Indian J Pediatr (January 2017) 84(1):68–75

DOI 10.1007/s12098-015-1938-5

REVIEW ARTICLE

Evidence-Based Social Communication Interventions

for Children with Autism Spectrum Disorder
Laci Watkins 1 & Michelle Kuhn 1 & Katherine Ledbetter-Cho 1 & Cindy Gevarter 1 &
Mark O’Reilly 1

Received: 29 June 2015 / Accepted: 21 October 2015 / Published online: 19 November 2015
# Dr. K C Chaudhuri Foundation 2015

Abstract Impairments in social communication skills are a 2] and deficits in these skills remain central to the diagnostic
core feature of autism spectrum disorder (ASD) and include definition of the disorder. With the advent of the fifth edition
deficits in social-emotional reciprocity, non-verbal communica- of The Diagnostic and Statistical Manual of Mental
tive behaviors used for social interaction, and developing, Disorders, social and communication impairments were com-
maintaining, and understanding relationships. In order to im- bined into one domain in recognition that socialization is in-
prove outcomes for children with ASD, much research has herently linked to the development of communication skills.
been focused on developing effective interventions to treat According to the diagnostic criteria, social communication
these social communication deficits. The purpose of this paper difficulties become apparent in early childhood and consist
is to highlight the evidence-based practices found within the of deficits in social-emotional reciprocity, non-verbal commu-
intervention literature that specifically targets social communi- nicative behaviors used for social interaction, and developing,
cation impairments and provide an overview of these strategies. maintaining, and understanding relationships [3].
Four relevant themes regarding evidence-based social commu- Social communication impairments can encompass a vari-
nication interventions are considered and discussed: (a) social ety of skills. Deficits in social-emotional reciprocity may in-
communication outcomes and practices relevant to different clude abnormal social approach and failure of normal back-
stages of development, (b) practices that both reduce interfering and-forth conversation; reduced sharing of interests, emo-
behaviors and improve social communication skills, (c) prac- tions, or affect; and/or failure to initiate or respond to social
tices that utilize an eclectic combination of intervention strate- interactions [3]. Deficits in nonverbal communicative behav-
gies, and (d) considerations for practice and research. iors used for social interaction can include poorly integrated
verbal and nonverbal communication, abnormalities in eye
Keywords Autism spectrum disorder . Social communication contact and body language, deficits in understanding and use
skills . Evidence-based practice of gestures, and/or a total lack of facial expressions and non-
verbal communication [3]. Deficits in social relationships can
range from difficulties in adjusting behavior to suit various
social contexts, to difficulties in sharing imaginative play or
Introduction
in making friends, to absence of interest in peers [3].
Intervening early to treat these impairments is vital,
The earliest descriptions of autism spectrum disorder (ASD)
and social communication skills are often cited as top
included impairments in social and communication skills [1,
treatment concerns for children with ASD [4, 5]. Suc-
cessfully treating these impairments may lead to better
short and long-term outcomes as well as contribute to
* Laci Watkins an overall improved quality of life. Fortunately, many
[email protected]; [email protected] interventions for children with ASD can be found in the
literature. As the prevalence of ASD has increased, so
1
Department of Special Education, The University of Texas at Austin, too has research on the development of effective inter-
1912 Speedway, D5300, Austin, TX 78712, USA ventions for individuals with ASD [6].
Indian J Pediatr (January 2017) 84(1):68–75 69

