Social information processing in boys with autistic spectrum disorder and mild to borderline intellectual disabilities

Social information processing in boys with autisticspectrum disorder and mild to borderline intellectualdisabilitiesjir_1204 922..931

P. Embregts1 & M. van Nieuwenhuijzen2

1 Behavioural Science Institute, Radboud University Nijmegen and HAN University of Applied Sciences, Nijmegen,The Netherlands2 Developmental Psychology, Utrecht University, Utrecht,The Netherlands

Abstract

Background Children with autistic spectrum disor-ders (ASD) and mild to borderline intellectual dis-ability (ID) have less adaptive behaviour and morebehaviour problems than children with mild to bor-derline ID. Social information processing appears tobe an important mechanism in the explanation ofthe socially inadequate behaviour of children withmild to borderline ID; however, little is knownabout the social information processing skills ofchildren with ASD and mild to borderline ID.Method In the present study, a total of 136 boys inthe age of 10–14 years participated; 26 with ASD(specifically Pervasive Developmental Disorder –Not Otherwise Specified) and mild to borderlineID, 54 with mild to borderline ID without ASD and56 typically developing boys. They completed theSocial Problem Solving Test to measure their socialinformation processing.Results The research results show boys with PDD-NOS and mild to borderline ID to differ from

typically developing boys in their encoding of infor-mation; they focus on negative and emotional infor-mation in the social situation. They differ from boyswith mild to borderline ID in response generation,evaluation of inadequate solutions (aggressiveand submissive responses) and assertive responsedecision.Conclusions The present study extends our knowl-edge regarding social information processing ofchildren with ASD (PDD-NOS) and mild to bor-derline ID. This knowledge may be helpful indesigning and adapting programmes (e.g. socialskills training, self-management training) for themanagement of behaviour problems and develop-ment of adaptive behaviour of children with ASDand mild to borderline ID.

Keywords autism spectrum disorders, mildintellectual disabilities, social behaviour, socialinformation processing

Introduction

Autistic spectrum disorders (ASD) co-occur withany level of intelligence, but around 50% of indi-viduals with ASD also have intellectual disabilities(IDs) (Chakrabarti & Fombonne 2005; Baird et al.

Correspondence: Dr Petri Embregts, Behavioural Science Institute,Radboud University Nijmegen, PO Box 9104, 6500 HE Nijmegen,The Netherlands (e-mail: [email protected]).Authors’ noteWe would like to thank the anonymous reviewer for his valuableremarks on a previous version of the manuscript.

Journal of Intellectual Disability Research doi: 10.1111/j.1365-2788.2009.01204.x

volume 53 part 11 pp 922–931 november 2009922

© 2009 The Authors. Journal Compilation © 2009 Blackwell Publishing Ltd

2006). Children with ASD and mild intellectualdisability (MID; limitations in intellectual function-ing (IQ between 55 and 85) and in social and adap-tive behaviour) find it difficult to interact withothers, and have less adaptive behaviour and morebehaviour problems than children with MID butwithout ASD (Carpentieri & Morgan 1996; Hartleyet al. 2008). Concerning employment, education,independent living and peer relations, the prognosisof those individuals is poor (Billstedt et al. 2005).Therefore, it is highly important to investigate theunderlying processes of the problems with socialinteractions in these lower cognitive functioningchildren with ASD. It has been argued that a lack ofsocial cognitive skills are a defining feature of avariety of atypical developmental disorders, includ-ing ASD. Despite ongoing attempts to elucidate thecomplex relationship of IDs to ASD, there is notmuch research known on social cognitive skills ofchildren with ASD and MID.

