Behavior Modification

Volume 31 Number 5
September 2007 682-707
© 2007 Sage Publications
Social-Skills Treatments 10.1177/0145445507301650
http://bmo.sagepub.com
for Children With Autism hosted at
http://online.sagepub.com

Spectrum Disorders
An Overview
Johnny L. Matson
Michael L. Matson
Tessa T. Rivet
Louisiana State University

Marked advances in the treatment of children with autism spectrum disorders

(ASDs) has occurred in the past few decades, primarily using applied behavior
analysis. However, reviews of trends in social skills treatment for children
with ASDs have been scant, despite a robust and growing empirical literature
on the topic. In this selective review of 79 treatment studies, the authors note
that the research has been particularly marked by fragmented development,
using a range of intervention approaches and definitions of the construct.
Modeling and reinforcement treatments have been the most popular model
from the outset, with most studies conducted in school settings by teachers
or psychologists. Investigators have been particularly attentive to issues of
generalization and follow-up. However, large-scale group studies and com-
parisons of different training strategies are almost nonexistent. These trends
and their implications for future research aimed at filling gaps in the existing
literature are discussed.

Keywords: social skills; children; autism spectrum disorders

A utism spectrum disorders (ASDs) are defined by a pattern of behav-

ioral deficits with one of the primary core features including severe
limitations in social reciprocity and communication (Lord & Risi, 1998). In
fact, it has been suggested that social impairments are the most critical ele-
ment in the definition of the disorder (Stella, Mundy, & Tuchman, 1999).
Furthermore, it has been argued that social excesses and deficits may have
some level of independence from other symptom domains of ASDs
(Charman et al., 1997). These assumptions may argue for treatments that
are specific to social skills playing a central role of intervention for children
with ASDs.
682

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 Matson et al. / Social-Skills Treatments Overview 683

Among the typically observed social behaviors present in this neurode-

velopmental disorder are poor eye contact (Willemsen-Swinkels, Buitelaar,
Weijnen, & van Engeland, 1998), failure to initiate social interactions
(Matson, Sevin, Fridley, & Love, 1990), and the presence of odd manner-
isms and speech (Matson & Minishawi, 2006). These symptoms are known
to persist into adulthood and can be extremely debilitating for the afflicted
person (Matson, Boisjoli, González, Smith, & Wilkins, in press). In fact,
without effective intervention, these deficits have tended to increase rather
than diminish with age (Howlin, Mawhood, & Rutter, 2000).
Unfortunately, the definitions for social skills in this population are quite
varied, which may be in part because of the many disciplines and theoretical
orientations of researchers and practitioners who have shown interest in the
area (Matson & Ollendick, 1988; Matson & Wilkins, 2007). For example,
there is a marked overlap between definitions of social skills and commu-
nication, whereas others have framed these target behaviors in the general
developmental context of play (Stella et al., 1999; Wing, Leekam, Libby,
Gould, & Larcombe, 2002). However, we have chosen to define social
skills here in the broader context of behavior therapy and analysis, which
has a long history relative to treatment, with a broad range of populations
(Hersen & Bellack, 1976; McFall & Marston, 1970).1 However, no matter
what the theoretical orientation, professional discipline, or treatment
approach taken, general consensus for children with ASDs is that the prob-
lem is central to the disorder and should be a primary goal in education and
treatment (Torres, Cardelle-Elawar, Mena, & Sánchez, 2003; Trianes &
Fernández-Figarés, 2001).

Definition

For the present review, the accepted definition in the behavior therapy
and analysis literature will be used. Thus, social skills is defined as inter-
personal responses with specific operational definitions that allow the child
to adapt to the environment through verbal and nonverbal communication
(Matson & Ollendick, 1988; Matson & Wilkins, 2007). Training may
consist of the development of new skills or the establishment of a rein-
forcement paradigm that will result in the display of existing skills (Kelly,
1982). Typical social-skills targets for children with ASDs and that have
been the focus of treatment include eye contact, appropriate content of
speech (e.g., saying please, thank you, you’re welcome; showing apprecia-
tion; talking about favorite things), appropriate speech intonation, number of