Efforts have been made to identify interventions that have age learners (6–11 y), middle school age learners (12–14 y),
sufficient empirical support to be considered evidence-based and high school age learners (15–18 y).
practices (EBPs). The National Standards Project (NSP) [7] Compared to EBPs for older children, relatively fewer so-
and the National Professional Development Center on Autism cial communication treatments for toddler age children have
Spectrum Disorders (NPDC) [8] each conducted comprehen- sufficient support to be considered evidence-based. This find-
sive reviews of the literature to identify focused intervention ing is unsurprising considering the average age of diagnosis
strategies (i.e., those that address a specific skill or goal) for for ASD is 4-y-old, even though a diagnosis as early as age 2
individuals with ASD that have adequate support to be con- can be reliable, valid, and stable [10]. In addition to those
sidered evidence-based. Wong and colleagues recently ex- practices effective for children of all ages, naturalistic inter-
tended and broadened the findings of previous reviews by ventions, parent-implemented interventions, and pivotal re-
conducting a systematic review of the intervention literature sponse training have all resulted in improvements in social
from 1990-2011 [9]. In order to qualify as an EBP, an inter- communication skills for this age group. Frequent outcomes
vention had to be supported by at least two high quality ex- for toddlers included nonverbal communicative behaviors
perimental or quasi-experimental group design studies, or at such as joint attention skills (i.e., the shared focus of two
least five high quality single subject design studies, or a com- individuals on an object or event) and functional play skills
bination of at least one high quality experimental or quasi- (i.e., playing with a toy or object according to its intended
experimental group design study and at least three high quality function). For example, Kasari and colleagues targeted both
single subject design studies [9]. The latter review identified these skills using a parent-implemented intervention in which
27 focused intervention strategies that had sufficient evidence caregivers were taught a series of behavioral strategies based
to be considered an EBP [9]. on the principles of applied behavior analysis (ABA) to im-
Of the practices that Wong and colleagues identified as prove joint engagement, which resulted in increases in the
evidence-based, 24 intervention strategies improved social children’s responsiveness to joint attention and diversity of
communication outcomes for children with ASD [9]. From functional play skills [11].
this corpus of research, the authors compiled findings to high- Twenty EPBs for improving social communication skills
light which EBPs specifically targeted social communication exist for preschoolers. Along with improvements in play skills
impairments (i.e., deficits in social-emotional reciprocity, non- and joint attention skills, social-emotional reciprocity skills
verbal communicative behaviors used for social interaction, were also common targeted outcomes. Frequently employed
and developing, maintaining, and understanding relation- EBPs for this age group included behavioral, naturalistic, and
ships) as described by the diagnostic criteria in the DSM-5 peer-mediated interventions, often times used in combination.
[3]. The authors offered a concise overview of each interven- For instance, teachers used naturalistic behavioral strategies to
tion strategy, provided the age groups for whom the EBP has stimulate a child’s interest in social activities as well as to
been effective, listed the commonly occurring social commu- facilitate the child’s social interaction and communication
nication outcomes targeted by each intervention, and provided with classmates [12]. Researchers also frequently used
the number of studies supporting each intervention strategy. prompting and reinforcement behavioral strategies to teach
From these findings, presented in Table 1, four relevant social interaction to young children with ASD [13, 14]. In-
themes regarding evidence-based social communication inter- structors often used prompting in the form of expectant
ventions are considered and discussed: (a) social communica- waiting, or material placement and environmental arrange-
tion outcomes and practices relevant to different stages of ments. Researchers used reinforcement both through granting
development, (b) practices that both reduce interfering behav- access to desired materials and social reactions. When deliv-
iors and improve social communication skills, (c) practices ered immediately after a social interaction behavior was ex-
that utilize an eclectic combination of intervention strategies, hibited, this strategy helped produce increasing numbers of
and (d) considerations for practice and research. subsequent social interactions [13, 14].
Twenty-four EBPs targeted social communication skills for
elementary school age children, constituting the largest evi-
Social Communication Interventions Across Stages dence base overall. Behavioral, peer-mediated intervention
of Development and instruction, social narratives, visual supports, and video
modeling were frequently used for this age group, with social-
Several EBPs that have improved social communication skills emotional reciprocity and social relationship skills regularly
are recommended for children of all ages. These include targeted outcomes. In particular, social behaviors needed for
antecedent-based interventions, modeling, prompting, rein- school success (e.g., following rules and complying with
forcement, video modeling, and visual supports (see Table 1 teacher requests, demonstrating appropriate classroom con-
for descriptions of EBPs). These practices are effective for duct, and engaging in prosocial behaviors) were target behav-
toddlers (0–2 y), preschoolers (3–5 y), elementary school iors for many interventions. For instance, Chan and O’Reilly
 70

