Your Family Physician

May 12, 2009 (Chicago, Illinois) – Peer support and one-on-one therapist guidance appear to be particularly effective in helping children with autism form friendships with their classmates.

In a rare, randomized, head-to-head trial, peer support alone or in combination with one-on-one guidance proved to help children with autism more than guidance alone or neither peer support nor guidance.

This points to a way that children can be included in regular classrooms rather than being relegated to special-education classes or having help from shadow teachers, lead investigator Connie Kasari, PhD, from the University of California, Los Angeles, told Medscape Psychiatry.

"And the good news is we can make differences in a short period of time," added Dr. Kasari.

The study was presented here at the 8th Annual International Meeting for Autism Research (IMFAR), Dr. Kasari and colleagues randomized 15 children with autism spectrum disorders (ASD) to each of these 4 approaches. There were a total of 54 boys and 6 girls, all of whom were in general-education classrooms. The participants' average age was 8 years and average IQ was 91.

Children randomized to one-on-one guidance had 2 sessions per week of direct instruction by a therapist in appropriate interaction with other children. Those randomized to peer support were given 2 sessions per week with 3 peers, each of whom was trained to help children with autism learn how to be a good friend and to include others in their play activities.

Children with ASD who had both one-on-one guidance and peer support had 2 sessions of each per week. The fourth group was given neither guidance nor peer support, but some of the children had outside aides or school aides and/or attended other social groups geared to helping them improve their social skills. Each of the approaches was used for 6 weeks.

After 6 weeks, the ASD children and other children were asked who played with whom on the playground. In addition, the children were asked who their top 3 friends were. The investigators used this information to determine whether children with ASD improved their ability to play with others and make friends.

Feelings of Friendship Reciprocated

The results revealed that significantly more children with ASD felt they had developed friendships after the study. Moreover, significantly more of these feelings of friendship were reciprocated by their non-ASD classmates.

Dr. Kasari and her coinvestigators also found that children with ASD who had received the combination of one-on-one therapist guidance and peer support improved their development of these social networks and increased their number of friends more than those with one-on-one guidance alone or with neither guidance nor peer support. The extent of improvement among children receiving the combination was the same as among those who received peer support alone.

In addition, teachers rated ASD children who had received peer support alone as having undergone the greatest positive change, while the clinicians involved in the study rated the peer-only and combination subjects as having undergone the greatest improvement in friendships.

Edwin Cook, Jr., MD, from the University of Illinois at Chicago's College of Medicine, commented that while the study involved only a small number of children, "the significant improvement in social networks for children with ASD was strong enough to be seen in a group of 15 compared with controls." He added that studies with larger numbers of subjects will help confirm these results.

The study was supported by the National Institutes of Health and the National Institute of Mental Health. Dr. Kasari has no conflicts of interest to disclose.

Source : http://www.medscape.com/viewarticle/702694?sssdmh=dm1.470812&src=nldne