Does a child with significant social skills delays, as indicated by a Social Skills (SS) score of 42, which is 3.62 standard deviations below the mean, require specially designed instruction (SDI) in social-emotional skills due to adverse educational impact on interactions with peers?

From the Guidelines

AA should receive specially designed instruction (SDI) focusing on improving his ability to interact with peers, initiate play, share possessions, respond appropriately to others' requests, participate in classroom discussions, and develop empathy skills, as outlined in the practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder 1. The intervention is necessary because AA's social skills score (SS 42) falls 3.62 standard deviations below the mean, placing him in the High-Risk category, despite displaying age-appropriate behavior in other areas. These social skill deficits are adversely impacting his educational experience by limiting his ability to engage effectively with peers and participate fully in classroom activities. Some evidence-based strategies that can be implemented include guided participation, Do-Watch-Listen-Say, play organizers, and buddy skills for infant/preschool age, and social stories, social skills groups, and peer network/circle of friends for school age, as outlined in the study 1. Early intervention in social-emotional development is critical as these skills form the foundation for future academic success, relationship building, and emotional regulation. The team should develop specific, measurable goals targeting these deficit areas, such as:

• Improving AA's ability to invite other peers to play or engage in activities
• Enhancing his ability to comfort other children when upset and be sensitive to other’s needs
• Increasing his participation in classroom discussions
• Developing his ability to share stories/possessions with others
• Improving his response to peers’ requests for play and sharing of toys/items. The implementation of these strategies should be based on the most recent and highest quality evidence available, and should prioritize AA's morbidity, mortality, and quality of life as the primary outcome.

From the Research

Social Skills Delays and Intervention

• AA is displaying significant delays in social skills, which fall in the High-Risk level, with a score of 42 and -3.62 SD 2, 3, 4.
• The team has determined that AA meets the eligibility criteria and is in need of receiving specially designed instruction (SDI) in social-emotional skills 2, 3, 4.
• An adverse educational impact is noted in AA's ability to play and interact with children, invite other peers to play or engage in activities, comfort other children when upset, and be sensitive to other's needs 2, 3, 4.

Parent-Child Interaction Therapy (PCIT)

• PCIT is an evidence-based intervention that has been shown to be effective in improving parenting behavior, emotional availability, child behavior, and attachment 2, 3, 4, 5.
• PCIT has been found to be effective in reducing disruptive behavior problems in children, as well as improving social-emotional skills 2, 3, 4.
• The therapy consists of two treatment phases: child-directed interaction (CDI) and parent-directed interaction (PDI), and has been shown to be effective in improving parent-child relationships and reducing child behavior problems 2, 3, 4.

Application to AA's Situation

• Given AA's significant delays in social skills and the adverse educational impact, PCIT may be a suitable intervention to address these issues 2, 3, 4, 5.
• PCIT has been shown to be effective in improving social-emotional skills and reducing behavior problems in children, which aligns with AA's needs 2, 3, 4, 5.
• The therapy's focus on improving parent-child relationships and teaching parents special skills to interact with their child may be beneficial in addressing AA's social skills delays and promoting positive interactions with peers 2, 3, 4, 5.