Table 1 Summary of evidence based social communication interventions for children with ASD [9]

Evidence-Based Interventions Ages Intervention description Social communication outcomes Evidence base

Antecedent-Based Intervention Toddlers, preschool, elementary Variety of modifications that are made Reduction of interfering or challenging 32 single case design studies
school, middle school, high school to the environment or context in an behaviors and increase in communication,
attempt to change or shape a learner’s play, initiations, and language skills
behavior
Cognitive Behavioral Intervention Elementary school, high school Learners are taught to examine their Reduction of problem behaviors related to 3 group design and 1 single case
own thoughts and emotions, recognize specific emotions (e.g., anger or anxiety), design studies
when negative thoughts and emotions are and increase in emotion recognition and
escalating in intensity, and then use strategies emotional regulation
to change their thinking and behavior
Differential Reinforcement of Preschool, elementary school, Reinforcement is provided for desired Reduction of interfering or challenging 26 single case design studies
Alternative, Incompatible, or middle school, high school behaviors, while inappropriate behaviors and increase in pro social
Other Behavior behaviors are ignored behavior, communication and language
skills
Discrete Trial Training Preschool, elementary school One-to-one instructional approach used Increase in joint attention, imitation, symbolic 13 single case design studies
to teach skills in a planned, controlled, play, perspective-taking, answering questions,
and systematic manner responses, requests, labeling emotions, and
expressive language
Functional Communication Preschool, elementary school, Systematic practice to replace inappropriate Reduction of interfering behaviors and subtle, 12 single case design studies
Training middle school, high school behavior or subtle communicative acts less-clear communicative forms with clearer
with more appropriate and effective language or communicative forms
communicative behaviors or skills
Modeling Toddlers, preschool, elementary Demonstration of a desired target behavior Increase in joint attention, play skills, language, 1 group design and 4 single case
school, middle school, high school that results in imitation of the behavior initiations, empathy, and social engagement design studies
by the learner and that leads to the
acquisition of the imitated behavior
Naturalistic Intervention Toddlers, preschool, elementary school Collection of practices including Increase in joint attention, turn-taking, speech 10 single case design studies
environmental arrangement, interaction intelligibility, use of gesture, requesting,
techniques, and strategies based on applied expressive language, social phrases, and
behavior analysis principles designed to social interaction
encourage specific target behaviors based
on learners’ interests by building more
complex skills that are naturally reinforcing
and appropriate to the interaction
Parent-Implemented Intervention Toddlers, preschool, elementary school Parents directly use individualized intervention Increase in joint attention, conversation skills, 8 group design and 12 single case
practices with their child to increase positive social interaction, spontaneous language, design studies
learning opportunities and acquisition of use of augmentative and alternative
important skills communication, and play skills
Peer-Mediated Instruction Preschool, elementary school, middle Typically developing peers are taught ways to Increase in initiations, responding, 15 single case design studies
and Intervention school, high school interact with and help learners with ASD conversational reciprocity, empathy,
acquire new social skills by increasing social social engagement, and social interaction
opportunities within natural environments
Picture Exchange Preschool, elementary school, middle Learners are taught to give a picture of a Increase in requesting, communicative 2 group design and 4 single case
Communication System school desired item to a communicative partner interaction, social functioning, and design studies
in exchange for the item play skills
Pivotal Response Training Toddlers, preschool, elementary school, Naturalistic intervention based on the principles Increase in joint attention, imitation, verbal 1 group design and 7 single case
middle school of applied behavior analysis that uses learner communication, social interaction, and design studies
initiative and interests to improve motivation, symbolic play skills
responding to multiple cues, self-management,
and self-initiations of social interactions
Prompting Toddlers, preschool, elementary school, Verbal, gestural, or physical assistance is given to Increase in joint attention, verbal and nonverbal 1 group design and 32 single case
middle school, high school learners to assist them in acquiring or engaging communication, initiations, requesting, asking design studies
in a targeted behavior or skill questions, emotion recognition, and pretend
play skills
Reinforcement Toddlers, preschool, elementary school, A consequence that increases the probability that Increase in joint attention, imitation, play skills, 43 single case design studies
middle school, high school a behavior will occur in the future, or at least be seeking assistance, social interaction, initiations,
maintained, is delivered contingent upon responses, and requesting
demonstration of a specific learner behavior
Response Interruption/ Preschool, elementary school, Introduction of a prompt, comment, or other Reduction of vocal stereotypy and increase in 10 single case design studies
Redirection (RI/R) middle school, high school distractors when an interfering behavior is social, communication, and play skills
Indian J Pediatr (January 2017) 84(1):68–75
Table 1 (continued)

