Social deficits are typically a major source of impairment for individuals with ASD, regardless of cognitive or language ability (Carter, Davis, Klin, & Volkmar, 2005). However, the considerable heterogeneity in the level of cognitive functioning and language ability among individuals with ASD may affect the presentation of social deficits. For example, Bauminger, Shulman, and Agam (2003) found that higher-functioning adolescents initiate social interaction with peers more frequently than do their lower-functioning peers; yet, their interactions are often awkward and sometimes even intrusive or offensive. In fact, high functioning adolescents may be no less affected by social deficits than those with cognitive limitations; rather, their heightened self-awareness and false appearance of being less impaired may actually increase the severity of their social limitations and motivation, perhaps increasing the likelihood of peer rejection and neglect. Consequences of poor social skills often manifest in the form of peer rejection, peer victimization, poor social support, and isolation. Consequently, individuals with ASD generally report higher levels of loneliness and poorer quality of friendships than same aged typically developing peers (Bauminger & Kasari, 2000; Capps, Sigman, & Yirmija, 1996; Humphrey & Symes, 2010). Thus, the importance of social skills training for individuals across the spectrum cannot be underestimated.

When considering the impact and relevance of social skills training, it is important to consider the specific social deficits often shared by individuals with ASD, which contribute to poor social outcomes. Broadly, social deficits often observed across the spectrum and throughout the lifespan include poor social communication, impaired social cognition, and lack of understanding of social cues. These deficits do not appear to improve as a result of development or maturation alone (White, Keonig, & Scahill, 2007); in fact, they may increase as children with ASD enter adolescence, when the social milieu becomes more complex and demanding.

Poor social communication is often exhibited through one-sided conversational patterns, in which the individual with ASD may perseverate on specific topics of personal interest (usually restricted interests), exhibiting difficulty changing conversational topics (Elder, Caterino, Chao, Shacknai, & De Simone, 2006). This inability to carry out a bidirectional conversation and take turns in conversations (Church, Alisanski, & Amanullah, 2000; Klin & Volkmar, 2003) makes it difficult for adolescents with ASD to trade information with social partners and find common interests (Laugeson & Frankel, 2010). One consequence of this failure to identify common ground with peers is that it becomes difficult to form friendships, particularly since friendships are often based upon common interests (Laugeson & Frankel, 2010). Consequently, enhancing social communication might be considered an essential element of social skills training for individuals with ASD, particularly upon reaching adolescence when the social demand for conversational skills increases.

The tendency to be overly verbose in conversations with peers is yet another social error often exhibited by individuals with ASD (Elder et al., 2006), with conversations typically focused on the restricted interests of the person with ASD, paying little regard to the interests of the other person. Poor speech prosody, which includes the natural rising and falling of voice pitch and inflection that occurs during speech, has also been identified as a communication deficit in individuals with ASD (Starr, Szatmari, Bryson, & Zwaigenbaum, 2003). This atypical pattern of speech can often manifest itself in the adolescent or adult with ASD sounding robotic and somewhat pedantic in their manner of talking. Parents often describe their adolescent or adult child as sounding like a robot or a computer (rather than a person), which can be rather odd and even jarring to the listener, making it difficult to interact with neurotypical peers. While atypical patterns of speech might be more appropriately addressed through speech and language therapy, one might argue that remediation of hyper-verbosity and focus on restricted interests in conversations is an appropriate and necessary element of social skills training for adolescents and adults with ASD.

Individuals with ASD are also known to think in very concrete and literal terms, which may impact their social functioning in a variety of ways. Research indicates that youth with ASD often have difficulty understanding and using humor appropriately (Winter, 2003), for example. Social challenges may include difficulty in understanding punch lines to jokes (Emerich, Creaghead, Grether, Murray, & Grasha, 2003) or telling jokes that are socially immature (Van Bourgondien & Mesibov, 1987), often with little regard to the reaction of the audience. Other forms of nonliteral language such as understanding sarcasm, analogies, metaphors, and figurative use of language have also been shown to be problematic for those with ASD (Kerbel & Grunwell, 1998; Starr et al., 2003). Therefore, targeted interventions to teach social skills to adolescents and adults with ASD might address the appropriate use of humor, while avoiding the use of figurative language during instruction.