Various mechanisms, including emotional andcognitive processes during social interaction, aresupposed to influence social behaviour. With respectto inadequate social behaviour, the theory of socialinformation processing (SIP) which describes socialproblem solving skills (Dodge 1986; Crick &Dodge 1994) seems promising. Various behaviourproblems have been related to atypical socialproblem solving (Crick & Dodge 1994), and thismodel may be applicable to inadequate socialbehaviour of clients with ASD and ID as well.Within the SIP model, it is assumed that socialbehaviour is preceded by the mental steps of encod-ing, interpretation, goal clarification, response gen-eration and response decision – with the latterincluding response evaluation, judgments of self-efficacy and response selection. That is, individualsencode and interpret the information in a givensocial situation and then set goals, search for pos-sible responses, evaluate their response options andselect a response for enactment upon the basis ofthe information that they have processed. It is pro-posed that individual differences in the differentsteps of SIP lead to different behavioural responses.Considerable evidence exists to support the hypoth-esis that the behaviour problems of children withoutMID are related to their social problem solvingskills (Crick & Dodge 1994; Matthys & Lochman2005).

The aim of the present study is to examine socialinformation processes in lower cognitive functioningchildren with ASD (specifically Pervasive Develop-mental Disorder – Not Otherwise Specified; PDD-NOS) and mild to borderline ID. Research onsocial cognition of children with ASD focuses onhigher cognitive functioning children. In particularchildren with Asperger’s Syndrome (AS) haverecently been examined on their emotional andsocial cognitive skills, and were found to differ inSIP from children without AS. In a recent study byMeyer et al. (2006), young people with AS wereshown to make more mistakes in the comprehen-sion and analysis of social situations than childrenwithout this syndrome. When young people with ASwere asked to evaluate hypothetical problem situa-tions, such as a peer entry situation presented onvideo, they had difficulties recognising the problemwithin the conflict situations.

Children with ASD also face difficulties with rec-ognition of emotions. Buitelaar et al. (1999) foundchildren with ASD to have no problems with recog-nising simple emotions such as happiness, sadnessor anger when portrayed by photographed or drawnfaces. Other researchers have determined that a dif-ference exists when more complex emotions areinvolved such as shame, humour or flirtation. Adultindividuals with autism barely recognise these emo-tions, and such problems may be exacerbated whenone can speak of an accompanying ID as well(Baron-Cohen et al. 1997). Deficits in identifyingfacial expressions have also been reported in chil-dren with PDD-NOS (Castelli 2005). Serra et al.(2003) concluded that children with PDD-NOSwere significantly slower in face recognition thanage-matched typically developing (TD) children,while the recognition of abstract visuospatial pat-terns did not discriminate between the groups.

In addition to the social perception procedures ofencoding and interpretation of social information,researchers have studied the generation of appropri-ate strategies for resolving social problems. Theability of higher cognitive functioning children withASD to cope with social problem situations differsfrom that of children without ASD. In a number ofstudies, it has been found that children with AS cangenerate just as many solutions to a problem aschildren without this syndrome but that the natureof the solutions differs (Channon et al. 2001; Meyer

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P. Embregts & M. van Nieuwenhuijzen • SIP and ASD


et al. 2006). Children with AS generate morepassive, and fewer assertive solutions than childrenwithout the syndrome.

Despite these studies on higher functioning chil-dren with ASD, knowledge on SIP in children withASD and ID is still lacking. From recent studieswith children with MIDs we have learned that theirSIP differs from that of children with average intel-ligence and that SIP of children with MID isrelated to externalising and aggressive behaviour(Leffert & Siperstein 1996; Van Nieuwenhuijzenet al. 2004, 2005, 2006). Children with MID tendto encode more negative information and also areless likely to generate assertive strategies than chil-dren with average intellectual functioning (VanNieuwenhuijzen et al. 2004). Children with behav-iour problems in addition to MID show primarilydifficulties with encoding of information and gener-ating adequate solutions to social problem situa-tions but show no problems whatsoever with theselection of the most adequate solution when pre-sented with various alternatives (Van Nieuwen-huijzen et al. 2005, 2006, 2009). SIP thus appearsto be an important mechanism for explaining thesocially inadequate behaviour of children with MID.