Evidence-Based Interventions Ages Intervention description Social communication outcomes Evidence base

occurring that is designed to divert the learner’s

attention away from the interfering behavior
and results in its reduction
Scripting Preschool, elementary school, Presenting learners with a verbal and/or written Increase in joint attention, play skills, verbal 1 group design and 8 single case
middle school, high school description about a specific skill or situation communication, conversational speech, design studies
that serves as a model for the learner requesting, initiations, and social interaction
Self-Management Preschool, elementary school, Learners are taught to discriminate between Reduction of interfering behaviors and increase 10 single case design studies
middle school, high school appropriate and inappropriate behaviors, in social communication skills such as giving
accurately monitor and record their own compliments, responding, initiating interactions,
behaviors, and reward themselves for play skills, and conversing with others
behaving appropriately
Social Narratives Preschool, elementary school, Stories or narratives that describe social Reduction of interfering behaviors and increase 17 single case design studies
middle school, high school situations in some detail by highlighting in social interaction, social engagement, socially
relevant cues and offering examples of appropriate behaviors, choice-making, expressive
Indian J Pediatr (January 2017) 84(1):68–75

appropriate responding language, and play skills

Social Skills Training Preschool, elementary school, Group or individual instruction designed to Increase in perspective-taking, conversation 7 group design and 8 single case
middle school, high school teach learners to appropriately interact skills, friendship skills, problem-solving, design studies
with typically developing peers social competence, emotion recognition, theory
of mind, and problem-solving
Structured Play Groups Elementary school Small group skill instruction with typically Reduction of interfering behaviors and increase 2 group design and 2 single case
developing peers characterized by occurrences in joint attention, language, collaborative design studies
in a defined area and with a defined activity, problem-solving, sharing, turn-taking, social
clear delineation of theme and roles by adult interaction, and play skills
leading the group, and prompting or scaffolding
as needed to support the students’ performance
related to the goals of the activity to appropriately
interact with typically developing peers
Task Analysis Preschool, elementary school, Complex behavioral skills are broken into smaller, Increase in responses to joint attention initiations, 8 single case design studies
middle school more manageable steps in order to teach the skill social interaction, play skills, and social
engagement
Technology-Aided Instruction Preschool, elementary school, Electronic devices, such as speech-generating Increase in joint attention, initiations, 9 group design and 11 single case
and Intervention middle school, high school devices, smart phones, tablets, computed-assisted requesting, expressive language, conversation design studies
instructional programs, and virtual networks, used skills, and emotion recognition
to support the goal or outcome of the learner
Time Delay Preschool, elementary school, Practice that focuses on fading the use of prompts Increase in joint attention, imitation, initiations, 12 single case design studies
middle school, high school during instructional activities requesting, verbal communication, manual
signs, and social play skills
Video Modeling Toddlers, preschool, elementary Mode of teaching that uses video recording and Increase in complimenting behaviors, imitation, 1 group design and 31 single case
school, middle school, high school display equipment to provide the learner with play sequences, conversation skills, initiations, design studies
a visual model of a targeted behavior or skill responses, requesting, social language, helping
behaviors, sharing, and perspective taking
Visual Supports Toddlers, preschool, elementary school, Concrete cues presented visually that provide Increase in play skills, verbal communication, 18 single case design studies
middle school, high school information about an activity, routine, or social interaction, social engagement,
expectation and/or support skill demonstration and initiations
71
72 Indian J Pediatr (January 2017) 84(1):68–75