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684 Behavior Modification

words spoken, appropriate facial affect, appropriate motor movements, ver-

bal disruptions, leaving the group, unpleasant demeanor, conversational
speech, number of interactions, and an overall rating of social-skill profi-
ciency (Matson, Kazdin, & Esveldt-Dawson, 1980). However, by far the
most frequently targeted of skills has been initiation of speech. Thus, social
avoidance appears to be a particularly crucial social-skill area. These skills
have been primarily trained in school settings, although clinics have been
the site of intervention in some cases (Strain & Danko, 1995; Taras,
Matson, & Leary, 1988).
We acknowledge that many precursor skills such as joint attention are
essential to adequate social-skills training (Jones, Carr, & Feeley, 2006).
However, studies of this sort were not included in this analysis because they
did not directly target social skills. A second issue related to the definition
of social skills is the difficulty in sorting out what are socials skills versus
communication skills versus behavior problems and abnormalities. The lit-
erature describes procedures that overlap all three of these major domains.
Given that these three areas are alternately described as the prominent
domains of ASDs, being able to better define demarcating lines among the
constructs has important implications for the etiology, assessment, and
treatment of ASDs. An effort to more carefully parse out these groupings
should therefore be a research priority.

Review Procedures

We did Medline and Google Scholar searches for social-skills training in

children with ASDs. We also did hand searches of Research in Developmental
Disabilities, Research in Autism Spectrum Disorders, Autism, Focus on
Autism and Other Developmental Disabilities, Journal of Applied Behavior
Analysis, Behavior Modification, Journal of Autism and Developmental
Disorders, and Journal of Positive Behavior Interventions. In addition, the
reference list of each article that met criteria for inclusion in our review was
reviewed. Inclusion criteria consisted of children being identified as evinc-
ing ASDs and at least some portion of the sample being 12 years of age or
younger, thus focusing on children versus adolescents or adults. In addition,
a recognized controlled experimental design, single-case design, or group
design was required.
Using these methods, we identified 79 studies for inclusion in our
review. This list is not exhaustive but qualifies as representative (see Tables 1
and 2). Because this is the most recently completed of the social-skills
(text continues on p. 692)

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 Table 1
Summary of Research Studies
Study Participants Trainer Follow-Up Generalization Training Setting

Modeling and reinforcement

Apple, Billingsley, and 2 Asperger’s; age 5 Teachers and peers No No School
Schwartz (2005)
Charlop and Milstein (1989) 3 autistic; ages 6-7 Therapist No Yes School
Charlop, Schreibman, and 7 autistic; ages 5-10 Experimenter Yes Yes School
Thibodeau (1985)
Charlop and Walsh (1986) 4 autistic; ages 6-8 No Yes School, home
Charlop-Christy, Le, and 5 autistic; ages 7-11 Therapists and No Yes After-school
Freeman (2000) students program
Chin and Bernard- 3 autistic; ages 5-7 Psychology student Yes Yes Home
Opitz (2000)
Coe, Matson, Fee, Manikam, 2 autistic, 1 Therapist No No School
and Linarello (1990) intellectually
disabled; ages 5-6
Drasgow, Halle, and 1 autistic; age 3 Parents No No Home
Phillips (2001)
Egel, Richman, and 4 autistic; ages 5-7 Therapist No No School
Koegel (1981)
Garrison-Harrel, Kamps, 3 autistic, 15 typical Peer No No School
and Kravitz (1997) peers; ages 6-7

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Gena, Krantz, McClannahan, 4 autistic; ages Therapist No Yes Residential
and Poulson (1996) 11-18 school
Gonzalez-Lopez and 4 autistic; ages 5-7 Teachers No Yes School
Kamps (1997) 12 nondisabled
peers; ages 5-8

685
(continued)
 Table 1 (Continued)

