This paper reports a stable improvement in social skills in a 15-year-old boy diagnosed with Asperger's syndrome (AS), after an outpatient treatment with Social Effectiveness Therapy for Children and Adolescents (SET-C), a specific and intensive type of social skill training. Its effectiveness should be further tested in randomized controlled and long-term follow-up studies.
A case report that was published in one of the last issue of Psychotherapy and Psychosomatics describes a novel psychotherapeutic approach in a boy with symptoms related to the autistic spectrum.
Asperger's syndrome (AS) is characterised by marked deficits in social skills, restricted interests and repetitive behaviour. Differently from full-blown autism, however, general cognitive functioning and intelligence are preserved in AS, and there is no significant language delay. It also seems likely that in the forthcoming DSM-V, AS as a denomination will disappear to be encompassed within the autism spectrum disorders. In AS, social skills deficits manifest early in life, and typically worsen during the school years, often resulting in rejection by the peer group; during adolescence and adulthood, the social skills deficits persist and impact negatively on occupational functioning.
This paper reports a stable improvement in social skills in a 15-year-old boy diagnosed with AS, after an outpatient treatment with Social Effectiveness Therapy for Children and Adolescents (SET-C) a specific and intensive type of SST. Parental ratings with the Childhood Asperger Syndrome Test corroborated the clinical diagnosis. To assess the degree of current social impairment and in order to identify the feared social situations, the boy completed the Social Phobia and Anxiety Inventory for Children and Adolescents (SPAI-C) and the Liebowitz scale, while the mother filled in the Child Behavior Checklist (CBCL) 6-18. Moreover, a test of facial emotion identification yielded a higher than-average rate of errors (n = 6, corresponding to 50% misclassified emotional stimuli) in identifying fear, anger and neutral pictures.
The boy also presented with tics, OCD symptoms as reported in the Y-BOCS structured interview (including fear of being contaminated by germs or contaminating others, with consequently prolonged washing/cleaning). This prompted a pharmacological treatment with citalopram 40 mg/day, which yielded a 50% improvement in distress on the Y-BOCS at 2 months. In spite of a good IQ (total: 116, without a significant difference between verbal and nonverbal abilities), academic difficulties had begun during the elementary school and had persisted thereafter and, although he was never given a remedial teacher, he repeated a class at the first year of high school. When interacting with doctors, the boy would talk at length and in details about a restricted span of idiosyncratic interests (such as insects), but proved poor at talking on most other topics, with manifest anxiety whenever conversation shifted to personal issues, such as social activities or personal feelings.
He described himself as having no friends, and there were no peer interactions outsideschool: social situations and peer interactions - even with small groups - were feared and avoided. In treating AS patients with SSTs, the available evidence is in favour of behavioural approaches based on teaching practical skills, rather than extensive cognitive intervention. Therefore, a SST program based on the SET-C was implemented.
The SET-C is a multifaceted behavioural treatment originally aimed at improving social skills and interpersonal functioning in youths with social anxiety and avoidance. This is a goal-directed and practical program particularly oriented at improving several of the language and social skills (such as: initiating a conversation, maintaining a conversation, being assertive) that are suboptimal in AS.