Special Interest Section Quarterly
Early Intervention
& School
Sponsored in part by The Psychological Corporation
Volume 15, Number 4 • December 2008
Published by The American Occupational Therapy Association, Inc.
Outcomes From an After-School Social
Skills Training Group
■ Deborah Marr, ScD, OTR/L, Amy Cullen,
Mark Hugentober, Rachel Hunger
A
utism spectrum disorder (ASD) is the current term used to
describe the disorders previously known as pervasive devel-
opmental disorders. The most well-known disorders of ASD
are autism, Asperger’s syndrome, and rare disorders such as Rett syn-
drome and childhood disintegrative disorder. These conditions are
characterized by varying degrees of impairment in communication
skills; social interactions; and restricted, repetitive, and stereotyped
patterns of behavior (Strock, 2004).
One of the hallmarks of ASD is difficulty in social interactions.
Persons with ASD often lack the necessary social skills to interact
with others in a socially accepted manner. Social skills that may be
affected are initiating conversations, maintaining appropriate body
space, understanding and responding appropriately to facial expres-
sions, understanding and responding appropriately to situations,
and understanding common abstract phrases (Sansosti & Powell-
Smith, 2006).
Occupational therapists consider social participation to be an
important occupation and can provide various types of interven-
tions to improve social skills for persons with ASD (American
Occupational Therapy Association [AOTA], 2002; Greene, 2004;
Lim, Kattapuram, & Lian, 2007). The most common approaches
used in occupational therapy intervention with persons with ASD
are behavioral; sensory processing; sensorimotor; and cognitive,
such as social stories (Greene, 2004; Huebner, 2001; Lim et al.,
2007; Murray-Slutsky & Paris, 2000). Other disciplines also have
focused on peer-mediated strategies, such as education and video
modeling in social skills groups (Rogers, 2000).
Although researchers in psychology have conducted numer-
ous studies on various social skill techniques, empirical outcomes
from occupational therapy intervention for social skills represent a
small but growing body of literature (Case-Smith & Arbesman,
2008; Gol & Jarus, 2005; Lim et al., 2007; Rodger, Ireland, & Vun,
2008). If occupational therapy considers social participation to be a
cornerstone of its focus with clients, then studies targeting this
population must be conducted and published. In line with AOTA’s
Centennial Vision (2007), this article continues the process of
examining occupational therapy evidence-based practice in social
skills training for children with ASD. The pilot study described
used both qualitative feedback from parents and a standardized
assessment to explore the outcomes of a 7-week social skills training
group.
Method
A single-subject, pretest-posttest pilot study examined the out-
comes of social skills training in an after-school club model that
focused on sensory processing, behavioral, and cognitive strategies
for children with ASD and social skills deficits.
Participants
Four participants with ASD and social skills deficits between 8 and
12 years of age were recruited through word of mouth in one com-
munity in Virginia. Some participants were recruited by a local
occupational therapist who shared printed flyers with her clients.
Table 1 shows participant demographics.
Measure
The standardized outcome measure used was the Social Respon-
siveness Scale: Parent Form (SRS; Constantino & Gruber, 2005),
which is a 65-item parent questionnaire used to assess the behavior
of children from 4 to 18 years of age. On a 4-point Likert scale, it
measures response to interventions over time. Five subscale results
(social awareness, social cognition, social communication, social
motivation, and autistic mannerisms) and a total score can be
obtained. Raw scores are transformed into T scores, which are based
on a mean of 50 and a standard deviation of 10. A decrease in
scores indicates an increase in function.
The SRS was administered before and at the conclusion of the
7-week social skills training group. Reliability scores of internal
consistency range from .93 to .97, which are considered very good.
Constantino et al. (2003) showed that the SRS can significantly
discriminate between children with and without pervasive devel-
opmental disorders.
The Short Sensory Profile (Dunn, 1999) was administered before
the sessions began to give the researchers a sense of the presence of
sensory modulation issues. Sensory modulation issues may con-
tribute to difficulty with social skills development because children
may not be able to concentrate on social skills when they are attend-