686
Study Participants Trainer Follow-Up Generalization Training Setting

Harchik, Harchik, Luce, 4 autistic; ages 9-13 Staff Yes Yes Group home
and Sherman (1990)
Hupp and Reitman (2000) 1 PDD-NOS; age 8 Parents 1 year No Outpatient clinic
Ingersoll and Gergans 3 autistic; ages 2-3 Therapist and parent Yes Yes University clinic
(in press)
Jahr, Eldevik, and 6 autistic; ages 4-12 Teachers Yes Yes Residential
Eikeseth (2000) program
Kamps et al. (1992) 3 autistic; age 7 Experimenter and Yes No School
teachers
LeBlanc et al. (2003) 3 autistic; ages 7-13 Experimenter Yes No School
Loveland and Tunali 13 autistic; 13 Down Experimenter No No School
(1991) syndrome
Maione and Mirenda 1 autistic, 2 nondisabled Parent Yes No Home
(2006) peers; ages 5-7
Matson, Sevin, Fridley, 3 autistic; ages 9-11 Psychologists Yes Yes Outpatient clinic
and Love (1990)
Nikopoulos and Keenan 6 autistic, 1 Asperger’s; Experimenter Yes Yes School
(2003) ages 9-15
Nikopoulos and Keenan 3 autistic; ages 7-9 Experimenter Yes No Experimental
(2004) room
Sainato, Goldstein, and 3 autistic, 3 nondisabled Peers No No Preschool
Strain (1992) peers; ages 3-4

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Sarokoff, Taylor, and 2 autistic; ages 8-9 Teachers No Yes Treatment center
Poulson (2001)
Shabani et al. (2002) 3 autistic; ages 6-7 Teacher No No School
Sherer et al. (2001) 5 autistic; ages 4-11 Therapist and peer Yes Yes Home and/or
model research lab
 Taras, Matson, and 2 autistic; ages 9-10 Experimenter Yes No Clinic
Leary (1988)
Taylor, Levin, and 2 autistic Teachers Yes Yes School
Jasper (1999)
Thiemann and Goldstein 5 autistic and related Teacher Yes Yes School
(2001) disabilities; ages 6-12
Wert and Neisworth 4 autistic; ages 3-5 Therapist Yes No School and home
(2003)
Williams, Donley, and 2 autistic; age 4 Experimenters Yes Yes Home
Keller (2000)
Zanolli, Daggett, and 2 autistic; age 4 Teacher No No School
Adams (1996)

Peer mediated
Barry et al. (2003) 4 autistic, 7 nondisabled Peers No Yes Outpatient clinic
peers; ages 6-9
Brady, Shores, McEvoy, 2 autistic; ages 8-10 Peers Yes Yes School
Ellis, and Fox (1987)
Charlop, Schreibman, 4 autistic; ages 4-14 Experimenter Yes Yes School
and Tryon (1983)
Chung et al. (in press) 4 autistic, 3 typical peers; Experimenters and peer No No University clinic
ages 6-7
Goldstein, Kaczmarek, 4 autistic, 1 PDD-NOS, Peers No No School
Pennington, and 10 typical peers;
Shafer (1992) ages 3-6
Kalyva and Avramidis 5 autistic; ages 3-4 Teacher Yes No School

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(2005)

(continued)

687
 Table 1 (Continued)

688
Study Participants Trainer Follow-Up Generalization Training Setting

Kamps, Potucek, Lopez, 3 autistic; ages 6-8 Teacher No Yes School

Kravits, and Kemmerer
(1997)
Laushey and Heflin (2000) 2 autistic or PDD-NOS, Teacher Yes Yes School
approximately 40
typical children;
ages 5-6
McGee, Almeida, Sulzer- 3 autistic, 3 typical Teacher and peers Yes Yes School
Azaroff, and Feldman peers; ages 3-4
(1992)
McGrath, Bosch, Sullivan, 1 autistic, 18 nondisabled Teachers and peers No No School
and Fuqua (2003) peers; ages 3-4
Morrison, Kamps, Garcia, 4 autistic, some typically Graduate students Yes No School
and Parker (2001) developing children
(n not stated);
ages 10-13
Odom and Strain (1986) 3 autistic, 4 nondisabled Peer or teacher No No School
peers; ages 4-5
Oke and Schreibman 1 autistic; age 5 Peers Yes Yes School
(1990)
Pierce and Schreibman 2 autistic; age 10 Peers Yes Yes School
(1995)