improved behaviors such as appropriate initiations and hand appropriate social communication skills. These EBPs include
raising during instructional activities using social narratives antecedent-based interventions, cognitive behavioral interven-
and behavioral role-playing strategies [15]. Similarly, a video tions, differential reinforcement of alternative/incompatible/
modeling intervention that also utilized prompting and rein- other behavior, functional communication training, response
forcement strategies resulted in increases in helping behaviors interruption/redirection, self-management, social narrative,
(e.g., sharing toys, snacks, and other materials) at school for and structured play groups. Before implementation, these in-
three children with ASD [16]. Researchers increased peer in- terventions are often preceded by strategies such as functional
teraction through strategies such as training peers to initiate behavior assessments (FBA) or functional analyses (FA) in
play with children with ASD [17], using a tactile prompting order to determine the function or purpose of the challenging
device (i.e., a vibrating pager) to prompt children with ASD to behavior. Although an FBA or FA does not intervene directly
initiate to peers [18], and employing visual strategies and on behavior, the use of such procedures is oftentimes a neces-
script training procedures to reduce perseverative speech and sary precursor in order to develop effective social communi-
increase social statements made to peers [19]. cation interventions.
Nineteen EBPs and 16 EBPs exist for adolescents in mid- Antecedent-based interventions, differential reinforcement,
dle school and high school, respectively. Behavioral, peer- functional communication training, response interruption, and
mediated intervention and instruction, self-management, and self-management have the most overall evidence of efficacy in
visual cue strategies were regularly used to treat social com- reducing challenging behaviors and improving appropriate
munication impairments, with a focus mostly on social- social communicative behaviors. Several studies have sought
emotional reciprocity and social relationship skills with peers. to decrease socially inappropriate behaviors and replace them
This focus on peer interaction in the intervention literature with more socially acceptable alternative behaviors. For ex-
reflects the increased amount of time adolescents typically ample, Carter utilized an antecedent-based intervention in
spend with their peer group during this developmental phase. which children exhibiting disruptive behaviors, a lack of en-
To both improve social interaction with peers and promote gagement in social play, and a lack of expressive language
academic engagement, Carter and colleagues trained multiple were offered a choice in which game to play during therapy
middle and high school age, typically developing peers to sessions [27]. When choice was offered prior to the therapy
adapt activities to allow students with ASD participate in session, disruptive behaviors reduced considerably and social
class, provide feedback to students, and prompt students’ in- play and pragmatic language skills increased [27]. Using dif-
teraction with other classmates [20]. Similarly, Koegel and ferential reinforcement and corrective feedback procedures,
Frea demonstrated that teaching social behaviors using behav- Hagopian and colleagues reduced the attention-maintained
ioral strategies including pivotal response training and self- inappropriate behaviors (e.g., inappropriate comments, social
management produced improvements in social behaviors withdrawal, and inappropriate touching of others) of an ado-
and social interaction in two adolescents with ASD [21]. lescent by providing edible reinforcers when problem behav-
Self-management and self-reinforcement procedures also re- iors were not exhibited as well as corrective feedback when
sulted in an increase in the number of relevant statements and inappropriate behaviors were present [28]. These procedures
questions used during conversation for three adolescents with resulted in a decrease in inappropriate behaviors and an in-
ASD [22]. crease in appropriate solicitations of attention and interactions
with others [28]. Similarly, Koegel and colleagues demon-
strated that teaching children to self-monitor their responsivity
Practices that Reduce Interfering Behaviors to social initiations from others in school, home, and commu-
and Improve Social Communication Skills nity settings resulted in a concomitant reduction of disruptive
behaviors [29].
Children with ASD may use challenging behaviors (e.g., ste- Severe challenging behavior and stereotypic behavior can
reotypy, aggression, tantrums, property destruction, self-inju- be resistant to treatment. Functional communication training
ry, echolalia) to communicate [23, 24], and research suggests (FCT) [30] and response interruption/redirection interventions
that 75–80 % of challenging behavior may have a communi- have been especially effective in treating these behaviors and
cative function [25, 26]. For this reason, interventions focused teaching appropriate communication skills [31]. For example,
on reducing challenging or interfering behaviors and teaching after conducting an FBA and FA to determine the function of
functionally equivalent replacement behaviors that provide an challenging behaviors (e.g., elopement, screaming, hitting,
appropriate means of communication are vital for a significant and biting) exhibited by a child with ASD, Olive and col-
number of children with ASD. leagues examined the effects of using FCT procedures to teach
Outcomes for eight of the 24 evidence-based social com- the child to use an augmentative and alternative communica-
munication interventions reported both a reduction in chal- tion device to request her mother’s attention [32]. Implemen-
lenging or interfering behaviors and produced an increase in tation of FCT resulted in a decrease in challenging behavior,
Indian J Pediatr (January 2017) 84(1):68–75 73