Impaired social cognition, also known as Theory of Mind, is another hallmark feature of ASD and often includes difficulties in expressing emotions, understanding the feelings of others, and empathizing (Baron-Cohen, 1995; Frith, 2004; Klin & Volkmar, 2003; Krasny, Williams, Provencal, & Ozonoff, 2003; Travis & Sigman, 1998), as well as an overall lack of understanding of social causality (Baron-Cohen, Leslie, & Frith, 1985). Such deficits make it very difficult to make sense of or predict the behavior of others. Consequently, incorporating perspective taking into social skills training is critical to improving social cognition.

Lack of understanding of social cues is another hallmark feature of ASD and manifests in many ways, including difficulty understanding the value and meaning of nonverbal elements of social interaction (Volkmar & Klin, 1998). For example, the use of social touch, gestures, and eye contact are often impaired in adolescents with ASD. Inability to interpret these social cues, assess the formality of social events, and act accordingly also appears to be in deficit (Griffin, Griffin, Fitch, Albera, & Gingras, 2006). Thus, social skills training programs would do well to include the interpretation of nonverbal forms of communication as a target of intervention.

Although most social skills training programs tend to focus on children with ASD (and to a lesser extent on adolescents), deficits in social communication, social cognition, and understanding of social cues remain prevalent for adults with ASD and may even exacerbate, leading to problems with friendships, romantic relationships, skills of daily living, and vocational success (Barnhill, 2007; Howlin, 2000). Although research suggests that social and behavioral symptoms may improve with some consistency in children and adolescents with ASD (Shattuck et al., 2007), this progress tends to slow as these individuals enter adulthood (Taylor & Seltzner, 2010). In fact social challenges specific to ASD may be greatest upon entering adulthood, possibly due to the greater salience and complexity of peer relationships, growing drive toward identity exploration, lack of availability and knowledge about appropriate services, and uncertainty about the balance of responsibility between the individuals themselves and those who support them (Tantam, 2003). Accordingly, adults with ASD often present with more depression and anxiety than their adolescent counterparts (Shtayermann, 2007). Interestingly, higher-functioning adults with greater intelligence and less autistic symptomatology tend to experience more depression, anxiety, social isolation, withdrawal, and peer victimization (Shtayermann, 2007; Sterling, Dawson, Estes, & Greenson, 2008) than lower-functioning individuals. This may be due in part to greater social expectations often placed on higher-functioning adults occurring as a result of placement in less protective and more inclusive settings. With higher-functioning adults with ASD often giving the appearance of seeming more “odd” than disabled by their peers, these individuals may be more susceptible to peer rejection, and consequently greater negative socioemotional outcomes like depression and anxiety. Furthermore, greater self-awareness about peer rejection and “differentness” more likely found in higher-functioning adults with ASD may also contribute to greater depression and anxiety (Sterling et al., 2008). Although outcomes for higher-functioning adults may be less optimistic, research does suggest that having good social skills and adequate social support relate to better quality of life in adults with ASD (Jennes-Coussens, Magill-Evans, & Koning, 2006; Wing, 1983). Thus, the need for effective social skills training programs is of great importance for this highly vulnerable population.