ing to other, potentially noxious sensory inputs. Incorporating
 —2—
Table 1. Participant Demographics Table 2. Standard Error of Measurements (SEMs) for Total
and Subscale T Scores
Participant Gender Age Diagnosisa Sensory Profile Scores
Score SEM
1 Female 7y 7m Autism 1 section typical performance
1 section probable difference Social awareness 7.1
6 sections definite difference Social cognition 5.8
2 Male 7y 6m Pervasive 1 section typical performance Social communication 4.2
developmental 2 sections probable difference Social motivation 5.7
disorder 5 sections definite difference Autism mannerisms 5.5
3 Male 8y 0m Developmental 3 sections typical performance Total
delay in 3 sections probable difference Male 2.4
social skills 2 sections definite difference Female 2.6
4 Male 9y 2m Asperger’s 3 sections typical performance
1 section probable difference
4 sections definite difference
making friends, (f) how to be a good friend, and (g) a general review
a
As reported by parent. of all topics. Participants were provided with a “social story” on
Note. y 5 years; m 5 months.
each topic the week before that topic was to be presented.
Embedded in the social story were opportunities for the child to
inhibitory techniques into programming may help children to learn write down ideas on the topic (i.e., drawing a picture of self or
and practice the intended social skills more easily. Inhibitory tech- friend, filling in conversation bubbles). These stories were given out
niques have been shown to increase children’s alertness and sense of at the end of each session so that participants could start thinking
calm (Mailloux & Roley, 2004), potentially allowing for more con- about the topic for the next week.
centrated effort on social skill development. Table 1 shows a break- Session descriptions. All activities were done as a group. The
down of each participant’s Short Sensory Profile scores. same format was used each week and consisted of the following:
1. An engaging opening activity, such as tossing a ball to one
Procedure another while calling out information about each person (e.g.,
Program details. The 7-week social skills program was held on the favorite color, pet’s name).
same day each week right after school, and each session lasted 1 hour. 2. Choosing an activity from the Drive Thru Menu (Bowen-Irish,
The program originally was scheduled for 8 sessions, but one was 2004), which was used as a self-regulation activity to start the
canceled because of snow. Because all 4 participants attended differ- session.
ent schools, the program was held in an occupational therapy clinic 3. Reading and reviewing the social story, including the drawings
at a local university and parents transported their children to the or statements each participant had added.
clinic. The program was directed by the first author and three occu- 4. Participating in activities that practice the targeted skill, includ-
pational therapy graduate students. The programming was devel- ing games, peer modeling, work sheets, and brainstorming.
oped collaboratively by all authors, and the responsibility of leading Specific examples of activities were identifying people’s emo-
each session rotated, although all four authors attended all sessions. tions from photographs, acting out a scripted conversation and
The parents were surveyed during the first session on the social suggesting improvements, and practicing strategies one can do
skills they thought their child needed help with the most, and the when feeling upset (e.g., take a deep breath).
identified areas reflected challenges both in and out of school. From 5. Participating in an obstacle course that was sometimes used as
that information, the topics most commonly identified were used a reward for the participants and other times as practice for the
as session topics. Although improving each participant’s social skill of the day.
interaction skills was the overarching outcome, this pilot study also 6. Saying good-bye and receiving the social story for the next
explored whether the SRS was sensitive enough to detect change in week’s topic.
children’s social skills.
Curriculum. Each session focused on a different aspect of social
Analysis
skills. One topic was presented each week in the following order: (a) Raw scores were converted into T scores, and each participant was
giving compliments, (b) conversation skills, (c) nonverbal commu- compared to himself or herself. A standard error of measurement
nication skills, (d) dealing with emotions, (e) do’s and don’ts of (SEM) for the total and subscale scores and T scores of parent rat-
ings were included in the analysis to interpret more accurately each
participant’s scores (see Table 2).

