Research

Empirical Research Regarding Spotlight

Spotlight actively participates in research to ensure our services meet quality standards for evidence-based practice (EBP). Based on a series of past and ongoing studies of the underlying intervention model used at Spotlight (Socio-Dramatic Affective Relational Intervention; SDARI), this intervention meets the American Psychological Association’s standard for Probably Efficacious Treatment (Crits-Christoph, Frank, Chambless, Brody & Karp, 1995) and may meet the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality’s Level II (“based on good evidence”) standard. The following is a list of published, presented, and unpublished studies on our model (SDARI), as well as studies that have taken place at Spotlight:

Goldstein, T.R., Lerner, M.D., & Winner, E. (in press). The arts as a venue for developmental science: realizing a latent opportunity. Child Development.

Children in all cultures readily engage in artistic activities (dance, drama, drawing and music). The arts are naturalistic activities that involve so many basic phenomena, such as attention, engagement, motivation, emotion, regulation, understanding of others, etc. and are latent opportunities in the “real world” to enrich our understanding of the development. Current wave of methodologically rigorous research studies shows the depth of arts learning, as well as how arts engagement can be harnessed for transfer to other skills. Focusing on expressive arts engagement at home or in school affects children’s cognitive and social-emotional development, this article presents exemplary research case studies. Such research program in the arts can be classified into broad types. Some of these studies have intrinsic goals (uncovering broad skills in parent domains without regards to transfer of skills to other areas; e.g., specific domain-specific habits of minds such as reflecting on process and product) being taught by the art) or instrumental goals (testing the “transfer effects” of engagement in arts on non-art ability; e.g., participation in theatre may lead to social-emotional competencies such as empathy). More importantly, there are emerging scientific literature that focuses on liminal aspects (“normative” learning can advance development in atypical populations; e.g., using drama and theater-based approaches to address core social deficits among youth with ASD), utilizing rigorous research programs to identify targeted theater games (such as those utilized in Socio-Dramatic Affective Relational Intervention). Taking these evidences together, this article discusses implications for arts informed-interventions and treatment programs and future areas of research, and as well as how the arts are no more difficult to study than other real world developmental phenomena and deserve a thorough examination.

Kang, E., Burns, A., Allegue, L., & Lerner, M.D. (2016). Performance-Based Social Skills Intervention Improves Explicit Social Cognition in Children with Autism Spectrum Disorder. Poster presented at International Meeting for Autism Research, Baltimore, MD, May 11-14.

Individuals with autism spectrum disorder (ASD) exhibit deficits in theory of mind (ToM), emotion recognition, and social knowledge, all of which are social cognition processes fundamental to social interactions. These involve explicit understanding of the correct information about a social situation and overt indication of such understanding is required for applying these skills to everyday life. Therefore, most social skills interventions (SSI) for ASD utilize didactic approach to directly and explicitly teach these target skills. On the other hand, there is a growing empirical support for performance-based approaches in SSI that provide enriched, in vivo social learning and practice opportunities without explicit instruction (e.g., SDARI; Lerner et al., 2011). This study examined which (if any) explicit social cognitive processes may be affected directly by these interventions – that is, can explicit social understanding be learned via non-didactic, performance-based approaches? Thirteen children with ASD participated in a 6-week social performance-based summer SDARI. Participants, on average, made improvements in social knowledge. Specifically, they developed greater tendency to believe more assertive, rather than passive, responses to social situations as correct. Also, participants, on average, made significantly fewer errors in identifying emotions in people’s faces after participating in the program, especially the subtler emotions that are harder to distinguish. In addition, participants, on average, showed improved social perspective-taking ability, as observed by parents, especially in more advanced perspective-taking ability – a change rarely seen in any social program. This study found that participating in an SSI that does not teach via didactic instruction led to improvements in ToM, identification of emotion in faces, and explicit social knowledge. Our results suggest that even with minimal didactic instruction or instrumental reinforcement of target skills (e.g., explicit training and feedback on face-emotion recognition or ToM activities), these social cognitive skills can be implicitly and experientially acquired in children with ASD via engaging in targeted activities. This provides additional support for intact implicit learning in ASD (Foti et al., 2014), and for social performance-based approaches to SSI that provide an enriched environment for children with ASD.

Rosen, T.E. & Lerner, M.D. (2016). Externalizing and internalizing symptoms moderate longitudinal patterns of facial emotion recognition in autism spectrum disorder. Journal of Autism & Developmental Disorders.