Having good social skills may not only improve quality of life and lessen the risk of depression and anxiety, good social functioning may also predict the ability to form romantic relationships for individuals with ASD, whose romantic functioning generally compares unfavorably to neurotypical peers (Stokes, Newton, & Kaur, 2007). Even though individuals with ASD report sharing similar interests in forming intimate relationships as typically developing individuals, those with ASD often lack the social skills knowledge and competence to appropriately pursue and engage in successful romantic relationships (Mehzabin & Stokes, 2011). For example, individuals with ASD have been known to naively behave in an intrusive manner with potential romantic partners, which may even be perceived as stalking behavior (Stokes et al., 2007). Consequently, instruction in appropriate dating behavior would be an important treatment priority for adults and older adolescents receiving social skills training.

Given the pervasive social deficits seen among adolescents and adults with ASD, it is not surprising that social skills training is an increasingly popular method of treatment for this population. Although typically developing individuals often learn basic rules of social etiquette through observation of peers and/or through instruction from parents in nonclinical settings (Gralinski & Kopp, 1993; Rubin & Sloman, 1984), adolescents and adults with ASD often require additional support and assistance.

Before examining the growing literature base in social skills training for adolescents and adults with ASD, perhaps it is wise to explain why there is such a desperate need for effective social skills interventions. Social skills are an important component of an individual’s behavior, affecting multiple areas of functioning. Orsmond, Krauss, and Selzter (2004) found that adolescents and adults with ASD who possessed well-developed social skills were more likely to participate in various social and recreational activities; the benefit of which includes access to peers and potential friends. The development and maintenance of friendships should not be undervalued. Having one or two close friends may positively impact later adjustment, buffer the impact of stressful life events (Miller & Ingham, 1976), improve self-esteem, and decrease anxious and depressive symptoms (Buhrmester, 1990). On the other hand, poor interpersonal skills are linked with academic and occupational difficulties, rejection by peers, delinquency, early withdrawal from school, and later mental health and adjustment problems (Buhrmester, 1990; Howlin & Goode, 1998; Myles, Bock, & Simpson, 2001; Tantam, 2003). Despite their apparent social difficulties, individuals with ASD often desire friendships and even express concern about their peer relationships (Church et al., 2000), which typically lack closeness and security, often leading to extreme loneliness (Bauminger & Kasari, 2000). Thus, there is a great need for adolescents and adults with ASD to learn the skills necessary for developing and maintaining relationships and to build the social competence required to function successfully in broader social contexts. Given that adolescents and adults with ASD typically desire social interactions, but are lacking the appropriate proficiency, training in appropriate social skills is a logical and necessary approach.

While social skills training has been utilized for decades and is not a particularly unique or novel treatment for individuals with ASD, the research literature suggests that these approaches have not been tremendously effective in improving the social functioning of individuals on the autism spectrum (Rao, Beidel, & Murray, 2008; White et al., 2007). However, certain empirically supported methods of treatment delivery have been identified, which may lead to more successful treatment outcomes. Targeting interventions to focus on common social deficits shared among individuals with ASD, while using evidence-based methods of social skills instruction, may make intervention more effective with this population. Treatment focusing on areas such as social communication, social cognition, friendship skills, understanding social cues, and strategies for handling peer rejection and conflict would fill a large gap. Within these targeted areas, crucial skills for adolescents and adults with ASD might include:

While these are just a few of the targeted areas in which social skills instruction might be focused, the level of functioning, cognitive abilities, and treatment goals of the individuals must also be considered when identifying an appropriate social skills program. Above all else, the skills that are taught through social skills instruction should be relevant to the population being served, and the skills must be ecologically valid.

