary or limited play
• Inappropriate social behaviour
• Poor joint attention
• Poor imitation
• Difficulty understanding social norms
• Poor social problem solving
• Facial expression incongruent to the situation
• Emotional extremes or flat affect
• Difficulties with emotion perception
• Difficulties with affective sharing
• Theory of mind deficits
Social & Emotional Deficits and
Mental Health in ASD
Emotional & Behavioural Disturbance Mental Health
Social skills Emotional skills Social support
Social skills Social reciprocity
Ratcliffe et al., 2013 Alongi, 2005; Hops, 2007
Mental Health and ASD in
Australia
• 100,000 in Australia have ASD & mental health
issues (Warren, 2012)
• 60-75% of people with ASD needed access to mental
health services (We Belong, 2012)
• Mental health services tend to exclude ID or ASD
(We Belong, 2012)
• “People with ASD fall between the cracks of disability
service provision” (Stronger together: a new direction
for disability services 2006-16)
EBSST: an inclusive
mental health treatment for ASD
• Developmentally appropriate
• School-based: accessibility
• Universal design:
- based on developmental theories of emotional competence
- meets specific learning needs of people with ASD
• Whole classroom & whole school models of intervention
• Delivery by a range of professionals
• Delivery via socially inclusive tech: iPads & interactive whiteboards
EBSST Research Development
2004 2006 2008 2010 2012 2014
Pilot Study
HFASD&AS
outpatients
RCT
HFASD&AS
outpatients
Pilot Study
ASD&Mild ID
outpatients
Controlled Trial
HFASD&AS schools
Pilot Study
EDBD whole school
Controlled Trial
ASD & Mild ID schools
Moderate ID Autism &
Mild ID
High Functioning Autism/Aspergers
Mild and Moderate ID
EBSST Versions
2 to 4 years old
4 to 8 years old
8 to 12 years old
12 to 18 years old
ASD with and without ID
Autism Spectrum Disorder
(ASD)
Intellectual Disability
(ID)
Mild ID = IQ 65-75
Up to 70% of DSM-V diagnosis of ASD have
comorbid ID.
Social-Emotional Programs
ASD & ID
Secret
Agent
Society
Stop
Think
Do
PEERS Social
Decision
Making
EBSST
Children with ASD without ID
Children with ASD and ID
Parent & teacher sessions
Emotion skill development
Social skill development
Evidence-based strategies
Based on theoretical model
Evaluated in controlled
studies
EBSST Curriculum
Module Children Parents & Teachers
1 Identifying emotions Psychoeducation
Emotion coaching
Emotionally attuned
parenting
2 Emotions problem
solving
Understanding others’
emotions
Emotional problem solving
Promoting theory of mind
3 Managing emotions Managing emotions
Session Format
Mod 1 • 5 sessions
Mod 2 • 5 sessions
Mod 3 • 5 sessions
Booster • 1 session
2 sessions
2 sessions
2 sessions
1 session
2 sessions
2 sessions
2 sessions
1 session
Training • 2 days
Child Parent Educators & Support Workers Facilitator core supplementary supplementary supplementary
Evidence-based Strategies
Information Processing Generalisation
• Visual cues
• Video modeling
• Written and video social stories
• Comic strip conversations
• Live modeling
• Repetition of key points using
varied teaching methods
• Structured breaks and games
• Modify pace
• Practice through home-based
tasks
• Parent and teacher programs,
handouts, and visual cues
• Promote parent and teacher
self-evaluation and monitoring
• Use of rewards to motivate
• Practice through role plays
• Breaks between modules
Insert video here
AIM
To evaluate in a controlled study the effectiveness
of school counsellors
delivering EBSST in mainstream schools to
children with Autism with and without ID,
their teachers and parents,
when comparing a treatment
to a delayed treatment group.