Though facial emotion recognition (FER) is thought to be a key deficit domain in autism spectrum disorders (ASD), there is dramatic variability in FER performance of ASD youth. Moreover, as the extant literature is based solely on cross-sectional studies (which measure FER only at one time point), little is known about intra-individual dynamics of FER over time. Longitudinal studies of FER (which measure FER repeatedly over multiple time points) in non-ASD samples reveal dramatic variability in FER performance over time, findings which are influenced differently by externalizing and internalizing symptoms. The present study sought to advance understanding of FER dynamics in ASD by examining trajectories of FER via repeated administration of an FER task, and by evaluating the effects of internalizing and externalizing symptoms on these trajectories. Seventeen youth with ASD, ages 11-17 (mean age = 14.318; 14 male), completed the Diagnostic Analysis of Nonverbal Accuracy-2 every three weeks over an 18 week period (seven administrations). Analyses revealed that, contrary to hypotheses, FER errors decreased over time, even for stimuli that are thought to be particularly difficult for youth with ASD, such as low-intensity and angry faces. Moreover, FER improvement was enhanced by internalizing symptoms but attenuated by externalizing symptoms. Results suggest that over time ASD youth may in fact improve in FER performance. Findings suggest that similar to non-ASD youth, ASD youth show longitudinal dynamics in FER that are differentially affected by externalizing and internalizing symptoms.

Lerner, M.D., McMahon, C.M., Britton, N. (2014). Autism spectrum disorder in adolescents: Promoting social and emotional development. In T.P. Gullotta & M. Bloom (Eds.), Encyclopedia of Primary Prevention and Health Promotion: Adolescence (Vol. 3, 2nd Ed.). New York: Springer.

This chapter reviews the body of empirical literature aimed at promoting social-emotional development in youth with autism spectrum disorders (ASD) and highlight strategies with the greatest current support and promise, in hopes of providing direction for future research and clinical practice. This review provides comprehensive information on the current research of social skills interventions (SSI) that vary in content and format for youth ages 13-22 with ASD. Key theories of social skills deficits in ASD in the intervention literature are reviewed, as well as an overview of strategies that have been developed based on these theories. One such theory is the knowledge/performance distinction (Gresham, 1997). This distinction suggests that there is a difference between a social knowledge deficit (i.e. not knowing what to do socially) and a social performance deficit (i.e. not doing what one may otherwise know). Socio-dramatic Affective Relational Intervention (SDARI) is an example of an SSI that focuses on social performance training. Few interventions for this population have received sufficient empirical inquiry to support the claim that they “work,” but several SSIs for adolescents with ASD are considered to be “promising.” This review presents evidences that SDARI fall under the “promising” category.

Lerner, M.D., Mikami, A.Y. (2014). Immediate Impact & Individual Differences: Using a “Micro-Dismantling” Approach to Elucidate Dissociable Effects of Knowledge- and Performance-Training Components. Presented at 2011 International Meeting for Autism Research, Atlanta, GA, May 14 – 17.

Previous studies comparing two social skills interventions, social performance-based Socio-dramatic Affective Relational Intervention (SDARI) and social knowledge-based Skillstreaming, demonstrated that SDARI leads to faster social preference effects (Lerner & Mikami, 2012). This study took a “micro-dismantling approach” to examine common components responsible for treatment outcomes and to identify differences in the effects of social knowledge- and social performance-training on peer engagement. 38 adolescents with ASD were randomly assigned to SDARI and Skillstreaming groups and were assessed on changes in social behaviors. Results showed greater increases in positive peer interaction during social performance-training, perhaps due to increased opportunities for engagement. Social performance-related factors, such as social information processing speed, predicted increases in interaction post-training regardless of condition, whereas social knowledge-related factors predicted increases in positive interaction during the interventions. These results suggest that interplay between aptitude for a treatment and being in a treatment condition may play a role in treatment outcomes. That is, different individual profiles of social performance- and social knowledge-related factors may reveal who would most likely to benefit from social performance-trainings such as SDARI.

White, S.W., Kreiser, N.L., Lerner, M.D. (2014). Autism spectrum disorders. In C.A. Alfano and D. Beidel (Eds.), Comprehensive Evidence-Based Interventions for School-Age Children and Adolescents (pp. 213 – 230). John Wiley & Sons, Inc.

