Beyond intervention into daily life: A systematic review of generalisation following social communication interventions for young children with autism

Abstract

Researchers have generally considered autistic individuals to have difficulties generalising learned skills across novel contexts. Successful generalisation is necessary for an intervention to have benefits in everyday life beyond the original learning environment. We conducted a systematic review of randomised controlled trials of early social communication interventions for children with autism in order to explore generalisation and its measurement. We identified nine RCTs that provided evidence of initial target learning and measured generalisation, of which eight demonstrated at least some successful generalisation across people, settings, and/or activities. The findings did not support the widely reported generalisation ‘difficulties’ associated with autism. However, generalisation was not consistent across all skills within studies, and one study found no generalisation despite evidence for initial target learning within the intervention context. In general, there are few methodologically sound social communication intervention studies exploring generalisation in autism and no consensus on how it should be measured. In particular, failure to demonstrate initial learning of target skills within the intervention setting and an absence of formal mediation analyses of the hypothesised mechanisms limit current research. We outline a framework within which measurement of generalisation can be considered for use in future trials. To maximise the effectiveness of interventions, the field needs to gain a better understanding of the nature of generalisation among autistic individuals and what additional strategies may further enhance learning. Autism Res 2020, 13: 506–522. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. Lay Summary It is generally considered that autistic individuals experience difficulties applying things they have learned in one context into different settings (e.g. from school to home). This is important to consider for intervention studies. Our review does not support a complete lack of generalisation but instead suggests that after early social communication intervention, autistic children can transfer some skills to new contexts. Overall, there is limited research in this area and further work is needed.

The behavioral effects of cooperative and competitive board games in preschoolers

“…In contrast to our predictions, children displayed similar amounts of cooperative and prosocial behaviors across conditions (cooperative vs competitive board games). Lack of difference between conditions could potentially reflect multiple types of difficulty in detecting generalization effects (Abikoff, 2009; Beach, 1999; Carruthers et al ., 2020; Chandler et al ., 1992; Packer, 2001). For example, it could be that the game learning and test situations are not perceived as sufficiently similar for any acquired role or event schemas to transfer.…”

“…However, although multiple studies have shown that cooperative activities may promote other‐oriented behaviors, not all such studies have successfully trained children to behave more cooperatively (e.g., Paulson, 1974; Sagotsky, Wood‐Schneider & Konop, 1981). There are numerous reasons why generalization or transfer effects should not be taken as given, as illustrated by studies taking developmental psychological (Chandler, Lubeck & Fowler, 1992), clinical (Abikoff, 2009; Carruthers, Pickles, Slonims, Howlin & Charman, 2020) and educational (Beach, 1999; Packer, 2001) perspectives.…”

“…Although the study is primarily practically rather than theoretically motivated, we note that (notwithstanding above‐mentioned caveats about the non‐universality of transfer and generalization effects) there are theoretical reasons to predict generalization in this context. Generalization is a central aspect of children’s development (Carruthers et al ., 2020) and the ability to generalize starts to emerge during the first months in life (Bahrick, 2002). Numerous simpler or more complex processes can result in generalization.…”

Utility of the Autism Diagnostic Observation Schedule and the Brief Observation of Social and Communication Change for Measuring Outcomes for a Parent‐Mediated Early Autism Intervention

“…The ADOS and ADOS‐BOSCC measure a range of social communication skills and repetitive behaviors and restricted interests during structured interaction with a researcher. Within parent‐mediated social communication interventions, such blind‐rated observational assessments with a non‐trained interaction partner are important outcome measures to assess whether target skills have generalized beyond the intervention context [Carruthers, Pickles, Slonims, Howlin, & Charman, 2020; Sandbank et al, 2020]. However, there is a need to consider how best to pair the methodological strengths of measures such as the ADOS and BOSCC, with the priorities of the autistic community and parents [Lai, Anagnostou, Wiznitzer, Allison, & Baron‐Cohen, 2020].…”

Implementation of Islamic religious learning strategies in children with autism in Indonesia

“…Children with autism are children who have obstacles in interaction with others. Children with autism are not without the ability to communicate, it is just that they have limitations in the communication process (Carruthers et al, 2020). In general, children with autism tend to limit themselves and are more interested in their world, thereby ignoring social contact with the wider community.…”