Social Skills Groups for Adults with Autism

Autism Spectrum Disorder (ASD) is primarily a social disorder. Lack of social skills is often the symptom that causes the most problems and the symptom that is the most difficult to treat. This article will provide a brief overview of what social skills are before moving into a more in-depth review of an intervention aimed at improving social skills: social skills groups. Both the theory behind group counseling and the scientific literature addressing the efficacy of social skills groups will be examined.

Social Skills

Social skills come naturally to neuro-typical individuals. Skills like deciding how close to stand to someone during a conversation, or identifying anger or irritation in another person, are essentially reflexive in someone without ASD. However, despite a desire to get along and fit in, individuals with high functioning autism and Asperger’s are bewildered by the constant onslaught of social cues and necessary responses. Generally social skills involve both expressive and receptive skills, including:

• Eye contact
• Facial expressions
• Body language
• Knowing and following the unspoken rules of relationships
• Theory of mind (understanding that others have thoughts and feelings different from your own)

Because there are innumerable social rules and regulations that change depending on personal and environmental factors, improving social skills, (also known as psychosocial rehabilitation), is not easy.

What is a Social Skills Group?

Popular psychosocial rehabilitation interventions include:

• Cognitive-behavioral therapy
• Assistive technology
• Education
• Social skills groups

Social skills groups are very popular. There are several presumed benefits of group counseling:

• It provides an opportunity to decrease feelings of isolation and meet connect with others who have similar difficulties
• It is ideal for replicating problematic social situations
• It is ideal for receiving behavioral feedback
• It is ideal for practicing new skills in a safe and structured environment

Group Structure

A social skills group usually consists of a leader, an optional co-leader, and participants. The size of the group is important:

• If a group is too small, you miss out on the benefits of group counseling
• If a group is too large…
• Quieter members may be not receive as much attention as more assertive members
• There is a danger of a didactic (teacher-student) structure emerging, as opposed to the interactive group counseling atmosphere

As a general rule a good size for a group is 6 to 12 participants.
Groups can also be open or closed. Open groups are ongoing and allow members to join or leave at any time. Closed groups usually have a beginning and ending date, and no new group members are allowed to join after the closing date.
The traditional group counseling schedule is one hour per week. However, depending on the endurance of the participants (group counseling is hard work) and their schedules, more frequent and/or longer meetings could be beneficial.

Group Sessions and Topics

A social skills group session is usually fairly highly structured. For instance, a group meeting might always follow this format:

1. Discussion of how things have been going since the last meeting
2. Review of last week’s skill
3. Review of last week’s homework
4. Introduction of a new skill
5. Activity to highlight the new skill, or role-plays with feedback from group and leaders
6. Summary and homework assignment
7. Free time for refreshments and mingling before leaving

Different social skills groups may have slightly different goals. For instance, a group may focus on improving self-awareness, problem solving abilities, conversational proficiency, or vocational skills. Even with a specific focus, a good group will cover a variety of topics. (For examples, see the AHEADD and Research Support sections below.)

AHEADD Social Skills Group

AHEADD recently launched a social skills/social thinking development program specifically geared toward college students with ASDs. The small, closed group meets for one hour weekly, and covers topics including:

• Communication, verbal and non-verbal
• Self-awareness
• Self-regulation
• Mindfulness and stress reduction techniques
• Motivation
• Empathy and empathic responses
• Managing and building relationships

For more information about the AHEADD social skills group, contact the Carolyn Komich Hare, AHEADD Director, by email at Carolyn@aheadd.org.

Research Support

Social skill groups for children are very popular and well-researched. Unfortunately, scientific evaluations of social skills groups for adults are lacking. A recent thorough literature search yielded only three peer-reviewed articles that examine if participation in a social skills group improved social skills in adults.

Howlin & Yates, 1999 – Social Skills Group

Howlin and Yates (1999) reported on a social skills group held at the Maudsley Hospital in London. Participants were 10 males with an average age of 28 and a diagnosis of autism or Asperger syndrome. The group met once a month, for 2 ½ hours, for a year. The aim of the group was to help participants to understand and cope with their social difficulties, with an emphasis on conversational skills. At the end of the group, the vast majority of the participants reported improvements in communication skills, ability to interpret emotions, and ability to relate to people. Many of the participants also moved to a more independent living situation and found jobs or enrolled in an educational program.

Hillier et al., 2007 – Aspirations Social Skills Group

Hillier, Fish, Cloppert, and Beversdorf (2007) reviewed a social skills group, Aspirations, to determine if the group had a positive effect on social skills. Participants were 13 individuals between the ages of 18 and 30 diagnosed with ASD. The group met for one hour, weekly, for eight weeks, followed by monthly reunions. Aspirations sessions were planned around specific objectives related to social skills deficits typical in autism. Results showed trends towards improving peer relations, trends towards decreasing ASD traits, and significant improvements in empathy. Notes from the staff, participants, and parents were positive and indicated an increase in positive social behaviors after the social skills group intervention.

Turner-Brown et al., 2008 – Social Cognitive and Interaction Training

Turner-Brown, Perry, Dichter, Bodfish, and Penn (2008) conducted a study in which they hypothesized that participants in a social skills group (Social Cognition and Interaction Training modified for individuals with Autism [SCIT-A]) would demonstrate significantly more improvement in social cognition and social functioning compared to a treatment as usual (TAU) group. Participants were 11 adults age 18 to 55 diagnosed with high-functioning autism. SCIT-A consisted of 50 minute weekly meetings for 18 weeks. SCIT-A had three phases: (1) emotion training, (2) figuring out situations, and (3) integration. The SCIT-A group significantly improved their Theory of Mind (ToM) skills compared to the TAU group, and there were also trend improvement in participants’ perceived social communication skills.

Conclusion

Difficulty with social skills is the trademark of autism. Social skills are complex and difficult to teach, but group counseling seems to be a promising intervention. It is unlikely that participation in any group will turn someone with autism into a social butterfly, but groups can definitely help to teach some basic skills and reduce social anxiety. Perhaps the greatest benefit of groups, and the most obvious, is that in a group you are not alone. For example, all members of one social skills group agreed that the group helped by offering the opportunity to meet and listen to individuals with problems similar to their own (Howlin & Yates, 1999).