This comprehensive review provides a brief overview of autism spectrum disorders (ASD) and provides practical, usable information on evidence-based intervention practices, its anticipated consumers (psychologists in practice or training), and the targeted client group (school-age children and adolescents with ASD who are without co-occurring intellectual disability) and also lists excellent resources on these. The chapter provides information on ‘probably efficacious’ treatments, focusing on interventions typically delivered in clinical settings for problems such as social disability, anxiety and mood problems, aggression and externalizing behaviors, etc. Social skills training in a group format is suggested as the most common psychosocial intervention for which there are many commercially available curricula specific for ASD. The chapter discusses emerging set of promising components such as those with focus on in vivo learning and performance training approaches as Socio-Dramatic Affective Relational Intervention (SDARI) and provides evidences for faster improvement in peer functioning in these approaches relative to more didactic approaches. Also, factors that play important roles in treatment are considered, such as parent involvement in treatment, and individualization of treatment protocols given the notable heterogeneity among children with ASD. Moreover, the chapter provides general clinical guidelines in measuring treatment effects.

Mendelson, J.L., Tudor, M.E., Lerner, M.D. (2014). Assessment of Fidelity in a Summer Program for Social Competency in Youth with ASD. Presented at 2014 International Meeting for Autism Research, Atlanta, GA, May 14 – 17.

This study explored the relationship between treatment fidelity and outcomes of a social skills intervention (SSI) for individuals with autism spectrum disorders (ASD), adding to previous findings on SDARI fidelity (Lerner & Tudor, 2013) by looking at both early fidelity (assessed by average of two initial sessions) and change in fidelity over the course of intervention, as well as by using child and peer reports. Thirty-four youth, primarily with ASD, participated in Socio-dramatic Affective Relational Intervention (SDARI) for 6 weeks during a summer. Participants and their parents completed reports of the youths’ social functioning immediately before and after the SDARI. This study examined manual fidelity, or the adherence to activities and training games, and conceptual fidelity, or the adherence to treatment principles such as use of person-specific motivators, positive social reinforcement, and relationship building, to SDARI. Early and increased manual fidelity predicted increased reciprocated friendships and social preference, whereas increased conceptual fidelity decreased reciprocated fidelity. Moreover, early manual fidelity predicted increased social preference. This suggests that the specific activities of SDARI may indeed be a uniquely valuable in promoting reciprocated friendships and social ability, and structure may be important early on in the intervention.

Tudor, M.E., Lerner, M.D. (2013). The Role of Treatment Fidelity in Therapeutic Alliance in a Social Skills Intervention for Adolescents with Autism Spectrum Disorders. Presented at 2013 Annual Convention for Association for Behavioral Cognitive Therapies Special Interest Group, Nashville, TN, November 21 – 24.

Therapeutic alliance (working relationship with the counselor) and treatment fidelity (counselor adherence to the treatment model) are two trans-theoretical “ingredients” that may affect outcomes for youth therapies. Socio-Dramatic Affective-Relationship Intervention (SDARI) may be ideal for studying these factors amongst youth with ASD, as therapists are trained in treatment principles and activities designed to increase child-therapist relationships. Alliance and fidelity in SDARI each seem to contribute to treatment outcomes (Lerner & Anthony, 2011; Lerner & Tudor, 2013), and this study sought to examine their relation concurrently and predictively across the course of treatment. Thirty-four youth, primarily with ASD, participated in SDARI for 6 weeks during a summer. Early conceptual fidelity predicted higher early therapeutic alliance and may have a meaningful effect, whereas early manual fidelity may have neutral or detrimental effects on early and ongoing therapeutic alliance for youth with ASD. These results suggest that flexible application of SDARI principles is most important to developing therapeutic alliance and may be especially important for youth with ASD, wherein flexible adherence to SDARI principles promotes improved social skills in naturalistic settings, which is also the targeted goal of the treatment.

Lerner, M.D. & Tudor, M.E. (2013). Exploring Treatment Fidelity and Outcomes in a Social Skills Intervention for Adolescents with Autism Spectrum Disorders, Presented at 2013 Annual Convention for Association for Behavioral Cognitive Therapies, Nashville, TN, November 21 – 24.