Social cognitive processes in children with ASDhave also been studied using another theoreticalframework: Theory of Mind (ToM). ToM refers tothe ability to attribute mental states, beliefs andthoughts to the self and to others, and is essentialfor understanding and interpreting social situationsand interacting adequately. Three meta-analyses byYirmiya et al. (1998) have shown that children withASD are characterised by deficits in ToM; bothhigh and low functioning children with ASD differfrom TD children and children with MID.However, children with MID also have deficits inToM abilities when compared with TD children,albeit less severe than in children with ASD. Oneplausible hypothesis, then, is that children withASD and MID differ in social cognitive processingcompared with both children with MID and TDchildren.

Thus, the question is whether SIP in childrenwith ASD and MID differs from children with mildto borderline ID and TD children. Therefore, in thepresent study the SIP skills of children with ASD,more specific PDD-NOS and mild to borderline IDwill be compared with those of children with mild

to borderline ID and TD children. We expectedboth groups to differ in their SIP performance fromTD children, but we also expected to find differ-ences between the two disability groups.

Method

Participants

A total of 136 boys in the age of 10–14 years par-ticipated in the present study; 26 with ASD (PDD-NOS) and mild to borderline ID, 54 with mild toborderline ID without ASD (PDD-NOS) and 56

boys with average intelligence (TD controls).According to the most recent definition of ID

provided by the American Association on MentalRetardation children with IDs are characterised by‘significant limitations both in intellectual function-ing and in adaptive behaviour as expressed inconceptual, social and practical adaptive skills’(Luckasson et al. 2002, p. 1). Both children withASD (PDD-NOS) and children with mild to bor-derline ID were selected from schools for specialeducation in the Netherlands. The criterion for suchschool attendance is below-average intellectualfunctioning (i.e. IQ range = 55–85) and limitationsin social and adaptive behaviour. Boys with ASD(PDD-NOS) were selected if they had been diag-nosed as having PDD-NOS by a psychologist orpsychiatrist. The TD group was selected fromregular schools and had a higher mean IQ thanboth the other groups. The group of children withPDD-NOS and mild to borderline ID had ahigher mean age than both the other groups (seeTable 1).

Instruments

IQ was determined on the basis of results of indi-vidual intelligence testing obtained from schoolrecords. In instances in which testing had not beenperformed within the preceding 12 months, we esti-mated the child’s IQ using the Raven’s StandardProgressive Matrices (Raven et al. 1983), which con-sists of incomplete arrays of abstract geometricalfigures. Participants were asked to discover the rela-tions between the elements in the incomplete arraysand choose the right figure on the basis of thisinformation to complete the array. The internal




consistency values are around 0.90, and the test–retest reliability varies from 0.90 for the short termto 0.80 for the long term. This instrument has mod-erate to high correlations with other situational testsof intelligence (Raven et al. 1983).

The Social Problem Solving Test (SPT, SocialeProbleem oplossings Test) (Cuperus 1997; Matthyset al. 1999) was designed to measure SIP. The origi-nal SPT consists of 12 video vignettes with a struc-tured interview. For the present study, the originalversion of the SPT was revised for use with chil-dren with MID (SPT-MID; Van Nieuwenhuijzenet al. 2001). Because a pilot study had shown the 12

vignettes to demand too much from children withMID with regard to their attention and concentra-tion, the number of video vignettes was reduced tofive and the questions were simplified. The remain-ing vignettes include both peer-entry and provoca-tion situations, which have shown to be part of oneand the same factor ‘Being disadvantaged’ (Matthyset al. 2001). With the assistance of child actors, thesocial problem of being placed at a disadvantage isdisplayed in each vignette. Each videotaped vignetteconsisted of two parts. First, the social problem waspresented (e.g. the protagonist trying to build aLego plane but not succeeding followed by anotherboy offering to help but breaking the plane). There-after, the protagonist enacted three solutions to theproblem: a pro-social/assertive response, anantisocial/aggressive response and a passive/submissive response.