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Pierce and Schreibman 2 autistic, 8 typical Peer trainers Yes Yes School
(1997a) peers; ages 7-9
Pierce and Schreibman 2 autistic, 8 typical Peers Yes Yes School
(1997b) children; ages 5-8
 Roeyers (1995) 3 autistic; ages 5-13 Teachers Yes No School
Roeyers (1996) 85 autistic or PDD-NOS, Teachers No No School
48 nondisabled peers;
ages 5-13
Shafer, Egel, and Neef 4 autistic, 16 typical Experimenter No Yes School
(1984) peers; ages 5-6
Strain, Kerr, and Ragland 4 autistic; ages 9-10 Teachers Yes Yes School
(1979)
Reinforcement schedules
or activities
Charlop and Trasowech 3 autistic; ages 7-8 Parent No Yes School
(1991)
Dawphin, Kinney, and 1 autistic; age 3 Teacher No No School
Stromer (2004)
Grindle and Remington 5 autistic; ages 5-10 Teacher Yes No School
(2004)
Ingenmey and Van Houten 1 autistic; age 10 Experimenter Yes Yes Home
(1991)
McEvoy et al. (1988) 3 autistic; ages 4-7 Teacher Yes Yes School
Shearer, Kohler, Buchan, and 3 autistic; preschool age Teacher Yes No School
McCullough (1996)
Taylor and Levin (1998) 1 autistic; age 9 Teacher Yes No School
Zanolli and Daggett (1998) 1 autistic, 1 language Teacher No No Preschool
delayed; ages 2-6

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Stories and scripts
Adams, Gouvousis, VanLue, 1 autistic; age 7 Experimenter No No School
and Waldron (2004)

(continued)

689
 Table 1 (Continued)

690
Study Participants Trainer Follow-Up Generalization Training Setting

Baker, Koegel, and Koegel 3 autistic; ages 5-8 Teachers No No School

(1998)
Charlop-Christy and 3 autistic; ages 8-11 Experimenter No Yes Therapy room
Kelso (2003)
Delano and Snell (2006) 3 autistic, 6 nondisabled Experimenter Yes Yes School
peers; ages 6-9
Krantz and McClannahan 4 autistic; ages 9-12 Teacher Yes Yes School
(1993)
Krantz and McClannahan 3 autistic; ages 4-5 Teacher No Yes School
(1998)
Kuoch and Mirenda (2003) 3 autistic; ages 3-6 Experimenter No No Home or school
Norris and Dattilo (1999) 1 autistic; age 8 Experimenter No No School
Sansosti and Powell-Smith 3 Asperger’s; ages 9-11 Parents Yes No School
(2006)
Woods and Poulson (2006) 2 autistic, 1 other health Experimenter No Yes School
impaired; ages 5-6

Note: PDD-NOS = pervasive developmental disorder, not otherwise specified.

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 Table 2
Miscellaneous
Study Participants Training Method Trainer Follow-Up Generalization Training Setting

Bauminger (2002) 15 autistic; ages 8-17 Social-skills Teachers No Yes School

curriculum
Charlop-Christy, 3 autistic; ages 3-12 PECS Therapist Yes No Outpatient clinic
Carpenter, Le, LeBlanc,
and Kellet (2002)
Ingersoll, Schreibman, 6 autistic, 3 typical Inclusive classroom Teacher No No Preschool
and Stahmer (2001) children; ages 2-3 model
Koegel, Koegel, Hurley, 2 autistic; ages 6-11 Self-management Child No No Clinic, commu-
and Frea (1992) nity, home,
school
Mahoney and Perales 20 autistic; ages 3-5 Parent training Parent Yes No School
(2003)
Matson, Sevin, Box, 3 autistic; ages 4-5 Time delay Therapist Yes Yes University out-
Francis, and Sevin patient clinic
(1993)
Schepis, Reid, Behrmann, 4 autistic; ages 3-5 Communication Experimenter No No School
and Sutton (1998) training
Thorp, Stahmer, and 3 autistic; ages 5-9 Pivotal response Experimenter Yes Yes Home, clinic,
Schreibman (1995) training school

Note: PECS = Picture Exchange Communication System.