an increase in requesting communicative behaviors, and an optimal approach to designing treatment programs that are
increase in correct pronoun use when speaking [32]. Ahearn individualized based upon the needs of the child [9, 36, 37].
and colleagues used response redirection/interruption to re- Given the variation of characteristics that exist in children with
duce vocal stereotypy in students with ASD [33]. When vocal ASD, this approach seems to be a promising way to target
stereotypy was present, a teacher verbally directed a previous- individual social communication needs and produce potentially
ly mastered demand to the student, thus redirecting the behav- robust clinical effects.
ior and resulting in a reduction of vocal stereotypy as well as The multi-component nature of these interventions poten-
an increase in appropriate communication [33]. tially makes it difficult to distinguish precisely which treat-
From the literature, it is evident that children with ASD can ments or combinations of treatments result in favorable out-
be taught communication skills that are more efficient and comes, and future research that refines interventions by iden-
effective than challenging behaviors. Using these EBPs to tifying the active components and eliminating superfluous
replace challenging or interfering behaviors with appropriate ones would seem warranted [23]. In order for the technical
forms of social communication can potentially aid in behavior eclectic approach to be most effective, programming should
management across school, home, and community settings, as be planned around individual needs, informed by the use of
well improve outcomes in academic achievement, relationship EBPs, focused on program quality, and appropriately imple-
development, and vocational prospects [23]. mented with fidelity [36]. When correctly and systematically
applied, this approach allows researchers and practitioners to
design comprehensive treatments utilizing focused evidence-
Combined Intervention Approaches based strategies that meet the varied needs of children with
ASD.
Interventions based on the principles of applied behavior anal-
ysis have by far the most support among the studies identified
by Wong and colleagues as evidence-based [9]. Specifically, Considerations for Practice and Research
studies using the behavioral strategies of prompting and rein-
forcement have considerable support in the literature. Whether As is evident from the results of Wong and colleague’s com-
used in isolation or in combination with another EBP, prehensive review of the literature [9], there are a number of
prompting, reinforcement, and other foundational behavioral evidence-based interventions available that teachers, parents,
strategies should be considered important components of so- and other service providers can use to inform their practice.
cial communication interventions for children with ASD. Re- However, no single intervention has been identified as effec-
gardless of intervention type, however, almost all of the strat- tive in improving social communication skills for every child
egies identified as evidence-based were used in combination with ASD, and practitioners must use their clinical expertise
with other practices. when designing a treatment plan. As demonstrated by studies
For example, Beaumont and Sofronoff improved the in the evidence base, the most beneficial treatment may in-
emotion-regulation and social competency of children with volve the combination of several empirically validated
ASD through a social skills training intervention that utilized approaches.
behavioral principles such as role-play, verbal prompting, and Regardless of the EBPs employed, it is essential that inter-
tangible reinforcement, as well as technology-aided instruc- ventions are individualized according to the child’s need and
tion and parent training components [34]. Similarly, Leaf and marked by ongoing assessment of goals and outcomes in or-
colleagues improved the conversation, play, and emotional der to determine the success of the treatment [38]. Instructors
skills of children with ASD through a social skills group that should consider the particular characteristics (e.g., develop-
utilized priming and a teaching interaction procedure with mental stage, interfering behaviors, existing skills, prefer-
behavioral components (e.g., prompting, modeling, role-play, ences, etc.) of the child when selecting which EBPs to imple-
and reinforcement) [35]. While both these studies utilized a ment. In addition, instructors also need to consider their ability
social skills training intervention, they employed unique com- to utilize a certain approach and the feasibility of
binations of EBPs not found in other interventions. This implementing the intervention in the instructional setting be-
unique combination of treatment components is representative fore developing a comprehensive treatment plan [9].
of many interventions in the evidence base. Identifying for whom a certain intervention approach is
Odom and colleagues have described this systematic use of effective has been an ongoing concern for future research
multiple focused intervention strategies as a Btechnical because children with different levels of functioning may re-
eclectic^ approach, meaning that a combination of interven- quire different intervention goals, procedures, and outcomes.
tions were used to target a specific outcome [36]. Experts in To exemplify, social skills research has typically included a
the field have suggested that combining and systematically majority of participants with medium and high cognitive func-
applying focused evidence-based interventions may be an tioning levels (i.e., an IQ of 55–85 and rudimentary
74 Indian J Pediatr (January 2017) 84(1):68–75