This study explored the relationship between treatment fidelity and outcomes of a social skills intervention (SSI) for individuals with autism spectrum disorders (ASD). Treatment fidelity refers to “extent to which intervention is implemented as intended,” and may be an ingredient in success of an intervention as well as a quality indicator. SDARI has demonstrated effectiveness in multiple studies and thus is an ideal setting for examining the role of treatment fidelity in SSIs. Thirty-four youth, primarily with ASD, participated in Socio-dramatic Affective Relational Intervention (SDARI) for 6 weeks during a summer. Participants and their parents completed reports of the youths’ social functioning immediately before and after the SDARI. This study examined manual fidelity, or the adherence to activities and training games, and conceptual fidelity, or the adherence to treatment principles such as use of person-specific motivators, positive social reinforcement, and relationship building, to SDARI. Fidelity was measured early on in the intervention from average of two initial sessions. Manual fidelity predicted improved social skills and decrease in ASD-related social problems as reported by parents, while conceptual fidelity had no effects on these variables. On the other hand, manual fidelity predicted increased social anxiety, whereas conceptual fidelity predicted decreased social anxiety. This suggests that the specific activities of SDARI may indeed contribute to changes in social skills and ASD symptoms, but may make participants more anxious to comply, while adhering to core treatment principles of SDARI helps reduce participants’ reactivity to social situations.

Lerner, M.D. & Mikami, A.Y. (2013). Knowing What to Do: The Role of Social Knowledge Deficits Among Youth with Autism Spectrum Disorders. Presented at 2013 Society for Research in Child Development Biennial Meeting, Seattle, WA, April 18 – 20.

Socio-dramatic Affective Relational Intervention (SDARI) is a social skills intervention that focuses on social performance-training component, whereas most interventions target social knowledge deficits. In order to better understand the nature of core difficulties in ASD and to design appropriate interventions, this study directly assessed the relative role of social knowledge and performance-related deficits in predicting symptoms in youth with ASD. Forty-one youth participated in the study and results indicate that ability to generate novel social responses (i.e. performance-based social reasoning) best predicted fewer overall, communication, and reciprocal social interaction symptoms. IQ also related to overall and social deficit scores. Conversely, knowledge of correct social behaviors (i.e. the corresponding knowledge component) did not predict overall symptoms, but did predict communication and restricted behaviors. Processing of facial information (i.e. performance-based social awareness) played a counter-intuitive role in restricted behaviors. This study calls into question the primacy of social knowledge in explaining symptoms among youth with ASD. Instead, knowledge and performance-related factors (especially social creativity) may have an effect on one another characterizing core deficits in ASD. Hence, the results highlight the importance of such interventions as SDARI that utilize the performance-related techniques in addressing core deficits in ASD beyond the traditional approaches of social knowledge-training.

Lerner, M.D., Lucchetti, A.R., Mikami, A.Y. (2013). Social knowledge and social creativity: Contributions to symptomatology in adolescents with ASD. Keynote address at ASDD Special Interest Group meeting at Annual Meeting of the for Behavioral and Cognitive Therapies Convention, Nashville, TN, Nov. 21 – 24.

This study directly examined relative contributions of social knowledge, or the awareness of correct social behavior, and social creativity, or the ability to generate novel social responses to social situations, to symptomatology in ASD. Based on results of this study, social creativity and social knowledge appear to be independent concepts and make discrete contributions to current ASD symptoms. Only social creativity was related to lifetime ASD symptoms according to parents, and the relationship was evident for communication and restricted behaviors. This indicates that the capacity for novel, flexible social responses, rather than knowledge of concrete social rules, may be especially critical for development of real-world social communication skills in ASD. Further exploration of the discrete components of social cognition that subtend social functioning in ASD is necessary. These results provide support for underlying mechanisms of such interventions as SDARI that focus on social creativity in addition to–or instead of–social knowledge.

McMahon, C.M., Lerner, M.D., & Britton, N. (2013). Group-based social skills interventions for adolescents with higher-functioning autism spectrum disorder: a review and looking to the future. Adolescent Health, Medicine and Therapeutics, 4, 23-38.