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691
692 Behavior Modification

treatment reviews, it also covers more studies than did previous reviews.
However, there are a number of previous reviews and commentaries that
warrant the reader’s attention. We direct the reader to DiSalvo and Oswald
(2002), Krantz (2000), McConnell (2002), Parsons and Mitchell (2002),
Reynhout and Carter (2006), Rogers (2000), Solomon, Goodlin-Jones, and
Anders (2004), Terpstra, Higgins, and Pierce (2002), and Weiss and Harris
(2001). These reviews focus more on descriptions of the treatments,
whereas our review primarily focuses on trends in the data.

Types of Interventions

All the published literature could best be described as operant or social

learning in theoretical orientation. We did not find any studies with an
acceptable research method that could be described as psychodynamic or
humanistic. Different authors of reviews have used several methods of orga-
nizing the available treatment literature. Weiss and Harris (2001), for example,
used the categories of scripts, social-skills training, self-management training,
and classroom interventions. DiSalvo and Oswald (2002) reviewed methods
they described as peer mediated, and Reynhout and Carter (2006) provided
an entire review on social stories. Rogers (2000) took a different approach
including more categories. These procedures included techniques such as peer-
mediated approaches, peer tutoring, social games, self-management, pivotal
response training, video modeling, direct instruction, visual cuing, circle of
friends, and social-skills groups. Obviously, at this point, many different pro-
cedures have been used. We wished to keep the list simple, so we settled on
five groups. These categories were determined by the number of studies pub-
lished on given topics in the 79 treatment studies surveyed. Even so, some
variability within categories was clearly evident. These categories were mod-
eling and reinforcement (33 studies), peer-mediated interventions (20 stud-
ies), reinforcement schedules and activities (8 studies), scripts and stories (10
studies), and miscellaneous (8 studies).

Modeling and Reinforcement

This method is the progenitor of social-skills training. Modeling is typi-

cally done by an individual and confederate (either an adult or child
preschooled in how to respond). They present a social situation that results in
eliciting a response from the target child. Discrete target behaviors such as
eye contact, voice volume, and contact in speech are rated. Feedback on the

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 Matson et al. / Social-Skills Treatments Overview 693

accuracy and appropriateness of the child’s response are given, along with
suggestions for further improvement. Additional practice attempts often fol-
low this feedback. Social and edible reinforcement for appropriate respond-
ing are also used. This procedure is efficient and effective but may be best for
older children with better mental skills and experiences and the ability to gen-
eralize these skills to other settings with minimal additional training.

Peer-Mediated Interventions

The notion that generalization should be programmed into social-skills

treatments is perhaps best exemplified by the employment of peers as train-
ers. Theoretically, the skills developed with normal developing peers will
generalize to various environments and activities in the school setting.
Methods vary, but typically an experimenter, therapist, or teacher works to
teach peers to model and/or prompt appropriate social behaviors for
children with ASDs. The substantial number of studies using this method
points to its popularity. This approach also reinforces the notion of “inclu-
sion” models of education for children with ASDs. The approach is limited
by the setting (generally would need to occur in the school) and age of the
child. Preschool-age children would likely be able to serve in such a capac-
ity in limited ways. Also, the ethical issue of whether children should serve
as “trainers” for other children, although rarely addressed, should be con-
sidered. The cost–benefit to the peer tutor, relative to other school activities,
deserves attention. Also, the potential for subtle coercion, even if unin-
tended, to participate is always present in an adult–child learning situation.
The opportunity to not participate or to end participation should be closely
monitored. Having noted these concerns, the method certainly has merit
and is likely to continue to be used and studied.