Early Published quarterly by The American

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Looking at the SRS subscales individually, one participant showed
an improvement in social awareness function greater than the
School MD. POSTMASTER: Send address
changes to Early Intervention & School SEM, whereas three showed an improvement in social cognition
Special Interest Section Quarterly, AOTA,
Special Interest Section PO Box 31220, Bethesda, MD 20824-1220. function, one in social communication function, and one in social
Quarterly Copyright © 2008 by The American motivation function greater than the SEM. One participant showed
Occupational Therapy Association, Inc.
Annual membership dues are $225 for a decrease in autistic mannerisms function greater than the SEM.
OTs, $131 for OTAs, $75 for Student-Plus
(ISSN 1093-7242) members, and $53 for Standard Student The total score reflects the overall severity of social deficits, and
members. All SIS Quarterlies are available two participants showed improvements greater than the SEM. A
to members at www.aota.org. The opin-
ions and positions stated by the contrib- decrease in scores by at least 1 SEM is considered to reflect a signifi-
utors are those of the authors and not
necessarily those of the editor or AOTA. cant treatment effect (Constantino & Gruber, 2005). In summary,
Sponsorship is accepted on the basis of one or more participants showed improvement in each subtest and
conformity with AOTA standards.
Chairperson: Barbara E. Chandler Acceptance of sponsorship does not in the total score as a result of this 7-week program based on
Editor: Leslie Jackson imply endorsement, official attitude, or
position of the editor or AOTA. parent ratings. Specific results can be obtained by contacting the
Production Editor: Jennifer Hart
first author.
 —3—
Subjective parent comments also were collected during the
final session. These comments included “[Child’s name] has
certainly enjoyed getting to know the staff and ‘friends’ in her
group,” “This has been a wonderful experience,” “I think the struc-
ture and the content of the group has been great!” and “[Child’s
name] had fun and couldn’t wait to go each week.” Parents reported
no changes to their children’s routines or medications during the
course of the study.
Discussion
Occupational therapists seek to improve social participation, and
the after-school club model means that instruction is provided in
an engaging, social climate as opposed to a regular classroom set-
ting. This program offered the opportunity to target social participa-
tion, which is an appropriate role of a school-based practitioner
(Case-Smith & Rogers, 2005). Programming for children with ASD
can be challenging and the outcomes difficult to assess. This pilot
study suggests that even a brief program focused on social skills
training can produce results of both a quantitative and a qualitative
nature.
With the pressure put on schools by the No Child Left Behind
legislation (Pub. L. 107-110) to focus on academic achievement, the
parents enjoyed having their children participate in these interven-
tions because they believed that their child was receiving assistance
in an area not always addressed in school-based services. Children
with typical development have numerous options for after-school
programs, but programs for children with special needs are limited.
Some parents, although noting that their child did not make much
progress, were happy to have an after-school activity that their
child could attend.
Occupational therapists should consider offering program-
ming that follows the after-school club model for children with
special needs because it does not interfere with these children’s
academic programming. Further, being part of a “club” is seen as
an activity similar to what children without special needs are
engaged in and, in some instances, could include opportunities
for peer modeling. It may be possible to fund such programs by
charging a modest fee. Depending on the location of the club,
other issues such as liability, transportation, and permission forms
would need to be addressed. “Clubs” whose primary focus is
developing social skills could use activities more commonly seen
in clubs for children who are typically developing, such as a news-
paper club, cooking club, or drama club. Families may be pleased
to see their child’s social skills develop in an engaging and inclu-
sive setting.
Limitations
A major limitation in this pilot study was the small number and
homogeneity of participants, who were of similar age and racial
background (non-Hispanic white) and were middle class. Although
only one of the four was female, this is consistent with the gender
composition of the ASD population. No parent training component
was included in this study because of time limitations, although
parents were able to read the social story with their child, which
may have reinforced skills each week. The length of the program
and use of a parent report measure also may have been limiting fac-
tors in achieving more positive outcomes. The most significant lim-
itation for the research team was finding a measurement tool
sensitive enough to measure small changes in behavior. Other pos-
sible measures to consider include survey feedback on a specific
behavioral outcome from teachers and other adults working with
the children. A future goal would be to include other professionals
such as teachers and speech therapists in the development and
facilitation process.
Another limitation was that the questionnaire stated that the
parents should rate their child’s behavior over the past 6 months. It
was not emphasized to the parents to rate the posttest on behavior
changes noted in the past 7 weeks; therefore, some parents may
have rated their child more poorly.
Directions for Future Research
Although research has suggested that an 8-week social skills group is
effective for acquiring some social skills (Barry et al., 2003), a general
sense from this pilot study was that the social skills training needs to
last longer. The researchers did not feel there was enough time to
both teach a skill and also practice the skill. We addressed too many
skills each week, and now believe that spending more time on each
topic and infusing more school and playground scenarios for practice
may be more beneficial. Future research should measure performance
more objectively, and in a more natural environment. One idea may
be placing blind evaluators in classroom, home, or playground
situations. Finding the best combination of approaches for occupa-
tional therapy interventions will be challenging but is a necessary
part of establishing occupational therapy’s role as a contributor to
the development of social skills. A final suggestion would be to
incorporate into the group several peers who are typically develop-
ing to serve as social models (Barry et al., 2003).
Conclusion
After-school social skills training has the potential to improve the
skills of children. Occupational therapists should take the lead in con-
ducting and publishing research that provides evidence on effective
strategies, potential outcomes, and appropriate measurement tools. ■
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No Child Left Behind Act of 2001. Pub. L. 107-110.

Rodger, S., Ireland, S., & Vun, M. (2008). Can cognitive orientation to daily
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Deborah Marr, ScD, OTR/L, is Associate Professor and Director, Division of

Occupational Therapy, Shenandoah University, 333 West Cork Street #510, Winchester,
Virginia 22601; dmarr@su.edu.
Amy Cullen, Mark Hugentober, and Rachel Hunger were Occupational
Therapy Students, Shenandoah University, Winchester, Virginia, at the time this article
was written.

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Outcomes from an after-school social skills training group. Early Intervention &

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