This paper synthesizes the current literature on group-based social skills interventions (GSSIs) for adolescents (ages 10–20 years) with higher-functioning autism spectrum disorder (ASD), such as SDARI. Research participants, the intervention, the assessment of the intervention, and the research methodology and results are considered to be integral and interconnected components of the GSSI literature, and each of these components are reviewed respectively. Participant characteristics (e.g., age, IQ, and sex) and intervention characteristics (e.g., targeted social skills, teaching strategies, duration and intensity) vary considerably across different GSSIs. Multiple assessments, such as parent-report, child-report, social cognitive assessments, are used to evaluate the efficacy of GSSIs. GSSIs seem to consistently show high parent and child satisfaction with the intervention, but findings on GSSIs are largely inconclusive. Based on this review, SDARI has demonstrated effectiveness in multiple studies. A better understanding of these components in the current GSSI literature and a more sophisticated and rigorous analysis of these components in future research will help answer key questions regarding the efficacy of these interventions for individuals with autism spectrum disorder.

Lerner, M.D., White, S.W., McPartland, J.C. (2012). Mechanisms of change in psychosocial interventions for autism spectrum disorders. Dialogues in Clinical Neuroscience, 14(3), 307 – 318.

Recent research into psychosocial interventions (particularly cognitive-behavior therapies and social skills training) for social-communication deficits among individuals with autism spectrum disorder (ASD) has provided some empirical support for the efficacy of these interventions, such as SDARI. This article describes methods for elucidating therapeutic mechanisms—the when, why, how, for whom, and under what conditions an intervention may produce change and identifying mechanisms underlying these effects (i.e., mediators and moderators). A moderator is a generally stable variable that is not meant to change in response to treatment that may affect the strength and/or direction of the relationship between treatment assignment and outcomes. A mediator is a variable that generally is influenced during treatment and directly by the treatment that may account for the influence of treatment conditions on change in a given outcome. This article also presents promising candidates for common mechanisms impacting treatment response: behavior modification, therapeutic relationship, social knowledge, social motivation, social information processing, executive functioning, and internalizing comorbidities. This paper highlights a need for a focus on research on common and unique mechanisms by which treatments as SDARI produce change in hopes of providing families and individuals with ASD with targeted, optimized, and responsively-designed treatments.

Lerner, M.D. & Mikami, A.Y. (2012). A preliminary randomized controlled trial of two social skills interventions for youth with high functioning autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 27, 145-155.

This study compared the treatment mechanisms and to consider relative efficacy of two interventions, Socio-dramatic Affective Relational Intervention (SDARI), a social performance training that focuses on evoking social behavior that may be known but not appropriately enacted, and Skillstreaming, a social knowledge training that focuses on presenting social knowledge that is presumed to be lacking. Thirteen youth with autism spectrum disorders (ASD) were randomly assigned to four weeks of one day/week SDARI or Skillstreaming. Both groups demonstrated notable improvements in reciprocal friendship nominations (nominating who he or she considered a friend) and social skills during the treatment sessions reported by staff members. These results are particularly encouraging that these interventions may be able to evoke friendship development within groups. Relative to Skillstreaming participants, SDARI participants liked and interacted more with each other after a single session, suggesting SDARI may promote rapid peer liking and social interactions. However, Skillstreaming participants increased in peer liking and interaction over the course of the intervention; SDARI participants decreased slightly. Parents reported no change in social functioning at home, perhaps due to short duration of the interventions.

Lerner, M.D., Calhoun, C.D., Mikami, A.Y., De Los Reyes, A. (2012). Understanding parent-child social informant discrepancy in youth with high functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 2680 – 2692.

This study investigated differences between self-report of youth with autism spectrum disorders (ASD) and their parents on their social functioning, looking at three distinct samples, two of which were drawn from the Spotlight Program. On average, parents rated their youth as less socially-skilled relative to peers, while youth viewed themselves as comparably-skilled relative to their peers. Positive discrepancies between parent- and self-reports predicted lower sense of self-efficacy for parents. Youths with higher opinion of their own social skills (relative to their parents) had lower attribution of hostile intent to peers in ambiguous social scenarios, marginally-lower depression, and decreased social anxiety after participating in a social skills intervention. Moreover, discrepancies predicted social skills intervention outcomes better than parent- or youth-report alone. In such ways, informant discrepancies may provide valuable and meaningful additional information regarding child psychopathology, parental perceptions of parenting stress, and youth treatment response. Results of this study provide a window into how a participant of Spotlight Program might see himself or herself. Therefore, considering the discrepancy between self-perception and parental perception of social competence among youth with ASD may be a useful pre-treatment indicator of possible treatment response profiles for interventions such as SDARI. Hence, considering the discrepancy may provide direction for improving interventions for youth with ASD and for working with parents to increase their sense of ability to help their children.

