Social skills training groups for children and adolescents with Asperger syndrome: A review

Background. First described in 1944 by Hans Asperger, Asperger syndrome (AS) is now considered in international diagnostic classifications as one of the pervasive developmental disorders (PDD) or autism spectrum disorders (ASD). The main symptoms of AS are severe impairment in social interaction and communication, and restricted interests, without significant delay in cognitive and language development. Its prevalence is not clearly established but might be around 0.26 per 1000. Symptoms of high-functioning autism (H FA), which is not an official diagnostic category, are quite similar. Children and adolescents with AS or HFA mostly have a social skills deficit, in connection with a lack of understanding concerning the rules governing social interactions. This deficit often leads to social isolation and peer rejection, which can alter their quality of life. Their lack of social skills can also have effects on success at school or work, integration among peers and mental health. According to recent guidelines of the French national authority for health (Haute autorite de sante, HAS) about the special needs of persons with PDD, professionals have to develop evidence-based interventions, emphasizing social interactions and participation, as described by the international classification of functioning, disability and health (ICF): social and professional participation as well as participation in leisure activities, clubs and societies, etc. Objectives. To explore the studies that give evidence of the value of these social skills training groups, to review the methods and programs worked out in these groups, and to highlight the best general operating principles to be adopted and combined. Methods. Systematic searches of electronic databases, journals, and reference lists identified 12 studies published since 1984, involving social competence group interventions, led by psychotherapists who were trained in cognitive behavioral therapies (CBT), for children and adolescents from 6 to 18 years old with a diagnosis of AS or HFA. Results. According to these 12 studies, these interventions are useful and significantly effective. Adaptation of their contents and educational means to how children and adolescents with AS function is necessary to facilitate learning and decrease anxiety. Concerning the groups' setting, most of these studies insist on the value of working with a small number of participants and creating a friendly, predictable and structured environment (even the progress of the sessions itself has to be structured). The programs' contents should ally didactic teaching and training exercises, which should be diverse and adapted to the objectives. The techniques usually applied in CBT (role plays, modeling, problem-solving strategies, etc.), must be completed with strategies known to be appropriate for children and adolescents with ASD, such as social scenarios. Conclusions. Although new studies are necessary to assess the generalization and long-term efficacy of such approaches, this review confirms the advantages of the main methods of social skills training groups for children and adolescents with AS. It opens up perspectives to developing new programs of social skills training groups, integrating various approaches, dimensions and objectives, working on a long-term basis. (C) 2011 Elsevier Masson SAS. All rights reserved.