Participants
ASD
without ID
ASD with ID Total
Children
(8-12 yrs)
217 114 331
Parents &
Teachers 217 114 331
School
Counsellors 41 14 55
Group
allocation
Treatment: 106
Delayed
treatment: 111
Treatment: 55
Delayed
treatment: 59
Treatment: 161
Delayed
treatment: 170
Procedure
Fac
ilita
tor
Trai
ning
Program development
Research evaluation
Program delivery
Data collection
Steering Committee & Project Management
RESULTS
• Mixed between x within model ANOVAS for:
Emotion Competence
(Emotions Development Questionnaire; Wong, Lopes & Heriot, 2009)
Social Skills
(Social Skills Improvement System, Gresham & Elliott, 2008)
Mental Health
(Developmental Behaviour Checklist, Einfeld & Tonge, 1992;
Strengths & Difficulties Questionnaire, Goodman, 1997)
• Parent and teacher reports for each measure
• Complete data sets for 66% (pre-post) and
15% & 30% (follow-up)
Emotional Competence
PARENT TEACHER
Time x Group – Significant
Time –Not Significant
Group –Not Significant
Time x Group – Significant
Time –Significant
Group –Significant
ASD
with ID
ASD
without
ID
105
110
115
120
125
130
135
140
145
1 2 3
105
110
115
120
125
130
135
140
145
1 2 3
105
110
115
120
125
130
135
140
145
1 2 3
105
110
115
120
125
130
135
140
145
1 2 3
Time x Group – Not Significant
Time –Significant
Group – Not Significant
Time x Group – Significant
Time – Not Significant
Group – Not Significant
High scores = Better skills
η2 = .18 η2 = .51
Treatment
Control η2 = .11
Social Skills
PARENT TEACHER
Time x Group – Not Significant
Time –Not Significant
Group –Not Significant
Time x Group – Not Significant
Time –Significant
Group –Not Significant
ASD
with ID
ASD
without
ID
Time x Group – Not Significant
Time –Not Significant
Group – Not Significant
Time x Group – Not Significant
Time – Significant
Group – Significant
70
75
80
85
90
95
1 2 3
70
75
80
85
90
95
1 2 3
70
75
80
85
90
95
1 2 3
70
75
80
85
90
95
1 2 3High scores = Better skills
Treatment
Control
*
Mental Health
PARENT TEACHER
Time x Group – Not Significant
Time –Not Significant
Group –Significant
Time x Group – Not Significant
Time –Not Significant
Group –Not Significant
ASD
with ID
ASD
without
ID
Time x Group – Not Significant
Time –Not Significant
Group – Not Significant
Time x Group – Not Significant
Time – Significant
Group – Significant
55
60
65
70
75
80
85
90
1 2 3
55
60
65
70
75
80
85
90
1 2 3
10
12
14
16
18
20
22
24
1 2 3
10
12
14
16
18
20
22
24
1 2 3
Low scores = Better mental health
Treatment
Control
RESULTS - Qualitative
Discussion
Children with ASD without ID
1. Statistically significant improvements in teacher
reported emotional competence. Gains
maintained 6-months post-intervention. Large
effect sizes.
2. Clinically significant improvements in teacher-
reported mental health.
3. Controlling for mental health, significant
improvements in teacher-reported social skills.
Discussion
Children with ASD and ID
1. First controlled study of a theoretically-based intervention developing emotion skills in children with ASD & ID.
2. Statistically significant improvements in teacher reported emotional competence, large effect size.
3. Positive trends
- emotional competence (parent report)
- social skills (parent & teacher report)
- mental health (parent & teacher report)
Discussion
Differences between parents and
teachers:
• Generalisability
• Parent vs teacher observations
• Peer modeling at school
• Intensity of training
Discussion
Research Limitations
• Measurement sensitivity
• Missing data
• Non-randomised
• Intervention fidelity in real world settings
Future Directions
• EDQ as an outcome measure
• Studies addressing differences between
teacher and parent outcomes
• Whole school study (IASSIDD 2014) and
whole classroom delivery
• Collate App for data collection
• Digitilisation: App, interactive whiteboard,
online facilitator training
• Publication, distribution, ongoing facilitator
training