Lerner, M. D., Mikami, A. Y., & Levine, K. (2011). Socio-dramatic affective-relational intervention for adolescents with asperger syndrome & high functioning autism: pilot study. Autism15(1), 21-42.

This study examined the effectiveness of Socio-dramatic affective-relational intervention (SDARI), which is designed to improve social skills among adolescents with ASD. SDARI adapts dramatic training activities to focus on in vivo practice of areas of social skill deficit among this population. SDARI was administered as a six-week Spotlight Summer Program. Nine SDARI participants and eight adolescents who were matched in age and diagnosis-group not receiving SDARI were compared in trajectory of individual change were assessed for treatment outcomes and maintenance after the treatment, beginning six weeks prior to intervention and ending six weeks post-intervention. SDARI participants demonstrated significant improvements on several measures of child social, such as social assertion and the ability to accurately detect emotions in adult voices, functioning compared to those who did not receive the intervention. The intervention group also showed maintenance in gains and decrease in social problems post-intervention. Based on the results of this study, SDARI may be an effective intervention for addressing some areas of social skills development as part of a continuum of care for adolescents with ASD.

Lerner, M.D., Anthony, M. (2011). The Therapeutic Alliance In a Social Skills Intervention for Adolescents with ASDs, Presented at 2011 International Meeting for Autism Research, San Diego, CA, May 12 – 14; Lerner, M.D., Anthony, M.R., Mikami, A.Y. (2011). Therapeutic Alliance in a Community-based Social Skills Intervention for Youth with Autism Spectrum Disorders, Presented at 2011 Annual Convention for Association for Behavioral Cognitive Therapies, Toronto, November 11 – 13.

Therapeutic alliance, the relationship between the participant and the counselor, may be an important mechanism of change in social skills interventions (SSI) for youths with autism spectrum disorders (ASD). Thirty-four youth, primarily with ASD, participated in a 6-week summer SSI (Socio-Dramatic Affective Relational Intervention; SDARI). SDARI is an ideal context to consider alliance in SSI, since it has demonstrated effectiveness in multiple studies and also has an explicit focus on fostering child-therapist relationships. Counselor experience with ASD (more experience) predicted higher alliance with their participants early on, while counselor age (older staff) predicted lower early alliance. Participants who developed early alliance made more friends and became more well-liked by the other kids in their group. These results suggest that alliance may play a role in friendship-making in SSIs for ASD populations, but vary based on therapist characteristics. This finding is particularly important, as it directly supports one of the core elements of the SDARI model, that the building of strong working relationships between counselors and participants is crucial to helping them effectively make friendships.

Lerner, M.D., Mikami, A.Y. (2011). A Social Positive Illusory Bias in Youth with High Functioning Autism Spectrum Disorders. Poster at International Society for Research on Child and Adolescent Psychopathology Conference, Chicago, IL, June 15 – 18.

The Positive Illusory Bias (PIB) is the tendency to systematically over-rate one’s own performance, may be most pronounced in social domains. Because children with ASD have limited ability to understand social cues, it has been suggested that they are unable to accurately estimate their own social competency. This study examined three distinct community-based samples, two of which were drawn from the Spotlight Program (SDARI). This study found evidence of these youth overestimating their social functioning relative to their parents, consistent with the presence of a social PIB. Youths with higher PIB made less hostile attributions to their peers in neutral social situations and exhibited higher PIB. Also, youth whose parents exhibited lower parental self-efficacy themselves exhibited higher PIB, even after accounting for effects of youth depression. Moreover, youth with higher baseline PIB exhibited greater reductions in social anxiety over the course of SDARI. Overall, these findings support that social PIB in youth with ASD may be a valid construct and reveal valuable information about parent and child functioning. Therefore, considering social PIB, or the discrepancy between self-perception and parental perception of social competence among youth with ASD, may be a useful pre-treatment indicator of possible treatment response profiles for interventions such as SDARI. Hence, considering the discrepancy may provide direction for improving interventions for youth with ASD and for working with parents to increase their sense of ability to help their children.

