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 Affectively 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 The following is a list of published, presented, and unpublished studies on our model:
Understanding Parent-Child Social Informant Discrepancy in Youth with
High Functioning Autism Spectrum Disorders
Lerner, M.D., Calhoun, C.D., Mikami, A.Y., De Los Reyes, A. (in press)
Understanding Parent-Child Social Informant Discrepancy in Youth with
High Functioning Autism Spectrum Disorders. Journal of Autism and Developmental Disorders. DOI: 10.1177/1088357612450613.
:We investigated discrepancies between parent- and self-reported social functioning among youth with autism spectrum disorders (ASD). Three distinct samples showed discrepancies indicating that parents viewed their children as performing one standard deviation below a standardization mean, while youth viewed themselves as comparably-skilled relative to peers. Discrepancies predicted lower parental self-efficacy, and lower youth-reported hostile attributions to peers, marginally-lower depression, and decreased post-treatment social anxiety. Discrepancies predicted outcomes better than parent- or youth-report alone. Informant discrepancies may provide valuable additional information regarding child psychopathology, parental perceptions of parenting stress, and youth treatment response. Findings support a model where abnormal self perceptions in ASD stem from inflated imputation of subjective experiences to others, and provide direction for improving interventions for youth and parents.
A preliminary randomized controlled trial of two social skills interventions for youth with high functioning autism spectrum disorders
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(3), 145-155.
ABSTRACT: This study examined the effects of two social skills interventions, Socio-dramatic Affective Relational Intervention (SDARI; Lerner, Mikami, & Levine, 2011) and Skillstreaming (Goldstein & McGinnis, 1997), to compare their treatment mechanisms, social performance- and knowledge-training. Thirteen youth with autism spectrum disorders were randomly assigned to four weeks of one day/week SDARI or Skillstreaming. Groups were matched on parent and child demographics and intervention staff training. Participants were assessed on social behavior during treatment sessions, peer sociometrics, staff-reported social skills, and parent-reported social skill generalization. Results indicated that both groups increased in reciprocated friendship nominations and staff-reported social skills. Relative to Skillstreaming participants, SDARI participants liked and interacted more with each other after a single session. 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. Implications for research and practice are discussed.
The Therapeutic Alliance In a Social Skills Intervention for Adolescents with ASDs
Lerner, M.D., Anthony, M. (2011). Presented at 2011 International Meeting for Autism Research, San Diego, CA, May 12 - 14.
ABSTRACT: While social skills interventions (SSIs) for youth with autism spectrum disorders (ASDs) have recently accumulated sufficient evidence to be considered "empirically-supported" (Reichow & Volkmar, 2009), the essential therapeutic ingredients remain unknown. The relationship with those administering such interventions may represent such an ingredient (Gutstein & Sheely, 2002). That the relationship is a mechanism of therapeutic change is consonant with established literature on the therapeutic alliance. Alliance relates to outcomes in child psychotherapy (Shirk & Karver, 2003), is influenced by therapist experience with target populations (Ackerman & Hilsenroth, 2003), and may play a role in friendship-making in SSIs for other populations (Lerner, Mikami, & McLeod, in press). However, alliance has never been examined in SSIs for youth with ASDs. Identifying the role of alliance in this population could provide direction in unpacking essential components of SSIs for this population.
Thirty-four youth (9 - 16 years; 23 male), primarily with ASDs, in a 6-week summer SSI with an explicit focus on fostering child-therapist relationships (Lerner, Mikami, & Levine, 2011) completed reports of their social skills (Social Skills Rating System; Gresham & Elliott, 1990) and social anxiety (Social Anxiety Scales; La Greca, 1999) immediately before and after the SSI. Additionally, they completed blinded sociometric ratings of their peers in their SSI group (Coie, Dodge, & Coppotelli, 1982), and alliance with group therapist (Therapeutic Alliance Scale for Children; Shirk & Saiz, 1992) after the first (early) and last (endpoint) week of the program. Their parents completed a baseline measure of child autism symptoms (Social Responsiveness Scale; Constantino & Gruber, 2005) and their own measure of alliance.
CONCLUSIONS: Therapist experience with ASDs predicted higher early child alliance, while therapist age predicted lower early alliance. Youth reporting higher early alliance increased in the number of reciprocated friends they made in the SSI relative to those with lower early alliance. Additionally, parents who reported the greatest increase in alliance reported the greatest decrease in child problem behaviors, and had children who became more well-liked. These results suggest that alliance may play a role in friendship-making in SSIs for ASD populations, but vary based on therapist characteristics.
To Know or to Do: Effects of Social Knowledge versus Performance Training in a School-Based Randomized Controlled Trial
Lerner MD, Klein, EF, American Psychological Association Annual Convention, Washington, DC, August, 2011.
ABSTRACT: This study compared the effects SDARI and a widely-used existing social skills program (Second Step; Committee for Children, 1992; 1997) in an adjunctive summer school-based program. In a 4-week daily summer program, participants were randomly assigned to 30 minutes/day of SDARI or Second Step. Teachers unaware of the condition to which children were assigned rated them using the Behavior Assessment Scale for Children-2 (Reynolds & Kamphaus, 2004). Results indicated improvements in both conditions improved in terms of functional communication, externalizing, withdrawal, and social skills. However, participation in SDARI evinced 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. Implications for research and treatment are discussed.