Prior to the presentation of each video vignette,participants were asked to identify with the protago-nist. Following the viewing of a vignette but prior tothe presentation of the three different solutions, anumber of questions were posed. The interviewersnoted participants’ responses. The first question

assessed the encoding of cues: ‘What happened in thisscene?’ The mention of verbal, situational, emo-tional or negative cues was coded. Phrases literallyrepeated from the segment were coded as verbalcues. Verbal descriptions of what happened in thevignette, such as ‘they are playing with Lego’, werecoded as situational cues. Remarks regarding thefeelings of one of the children in the vignette (e.g.‘he looks a bit sad’ or ‘he gets angry and startsshouting’) were coded as the encoding of emotionalcues. When cues were interpreted negatively (e.g.‘he said it in an unfriendly way’), they were codedas negative cues. The average number of cuesencoded and the average number of verbal, situ-ational, emotional and negative cues encoded werecalculated by summing the relevant number of cuesacross the five vignettes and dividing by five.

The second question assessed children’s interpre-tation of the information presented: ‘[event] hap-pened, why did this happen?’ The participant wasasked to select one of three answers: (1) benignintent (‘it wasn’t his fault, he tried to help me’); (2)unkind (but not hostile) intent (‘he is clumsy’); or(3) hostile intent (‘he did it on purpose’). A totalhostile intent attribution score was obtained bycounting the number of vignettes for which anunkind or hostile answer was provided, with aminimum of 0 (for none of the vignettes) and amaximum of 5 (for all of the vignettes).

The next question assessed response generation:‘What would you do?’ After provision of an initialresponse, participants were asked to think of otherways of responding to the situation. The totalnumber of responses generated was then codedalong with the quality of each response: pro-social/assertive, antisocial/aggressive or passive/submissive.Spontaneous response scores were obtained by

Table 1 Age and IQ scores for childrenwith ASD (PDD-NOS), children withmild to borderline ID, and typicallydeveloping children

ASD Mild/borderline ID TD

F P

N = 26 N = 54 N = 56

M SD M SD M SD

Age 12.54a,b 1.27 11.19a 1.60 10.54b 1.68 14.24 0.000IQ 83.33a 16.32 78.52b 14.98 97.25a,b 14.52 22.07 0.000

a, b: Mean scores with corresponding superscripts differ significantly.




counting the number of times each kind of responsewas provided as the initial response, with aminimum of 0 (never) and a maximum of 5

(always). A percentage score was then calculatedfor each response category by summing the numberof responses representing a particular categoryacross the five vignettes and dividing this numberby the total number of responses. A total responsegeneration score was also obtained by summingthe number of generated responses across thefive vignettes and dividing this number by five.A response variability score (i.e. indicator of achild’s response repertoire) was obtained bycounting the number of qualitatively differentresponses across the five vignettes and dividing byfive.

Next, the different enacted solutions to theproblem were viewed. Each solution was followedby a number of questions to assess response evalua-tion and self-efficacy. The first question concernedevaluation of response outcomes either on the basisof moral values or on pragmatic considerations suchas likely outcome: ‘Was this a good way for thechild to respond?’ to be answered ‘yes’ or ‘no’. Thesecond question addressed participants’ confidencein enacting the response (self-efficacy): ‘Would yoube able to behave in the same way?’ For each solu-tion, a total evaluation score and a total self-efficacyscore were calculated by summing the number ofpositive answers across the five vignettes, with aminimum of 0 (never positive) and a maximum of 5

(always positive). After presentation of the threealternative solutions and assessment of the partici-pant’s reactions, the three videotaped solutions wereagain presented to assess response selection. Partici-pants were asked: ‘Which of the three responseswould you choose?’ The total number of assertiveand aggressive solutions chosen was summed overthe five vignettes.

To assess inter-rater reliability for coding of par-ticipants’ answers to the open questions, both agraduate student and the first author scored theseanswers for 50 randomly chosen vignettes. TheKappa values were found to be 0.79 for encodingand 0.88 for response generation. In a previousstudy on SIP in children with MID the answers tothe response generation question have correlatedmoderately with actual behaviour in real-lifeproblem situations (r = 0.30) and highly with

behaviour in class as reported by the teacher(r = 0.49) (Van Nieuwenhuijzen et al. 2005).