communication skills, and an IQ>85 and well developed ver- EBPs identified by Wong and colleagues [9], no independent
bal communication, respectively), and it is unknown if the strategy was found to be successful across all measures,
positive outcomes reported in the literature will be effectively highlighting the importance of matching appropriate strategies
replicated with lower functioning participants [39]. Therefore, or combinations of strategies to the individual. Moreover, the
future studies should examine the potential of using different most effective approach for improving social communication
EBPs based upon a particular participant profile in order to skills and reducing interfering behaviors may be the system-
better determine for whom certain strategies will be most ef- atic application of multiple EBPs based upon individual char-
ficient and effective in improving social communication out- acteristics [9, 36]. Additionally, with different stages of devel-
comes [40]. opment requiring various social communication needs (e.g.,
Similarly, it also apparent from the literature that future play in early childhood, peer relationships in middle and high
research concerning social communication interventions school, etc.) an awareness of developmentally-appropriate
should include participants with a wider range of ages. There targeted outcomes is essential. The increasing empirical evi-
is considerable support for a variety of EBPs for elementary dence for various interventions, however, provides both a
school age learners, and research involving this population strong knowledge base and confidence in the ability to assist
can provide valuable guidance in developing social skill inter- individuals with ASD in meeting goals created to improve
ventions for other age groups. However, as the social commu- these skills.
nication skills and outcomes targeted may vary according to
the child’s developmental stage, research is needed to deter- Acknowledgments The authors would like to thank their colleagues at
the University of Texas at Austin for their careful reading and insightful
mine if other EBPs can be successfully applied to younger and
feedback of this work.
older children. The expansion of the age ranges included in
interventions has been consistently identified as a need for Contributions LW, MK, and KLC wrote the initial draft. CG and MOR
future research [9, 39]. revised and reviewed the draft. LW will act as guarantor for this paper.
Finally, future research that examines the effectiveness of
Conflict of Interest None.
applying evidence based interventions to more complex social
communication skills and skill sequences seems warranted. Source of Funding None.
Outcomes of the studies included in the evidence base often
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