Socio-Dramatic Affective-Relational Intervention for Adolescents with Asperger Syndrome: Pilot Study
Lerner, M.D., Mikami, A.Y., Levine, K. (2011) Autism, 15, 21-42.
ABSTRACT: This study examined the effectiveness of a novel intervention called ‘socio-dramatic affective-relational intervention’ (SDARI), intended to improve social skills among adolescents with Asperger syndrome and high functioning autism diagnoses. SDARI adapts dramatic training activities to focus on inn vivo practice of areas of social skill deficit among this population. SDARI was administered as a six-week summer program in a community human service agency. Nine SDARI participants and eight age- and diagnosis-group matched adolescents not receiving SDARI were compared on child- and parent-report of social functioning at three week intervals beginning six weeks prior to intervention and ending six weeks post-intervention. Hierarchical Linear Modeling (HLM) was used to estimate growth trends between groups to assess treatment outcomes and post-treatment maintenance. Results indicated significant improvement and post-treatment maintenance among SDARI participants on several measures of child social functioning. Implications for practice and research are discussed.
The Spotlight Method: An Integrative Approach to Teaching Social Pragmatics Using Dramatic Principles
Lerner M.D., Levine K. (2007), Journal of Developmental Processes, 2(2), 91-102.
ABSTRACT: Effective techniques for social pragmatic development for adolescents with Asperger syndrome have been elusive in the existing body of research literature. Attempts to structure interventions that lead to effective generalization of skills beyond the clinical setting have been particularly inconclusive. This paper outlines the development of a novel theoretically-based, affectively-driven intervention: the Drama-based Social Pragmatic Intervention approach designed to address the concerns present in existing research. Theoretical principles as well as specific activities and basic curriculum structure are presented. Additionally, triumphs and challenges of a program that has successfully used this approach for several years are presented.
Critical Self-Referent Attributions Potentiate Social Skills Intervention Response in Adolescents with Asperger Syndrome & High-Functioning Autism
Lerner MD, Spies J, Jordan B, Mikami AY, International Meeting for Autism Research, Chicago, IL, May 8, 2009.
ABSTRACT: Background:A need exists for empirically-validated interventions addressing social skills in adolescents with autism spectrum disorder (ASD) and for a greater understanding of mechanisms of change in interventions (White, Keonig, Scahill, 2007; Kazdin, 2008). Critical self-referent attributions (CSA)—social cognitions representing the tendency to derive pejorative self-evaluations from ambiguous peer cues—have been shown to be associated with actual peer experiences and are thought to be linked to maladaptive social behaviors and depressive symptoms in typical child populations (Prinstein, Cheah, Guyer, 2005), but to our knowledge have never been assessed in ASD populations. Given the high rates of these symptoms in adolescents with asperger syndrome (AS) and high-functioning ASD (HFA) (Williamson, Craig, Slinger, 2008), we expect CSA to be relevant in this population. Given that CSA entails a heightened sensitivity to social failure, we hypothesize that it may facilitate receptiveness to interventions designed to address such failure, thereby potentiating social skills intervention effects. Objectives: 1. To ascertain whether participation in the SDARI 6-week summer program (Spotlight) is effective in improving parent-reported social skills as compared to a matched comparison group in two sequential summers' worth of Spotlight participants. 2. To determine if baseline CSA predicted response within this intervention. Conclusions: Results support the hypothesis that autism-related social skills ratings of SDARI participants improve over time relative to comparison condition participants, and that CSA is a significant predictor of these effects. 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 or that such individuals may be more receptive to social skills interventions in general. Further research should assess both the specific efficacy of SDARI for ASD populations and the role that social cognitive factors such as CSA play for this population in terms of both taxonomy and intervention.
Biased Self-Perception Predicts Decreases in Social Anxiety for Autistic Spectrum Adolescents
ABSTRACT: This study examines the effect of positive illusory bias (PIB), or the overly-positive rating of a child in terms of their own social skills, on change in social anxiety in an adolescent autism spectrum population during a summer social skills intervention (Spotlight). Results demonstrate that participants in the intervention experienced a decrease in social anxiety, but that higher PIB significantly predicted greater decreases in social anxiety over the course of the intervention. Implications for research and treatment are discussed.
Putting the Spotlight on Northeast Arc's Spotlight Program: Examining the Efficacy of a Social Pragmatics Program
Pierce, A., Malavich, E., & Grieves, K. (2010). Unpublished Manuscript, Salem State College School of Social Work, Salem, MA.
ABSTRACT: Youth that have various conditions, such as Asperger’s Syndrome, Attention Deficit Hyperactive Disorder (ADHD), Pervasive Developmental Disorder (PDD), and Autism, which effect several areas of development, also struggle with social skill development. Social skill development is often not a focus in the academic arena. As a result, supplementary, self-pay, social skill programs have been created to bridge this gap. The Northeast Arc’s Spotlight program is a drama-based social skills program servicing youth in the North Shore area of Massachusetts. Very little literature exists on the efficacy of these programs. In evaluating Spotlight, the researchers spoke to the youth participants and their parents to discover their views on the efficacy of the program. Few studies choose to interview children and their parents. This study found that the subscribers of Spotlight had great insight into the program and its efficacy. The researchers also used surveys completed by staff to track growth over one session. Overall, participants with a diagnosis of ADHD showed the most improvement.