Reinforcement Schedules and Activities

This procedure appears to show considerable promise, for young

children in particular. We say this because the treatment is fairly basic, with
reinforcement and, in some instances, prompts or time delays between
prompts and reinforcement (Ingenmey & Van Houten, 1991). No particular
advanced conceptual skills are required, as is the case with modeling or most
peer-mediated interventions. Similarly, edible reinforcers are commonly
employed and, for ASD children, may be more effective in many instances

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694 Behavior Modification

given the fact that social avoidance and aversion to physical contact and
praise can be symptomatic of the disorders. Similarly, using activity sched-
ules can be a very effective procedure that can be provided as part of a rein-
forcement schedule. The need for sameness can make schedules particularly
salient and effective with this population.

Scripts and Social Stories

The reader is referred to Reynhout and Carter (2006) for a detailed

description of this method. In effect, this approach to social-skills training
is a form of school-based curriculum or study plan. The content involves
various lessons on socialization presented by reading from a book, through
presentation on a computer, via music, or by visual symbols. Generally,
several stories are used (e.g., three or four). They may center on one theme
such as social interactions. Other researchers have addressed multiple
themes, including socialization, communication, or aggression. Exercises
are often included and can involve taking social stories home to be read by
the parents or practicing behaviors described in the stories. This format is
particularly adaptable to school settings because the format is similar to
what is employed in many other classroom activities.

Miscellaneous

Several interventions defy categorization into one of the previously

reviewed main topics. Social-skills curriculums have received limited atten-
tion. Similarly, efforts to borrow well-researched treatment strategies for
ASD children, typically used to teach communication and other viable skills,
have been tested. Pivotal response training, Picture Exchange Communication
System, and inclusion in classrooms with typically developing, same-age
peers are examples of these methods. Self-management has also been tried.
However, this procedure’s practicality is markedly limited with young
children, particularly where intellectual disability co-occurs. We found only
one instance of parent training. This procedure is woefully understudied in
our view. Obviously, parents are a great source of support and learning for
their child. Parental skills that can be transported to the home and other
natural environments appears to be an area where much greater resources
should be invested with respect to the treatment literature.

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 Matson et al. / Social-Skills Treatments Overview 695

Selection of Target Behaviors

A particularly concerning issue was the haphazard manner of target

behavior selection. In almost every instance, no rationale was provided for
the selection of target behaviors; they were just described. It is highly
likely, given the complexity and number of social skills and the substantial
number of deficits these children with ASDs exhibit, that many other
social skills require remediation. We argue for more-systematic methods
of identifying these behaviors to ensure that the skill most likely to bene-
fit the individual is targeted for intervention first. For example, a social-
skills measure, such as the Matson Evaluation of Social Skills with
Youngsters (Matson, Rotatori, & Helsel, 1983), might be administered.
Next, deficit skills might be ranked based on ease with which the skill
might be trained and its overall impact on the child’s improved adaptabil-
ity. Furthermore, some skills naturally group together and could be
grouped into clusters. Some skills the child already uses might be suc-
cessfully added in with skills with which the child is deficient, using a
behavioral momentum model. In addition, functional assessment might be
important to include. Some social behaviors might be replacement behav-
iors for stereotypes, self-injury, aggression, and property destruction.
Example social skills that might serve this role include initiating com-
ments, securing attention, and initiating requests. The assessment litera-
ture on social skills and replacement behaviors has advanced to a point
where these technologies should be incorporated into social-skills training
paradigms (Matson & Wilkins, 2007).

Social Validation

Social validity as a construct for evaluating the social significance and

desirability of interventions has been available for several decades. Having
said this, precious few studies we reviewed, less than 10%, used such pro-
cedures. We strongly encourage researchers to incorporate these methods in
future research on social-skills treatment of children with ASDs. Several
methods were used in the studies reviewed. In one study, a focus group of
knowledgeable people evaluated target behaviors for greatest functional
improvement in the natural environment. In addition, they selected social
skills used in previous research (Laushey & Heflin, 2000). In another study,
10 parents of nonhandicapped elementary-age children rated pre–post
videotapes of ASD children interacting with a therapist to assess social

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696 Behavior Modification

importance of treatment effects (Charlop & Milstein, 1989). Gena, Krantz,

McClannahan, and Poulson (1996) had participants’ parents and graduate
psychology students rate videotaped scenarios of children. The raters’ task
was to identify the scene of each vignette where the participants’ behavior
was the most socially appropriate. Other methods, such as questionnaires
aimed at client satisfaction, could also be used along with these measures
of social validation of target behavior selection (conducted prior to inter-
vention) and at the conclusion of treatment. Thus, it is important to note that
social validation procedures have an important role to play prior to and at
the conclusion of therapy.

