Developing an Adaptive Treatment Strategy for Peer-Related Social Skills for Children With Autism Spectrum Disorders

The purpose of this study was to understand the trajectories of children's response to an intervention prior to the end of the treatment in order to inform adaptive treatment models for future studies. Participants with autism spectrum disorder (ASD) were drawn from a randomized controlled trial comparing 2 different social skills interventions at children's schools. We excluded children with ASD who entered the study with at least 80% time engaged (the average time of neurotypical children in the same classes) in order to examine only those who were engaged below the typical developing peers' average percentage of time engaged. The final sample included 92 children with ASD (82% male, average age = 8.14 years, average IQ = 89.6). We explored whether playground engagement scores measured at entry and midpoint of treatment predicted their engagement scores at end of treatment using the Classification and Regression Tree (CART) method. Using the CART approach, 4 meaningful subgroups based on children's playground engagement scores measured at entry and changes from entry to midpoint were identified. These data suggest that measurements of children's behavior midstudy can be used to predict children's treatment outcomes. Such data may be used to inform decisions to augment or alter programming prior to treatment end in order to tailor intervention to best meet the needs of individual children.