Data analysis

In order to determine whether the SIP skills of theboys with ASD (PDD-NOS) and mild to borderlineID differed from those of the boys with mild toborderline ID and from the TD boys, a multivariateanalysis of covariance (MANCOVA) was conductedwith group (ASD, MID, TD) as the independentvariable, the SIP variables as the dependent vari-ables and age as covariate because groups differedin age.

Results

After controlling for age, a multivariate main effectof group was found, F38,230 = 4.17, P = 0.000. Next,univariate ANOVAs were conducted for each SIPvariable separately.

Univariate main effects of group were found onthe encoding of emotional cues, F2,136 = 4.31,P = 0.02 and a trend for negative cues, F2,136 = 2.80,P = 0.06. As can be seen from Table 2, the groupASD (PDD-NOS) encoded more emotional andmore negative information than the group TD.Concerning response generation univariate maineffects of group were found on the spontaneoussubmissive response generation, F2,136 = 4.57,P = 0.01. Both groups ASD and TD generatedfewer spontaneous submissive responses than thegroup mild to borderline ID. Univariate maineffects of group were also found on the evaluationof assertive, F2,136 = 16.29, P = 0.000, aggressive,F2,136 = 10.28, P = 0.000, and submissive responses,F2,136 = 8.13, P = 0.000. As can be seen in Table 2,compared with the group TD, both groups ASD(PDD-NOS) and mild to borderline ID positivelyevaluated assertive responses less often, with thegroup mild to borderline ID the least. In addition,the group ASD (PDD-NOS) positively evaluatedaggressive and submissive response less often thanboth the groups mild to borderline ID and TD.

Concerning self-efficacy, univariate main effectsof group were found on self-efficacy of enactingassertive F2,136 = 10.37, P = 0.000, and submissiveresponses, F2,136 = 7.37, P = 0.001. The groups ASD(PDD-NOS) and mild to borderline ID were less




confident in enacting an assertive response than thegroup TD. In addition, both the groups ASD(PDD-NOS) and TD were less confident inenacting submissive responses than the group mildto borderline ID. Finally, a univariate effect wasfound on assertive response decision, F2,136 = 4.40,P = 0.01. Both the groups ASD (PDD-NOS) andTD chose more often an assertive response than thegroup mild to borderline ID.

Discussion

In the present study the SIP skills of boys withPDD-NOS and mild to borderline ID are com-pared with those of boys with mild to borderline IDand TD boys. The research results show boys withASD (PDD-NOS) and mild to borderline ID to

differ from both boys with mild to borderline IDand TD, but in different ways. On the one hand,boys with ASD (PDD-NOS) differ from TD intheir encoding of information and evaluation ofassertive responses; they focus on negative andemotional information in the social situation andevaluate assertive responses less positively. On theother hand they differ from mild to borderline IDin response generation, evaluation of inadequatesolutions (aggressive and submissive responses) andassertive response decision. In other words, boyswith ASD (PDD-NOS) and mild to borderline IDappear to demonstrate greater competence in someaspects of social problem-solving than boys withmild to borderline ID. But even though boys withASD (PDD-NOS) and mild to borderline ID seemto know that aggressive and submissive responses

Table 2 SIP scores for children with ASD (PDD-NOS), with mild to borderline ID, and typically developing children

ASD Mild/borderline ID TD

F P

N = 26 N = 54 N = 56

M SD M SD M SD

EncodingSituational cues 2.71 1.23 2.77 1.15 2.92 0.97 2.58 n.s.Verbal cues 0.84 0.50 0.68 0.48 0.59 0.44 1.56 n.s.Emotional cues 0.30a 0.25 0.18 0.21 0.11a 0.16 4.31 0.02Negative cues 0.55a 0.26 0.52 0.24 0.46a 0.21 2.80 0.06Total cues 3.85 1.55 3.64 1.51 3.62 1.09 0.29 n.s.

InterpretationHostile intent attribution 2.73 1.00 2.74 0.94 2.57 0.95 0.41 n.s.