Experimental Design and Setting

Single-case experimental designs constituted more than 90% of the stud-

ies. Typically, 3 or 4 children participated. Multiple baseline designs were
the most common, and multielement procedures were used in a substantial
number of the studies. It was common to see some form of generalization
and of follow-up. The latter measure was typically in weeks or months ver-
sus years. Most studies were school based, with either teachers or experi-
menters or therapists (usually graduate students, we would deduce) serving
as instructors.
There is plenty of room for additional small-N studies. However, at this
point, there is a particular need for group research designs. These methods
could be used to further establish the viability of given interventions while
demonstrating if large-scale intervention programs for social skills are both
practical and effective. Second, testing different treatment methods against
one another is overdue. Of course, these studies take more resources and are
often harder to conduct. However, even if, as has occurred in many treat-
ment studies, behavioral methods produce similar effects, that would be
very valuable to know. Additional measures about practical issues in imple-
mentation, such as length of time needed to learn the strategy, the attitude
of staff toward specific procedures, the resources needed to implement a
training model, and so on, would be invaluable. Thus, if two methods were
nearly equal in effectiveness but one method required far fewer resources,
it might prove to be more preferred.
Experimenters were consistently aware of the need to program for
generalization. These issues are particularly salient for young children and
persons with intellectual disabilities (ID) and/or ASDs. Thus, it is laudable

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 Matson et al. / Social-Skills Treatments Overview 697

that such efforts have been so frequently made in the ASD social skills lit-
erature. However, given the often intractable nature of social deficits in this
population, longer treatment phases, with much longer follow-ups and
using a broader, more comprehensive set of social behaviors, would be of
great value in future research.
Although early treatment studies on social-skills training were con-
ducted by clinical psychologists, often in clinic settings, children with
ASDs receiving social-skills training has largely been the domain of the
school and has been planned by educators. It is good that these individuals
have been so active. However, those in the mental health disciplines have,
to some extent, dropped the ball. Efforts to develop parent-training models,
in-home programs, and programs that address comorbid psychopathology
of ASD children in the context of social-skills training are greatly needed.

Participant Characteristics

Almost without exception, the children studied are autistic; therefore,

studies on related ASDs are required. Of particular concern for many of the
studies is that the methods of classification are often poorly described or
sorely lacking. Thus, the validity of diagnoses in the bulk of the studies is
questionable. Often no reliability data on diagnoses are present. Frequently,
the diagnoses were not done for the study, and thus we are left with vague
references to diagnoses made by a psychologist, psychiatrist, educator, or
multidisciplinary team. It is suggested that diagnoses be provided for given
studies using evidence-based assessment scales. Interrater data with two
independent diagnoses for at least some subset of diagnosed children would
be optimal. Other related participant characteristics that require evaluation
in the context of different social-skills treatments and their effectiveness are
level of intellectual disability if present, severity of ASD symptoms as a
group and individually, presence of comorbid psychopathology, and type of
comorbidity.
Krantz (2000), in an interesting commentary, noted that children with
ASD should have intervention for social skills well before age 5. She noted
that most children have already developed rudimentary social behavior in
the first 2 years of life and that marked deficits in such skills after 5 may be
in large part because of the absence of early intervention or ineffective
treatment to that point. It is not uncommon for early-intervention programs
to begin at age 2 or 3 (Matson & Minishawi, 2006). However, a review of