Lerner M.D., Klein, E.F., To Know or to Do: Effects of Social Knowledge versus Performance Training in a School-Based Randomized Controlled Trial. American Psychological Association Annual Convention, Washington, DC, August, 2011

This study sought to differentiate knowledge and performance training outcomes by comparing the effects of Socio-Dramatic Affective Relational Intervention (SDARI), and a widely-used existing social skills program (Second Step; Committee for Children, 1992; 1997) in an 4-week adjunctive summer school-based program. While Second Step’s strategies focus on didactically presenting social knowledge presumed to be lacking in children with ASD, SDARI’s strategies focus on practicing performance of social behavior that this population often fails to do. Based on blinded teacher reports, children in both conditions improved in terms of functional communication, externalizing behaviors, withdrawal, and social skills. However, participants in SDARI showed improvements in functional communication, atypicality, and internalizing symptoms relative to Second Step. These results suggest that the approaches used in SDARI may be particularly effective in improving in improving social functioning when administered adjunctively in a school-based summer treatment program.

Pierce, A., Malavich, E., & Grieves, K. (2010). Putting the Spotlight on Northeast Arc’s Spotlight Program: Examining the Efficacy of a Social Pragmatics Program, Unpublished Manuscript, Salem State College School of Social Work, Salem, MA.

Supplementary social skill programs that are often sought by families to bridge the gap between the needs of youth with autism spectrum disorders (ASD) and services that are offered at schools. In evaluating Spotlight Program, the researchers interviewed the youth participants and their parents to discover their views on the efficacy of the program. This study found that participants in Spotlight had great insight into the program and its efficacy. The researchers also used surveys completed by staff to track growth of participants over one session. The area showing the greatest average improvement was the participants’ level of comfort in attending the program. This finding is important when evaluating the program because it affirms that the staff at Spotlight is invested in providing a comfortable and nurturing environment from which these children can succeed. Overall, participants with a diagnosis of ADHD showed the most improvement.

Lerner M.D., Spies J., Jordan B., Mikami A.Y., Critical Self-Referent Attributions Potentiate Social Skills Intervention Response in Adolescents with Asperger Syndrome & High-Functioning Autism, International Meeting for Autism Research, Chicago, IL, May 8, 2009.

“Critical self-referent attributions (CSA)” represent the tendency to evaluate self negatively or pejoratively from ambiguous peer cues. CSA may be associated with actual peer experiences and linked to maladaptive social behaviors and depressive symptoms, which occurs at high rates of in adolescents with ASD. Two sequential summers’ worth of SDARI 6-week summer program (Spotlight) participants were assessed to see if participation in SDARI was effective in improving parent-reported social skills as compared to a matched comparison group. Autism-related social skills ratings of SDARI participants improved over time relative to comparison condition participants. Those with higher CSA seem to benefit more from SDARI than those with lower CSA, indicating either that SDARI may be optimally effective for individuals with ASDs who are highly self-critical. It may be that such individuals may be more receptive to social skills interventions in general.

Lerner, M.D., Calhoun, C.D., Mikami, A.Y., Biased Self-Perception Predicts Decreases in Social Anxiety for Autistic Spectrum Adolescents Association for Psychological Science Annual Convention, San Francisco, CA, May 23, 2009

This study examines the effect of positive illusory bias (PIB), or the overly-positive rating of a child in terms of his/her own social skills, on change in social anxiety, which often co-occur in individuals with ASD, in an adolescent autism spectrum population during a summer social skills intervention (Spotlight Program). Results demonstrate that participants adolescents with ASD with higher PIB showed greater decreases in social anxiety over the course of the intervention and 4 weeks after the intervention, suggesting that PIB may serve a protective function for the short-term improvement in internalizing symptoms. Therefore, considering PIB among youth with ASD may be a useful pre-treatment indicator of possible treatment response profiles for interventions such as SDARI. Hence, considering the discrepancy may provide direction for improving interventions for youth with ASD.

Lerner M.D., Levine K. (2007). The Spotlight Method: An Integrative Approach to Teaching Social Pragmatics Using Dramatic Principles. Journal of Developmental Processes, 2(2), 91- 102.

This paper outlines the development of a novel theoretically-based, affectively-driven intervention: the Drama-based Social Pragmatic Intervention (Socio-Dramatic Affective Relational Intervention/Spotlight Program) approach designed to address the concerns present in existing research on social pragmatic development for adolescents with autism spectrum disorders (ASD). Theoretical principles as well as specific examples of activities and basic curriculum structure are presented in this paper. Additionally, triumphs (e.g. children’s progress, family support, enrollment, research) and challenges (e.g. tracking children to monitor maintenance and generalized use of learned skills, parent and teacher training) of a program that has successfully used this approach for several years are presented.