Response generationSpontaneous assertive 2.85 1.57 2.43 1.18 2.80 1.33 1.52 n.s.Spontaneous aggressive 0.88 1.03 0.69 0.93 0.89 1.07 0.69 n.s.Spontaneous submissive 1.19a 1.17 1.87a,b 1.24 1.30b 1.01 4.57 0.01Mean number of responses 2.18 1.15 1.99 0.32 1.90 0.36 0.96 n.s.

EvaluationAssertive response 3.31a,b 1.12 2.67a,c 1.03 3.79b,c 1.00 16.29 0.000Aggressive response 0.81a,b 0.85 1.96a,c 1.12 1.45b,c 1.31 10.28 0.000Submissive response 1.92a 1.16 2.87a,b 1.26 2.09b 1.18 8.13 0.000

Self-efficacy for enactmentAssertive response 2.35a 1.35 2.22b 1.33 3.23a,b 1.19 10.37 0.000Aggressive response 1.38 1.30 1.67 1.08 1.46 1.32 0.76 n.s.Submissive response 1.27a 0.83 2.33a,b 1.37 1.63b 1.26 7.37 0.001

SelectionAssertive response 3.42a 1.21 2.54a,b 1.18 3.02b 1.24 4.40 0.01Aggressive response 0.46 0.90 1.00 1.24 0.79 1.02 2.34 n.s.

a, b, c: Mean scores with corresponding superscripts differ significantly.




are not quite adequate to solve social problem situ-ations, they do not believe assertive responses havepositive consequences and do not consider them-selves capable enough to enact those responses.

The results seem to be in line with other researchfindings (Van Nieuwenhuijzen et al. 2009), thatshowed children with MID to choose more often anassertive response out of three possible solutions,but not to generate them spontaneously. Similar tochildren with MID, children with ASD (PDD-NOS) and mild to borderline ID seem to know howto respond adequately in social problem situations,but apparently do not behave accordingly; possiblybecause they find difficulties in transferring theirknowledge to other social situations or because theyare not confident enough in enacting adequateresponses.

At the same time, however, they focus on nega-tive information in a social situation more oftenthan TD boys. A similar phenomenon appears tooccur for children who are aggressive, anxious ordepressed: Such children tend to interpret situa-tions more often as threatening and hostile thanchildren who do not show these characteristics(Garber et al. 1991; Quiggle et al. 1992; Bell-Dolan1995; Daleiden & Vasey 1997; Orobio de Castroet al. 2002). Apparently such children view theoutside world with suspicion. While it is not clearwhere this predisposition comes from, it is possiblethat previous experiences in which others intention-ally mistreated them have been saved as schemes intheir memories.

There are, however, also some unexpected find-ings. Boys with mild to borderline ID and ASDappear to demonstrate greater competence in someaspects of social problem-solving than boys withmild to borderline ID alone; they generated lesssubmissive responses and chose more often anassertive response. One possible explanation for thehigher assertive scores in the ASD (PDD-NOS)group is that children with PDD-NOS may havereceived extra training in social problem-solvingskills. At almost all schools for special educationchildren receive social skills training. However,although we did not collect data on treatment, it isvery likely that part of these children with PDD-NOS received some kind of treatment outside ofschool because of their dual diagnosis, which mayhave influenced their problem solving skills.

Another explanation is that boys with ASD andmild to borderline ID may not actually be demon-strating greater skill in social cognition than chil-dren with ID, but rather different patterns. There isevidence from previous research (Siperstein &Leffert 1997) suggesting that ‘low-risk’ submissivestrategies may actually be adaptive for this popula-tion. In this study, the socially accepted childrenwith ID were more likely to generate submissivestrategies than socially rejected children with ID.Although these findings were obtained in publicschool settings, they may be true for special schoolsas well. It may be that children with ID find peerinteractions and conflicts risky and that based ontheir experiences, they have concluded that the bestway to cope with these conflicts is by employingsubmissive strategies. Only if we had data regardingthe social behaviour and/or social status of thesechildren could we interpret these results moreclearly. Nevertheless, this study uncovered differ-ences in SIP between the two disability groups, andfurther research is needed to explore the connectionbetween social cognition and social behaviour inthis population so that we can better understandtheir characteristic patterns of social cognition andthe role that these patterns play in their overallsocial functioning.