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698 Behavior Modification

the social-skills training literature shows that treatment at such early ages
rarely happens. The bulk of the intervention studies targeted children from
6 to 9 years of age, well past the periods now recommended for the initia-
tion of such interventions. This factor is most likely in large part because of
the lack of substantial numbers of programs (Matson, Nebel-Schwalm, &
Matson, 2007). However, in instances where early-intervention programs
are in place, they rarely feature social skills as one of the primary compo-
nents for training. Furthermore, early-intervention programs tend to be
through clinics, schools, residential organizations, or other private organi-
zations. They are not typically linked to the school system and therefore do
not afford continuity in programs as the child grows older. Given the
chronic nature of ASDs, a reformulation of service provision may be war-
ranted. For example, Gabriels, Ivers, Hill, Agnew, and McNeill (in press)
note that based on their follow-up data of 5 years post–early intervention,
it may be necessary to continue the intervention, targeting communication
for below-average cognitive groups while emphasizing social skills for
higher functioning children. Given that skills tend to degrade if not prac-
ticed, particularly in populations with special needs, protracted intervention
strategies should be considered. “Cure,” although a debated topic in the
early-intervention literature on ASDs, may be possible (Matson & Minishawi,
2006). However, even if that occurs, it would be in a subset versus all ASD
children, thus making long-term social-skills training a priority for children
with ASDs. The notion of a chronic condition that can be improved versus
eradicated appears to be more in line with the conventional wisdom at this
time (Howlin et al., 2000).

Trends in Treatment

Figure 1 represents the number of treatment studies published each year

that we reviewed. The most obvious finding here is that the number of stud-
ies has been increasing during the past 25 years. This trend is fairly consis-
tent, and, based on these data, one could expect this trajectory to continue.
The data are broken down a bit further into each of the five treatment cate-
gories in Figure 2. The variety of treatments has increased with time as
well. Thus, not only is the greatest number of studies on social skills with
ASDs in the 2001 to in-press time block, but more variability in the types
of procedures is available now than ever before. Again, this may underscore
the need for studies that better define what treatments are best for what

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 Matson et al. / Social-Skills Treatments Overview 699

Figure 1
Number of Social-Skills Treatment Studies on Children With
Autism Spectrum Disorders Across Time

35

30
Number of Studies

25

20

15

10

0
1979-1985 1986-1989 1980-1995 1996-2000 2001-in press

Years

children under what conditions. Having said this, modeling and reinforcement
has been and continues to be the most popular intervention strategy
in the published research. These results would suggest the viability of this
particular method. However, more clearly establishing comparative studies
using social validation criteria, which has been infrequent in this literature
to date, might help to better determine optimal treatment models.
Most researchers, by the nature of the interventions they describe, assume
a skill deficit on the part of the child. We caution the reader not to quickly
conclude that this is always the nature of the deficit. Another possibility is
that the child has the skills, but the nature of his or her disability or inade-
quate natural reinforcement in the environment may impede the person with
an ASD from evincing the requisite social behaviors. Thus, systematic
assessment of social skills, which can help illuminate the etiology of social-
skill deficits, should be used as a component of case formulation (Matson &
Wilkins, 2007). The issues noted above await future examination. However,
clinical, public, and research interest in ASDs has never been greater.
Hopefully, a good deal of this attention will go toward better understanding
and development of comprehensive social-skill treatments.

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700 Behavior Modification

Figure 2
Number of Social-Skills Treatment Studies by Category
of Treatment Methods on Children With Autism
Spectrum Disorders Across Time

14

12
Number of Studies

10

0
1979-1985 1986-1989 1980-1995 1996-2000 2001-in press

Years
Modeling and Reinforcement
Peer-Mediated
Reinforcement Schedules and Activities
Scripts and Stories
Miscellaneous

Note
1. An excellent and broader overview including adult and peer mediation strategies, play
skills, self-management, scripts, and classroom intervention was previously published in this
journal (Weiss & Harris, 2001).

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 Matson et al. / Social-Skills Treatments Overview 707

Johnny L. Matson is a professor and distinguished research master in the Department of

Psychology at Louisiana State University. His research interests are in developmental disabil-
ities and autism spectrum disorders. He is the author of 450 publications, including 32 books.

Michael L. Matson is a student at Louisiana State University. His research interests are in
developmental disabilities and autism spectrum disorders. He is the author of two books and
eight journal articles on the topic.

Tessa T. Rivet is a doctoral student in clinical psychology at Louisiana State University. Her
research interests are in developmental disabilities and autism spectrum disorders.

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