In addition we did not expect children with mildto borderline ID and ASD to encode more emo-tional information than TD children, because chil-dren with ASD are generally characterised by pooremotion processing. However, previous studies haveshown children with PDD-NOS to have betterabilities than children with ASD regarding facesrecognition and emotion processing, and even thesame as TD children (Serra et al. 1998).

When interpreting the results of our study, itsstrengths and limitations should be taken intoaccount. An important strength concerns the inclu-sion of children with ASD (PDD-NOS) and mildto borderline ID; the study is the first to apply theSIP theory to children with ASD (PDD-NOS). It isimportant to gain knowledge on their social cogni-tive skills, as more and more children are beingidentified as having ASD (PDD-NOS).

A potential limitation concerns the sample.Because the study only included boys in the agerange of 10–14 years old, these results cannot begeneralised to all children with ASD (PDD-NOS)




and mild to borderline ID. In addition, the group ofchildren with ASD (PDD-NOS) and mild to bor-derline ID was relatively small compared with theother two groups in the study. Therefore, we suggestthat future research studies replicate these findingson a larger scale.

A second limitation concerns social abilities ofthe respondents in this sample. The premise of thestudy is that both children with ASD (PDD-NOS)and mild to borderline ID, and children with mildto borderline ID might be socially impaired owingto atypical SIP. However, this study lacks data onsocial ability or social impairment of the respon-dents. All respondents were selected from schoolsfor special education in the Netherlands. Admissioncriteria for these schools imply that they havebelow-average IQ and limitations in adaptive behav-iour. Previous research has shown that childrenfrom special education score lower on social skillsand social adaptive behaviour than TD childrenfrom normal schools (Dekker et al. 2002; Van Nieu-wenhuijzen et al. 2004).

These findings have implications for treatment ofbehaviour problems in children with ASD (PDD-NOS) and mild to borderline ID and interventionprogrammes. If children with ASD (PDD-NOS)know how to respond adequately, but do not evalu-ate those responses positively and have not enoughconfidence to enact those responses, they should betrained in problem-solving skills. By practising theseskills in role plays they will experience positive out-comes and which may increase their self-esteem.Recently, a cognitive behaviour training programmehas been developed for children with MID, basedon the proven effective Coping Power Program(Lochman & Wells 2003, 2004). The programmeentitled ‘Samen Stevig Staan’ [Standing StrongTogether] includes a social problem-solving trainingprotocol for children and a training of parentingskills for their parents (Van ‘t Hof et al. 2009). Theprogramme may be relevant for children with ASD(PDD-NOS) as well, after adaptation for childrenwith ASD.

Past literature that has looked at children’s per-formance of social cognitive processes has cited theexistence of a gap between children’s ability toreason in hypothetical or practice situations andtheir behaviour in response to social challenges inreal life. The use of self-management procedures

would be helpful in overcoming this gap (e.g.Sherer et al. 2001). Procedures of self-management,such as self-monitoring, self-recording, self-evaluation and self-administering consequenceshave shown to be effective with youth with MIDand behaviour problems (Embregts 2000, 2002).Research has shown that self-monitoring can behelpful in reducing external control with peoplewith ASD and by consequence, to facilitate gener-alisation across stimulus dimensions (e.g. Koegel &Koegel 1990). Therefore, we recommend a combi-nation of a social problem-solving training protocolwith self-management in the natural setting (athome or the classroom) of the child to maximisethe effects of the training.

Additional research is needed with larger repre-sentative samples including girls, not only to furtherstudy SIP of children with ASD (PDD-NOS) andmild to borderline ID, but also to examine the rela-tions between social problem-solving skills andbehaviour problems, in order to develop effectiveinterventions. More research to improve the devel-opmental prognosis for such children is needed andmore research to adapt the parenting and guidanceof these children to their potential and possibilitiesis essential.

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Accepted 17 July 2009




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Social information processing in boys with autistic spectrum disorder and mild to borderline intellectual disabilities