Ecologically valid social skills are those behaviors that are naturally exhibited by socially accepted adolescents or adults in a given social context. Far too often, social skills instruction includes rules of social etiquette deemed appropriate by adults, clinicians, or researchers, rather than those rules established by the dominant peer group. The problem with this method of social skills instruction is that if the goal is for the adolescent or adult to be accepted by the dominant peer group, teaching the wrong set of social behaviors is futile and ineffective. For example, consider the strategies often taught for handling verbal bullying. What do most adults tell adolescents to do in response to teasing? In our clinical experience, the vast majority of adolescents will say they are told to ignore the person, walk away, or tell an adult. However, if you ask adolescents whether these strategies work, they will often say they do not. Perhaps this is because these strategies are not ecologically valid. Instead, socially accepted teens will often take a very different tactic toward handling verbal teasing. This tactic typically involves giving a short comeback that suggests that what the teaser said did not bother them (Laugeson & Frankel, 2010). For example, the adolescent being teased might respond by saying, “Whatever” or “Anyway” or “Yeah, and?” or “Am I supposed to care?” or any other number of comments that show the teaser they were unaffected. This ecologically valid approach makes the teasing less fun for the teaser and thus, less reinforcing. Consequently, because the teaser finds the experience of teasing less enjoyable, he or she will be less likely to target this individual after repeated failure to elicit the desired response. This strategy for handling verbal bullying is a good example of the importance of teaching ecologically valid skills during social skills instruction. Teaching strategies for handling challenging social situations simply because the skills “appear” to be appropriate is less likely to result in positive social outcomes. Instead, teaching social skills naturally utilized by socially accepted individuals will be more likely to lead to improved social functioning and peer acceptance.

An example of teaching ecologically valid social skills relevant to adults with ASD relates to handling peer pressure. If you were to ask adults with ASD what they are typically told to do in response to peer pressure, they might say they have been told to just say no; a popular catch phrase from the 1980s anti-drug movement, but not particularly ecologically valid. Anecdotally, if you were to inquire as to how adults with ASD often respond to peer pressure, they will often report a tendency to police the person offering the unwanted pressure. For example, they might point out the illegality of offering alcohol to a minor, or taking drugs without a prescription. Even worse, they might accept unwanted offers of peer pressure out of naiveté or lack of effective strategies for turning down such offers. Furthermore, instances of peer pressure might actually result in the termination of a friendship, or the gaining of a bad reputation among the peer group. Thus, just saying no, policing, or accepting unwanted offers are not particularly effective or ecologically valid social skills for handling peer pressure. Instead, if you were to observe the social skills exhibited by socially savvy youth when confronted with peer pressure, you would find a variety of far more effective strategies that would not necessarily result in the termination of a friendship or the acquisition of a bad reputation. For example, effective strategies for declining alcohol or drugs might include (Gantman, Kapp, Orenski, & Laugeson, 2012): making an excuse (e.g., “I have to get up early tomorrow,” or “Alcohol makes me feel sick,” or “I have to drive,” or “My work does random drug testing”); stalling (e.g., “Maybe later,” or “Maybe another time”); or in cases of extreme and persistent pressure, reversing the peer pressure (e.g., “Why do you care so much if I drink?”).

The bottom line is that whatever skills are targeted for treatment, social skills training programs must be adapted to include instruction in ecologically valid social skills. The practice of therapists designing their own curriculum based on their own personal beliefs about what good social skills should include are not likely to lead to positive outcomes. If the goal is to teach socially motivated adolescents and adults with ASD how to interact effectively in a neurotypical world, then understanding the ecologically valid social customs of the dominant peer group is essential.

The social deficits that characterize adolescents and adults with ASD should not only influence which skills are taught, but how they are taught. Research suggests that there are several key ingredients needed to successfully teach social skills. Effective treatment delivery methods for teaching social skills include:

One critical component to social skills training includes the use of behavioral modeling, or role-playing demonstrations. This method involves acting out certain targeted behaviors. For example, adults with ASD receiving instruction about strategies for handling peer pressure would more successfully synthesize this information by visually observing these tactics in action either in person by two social coaches, or by watching a video demonstration of these strategies (video modeling). This method of instruction is particularly important in social skills training as it brings life to the lesson being taught; making concepts that might be viewed as theoretical or conceptual, more real and concrete.

Another important approach to teaching social skills involves the use of behavioral rehearsal with performance feedback through coaching. It is recommended that adolescents and adults with ASD practice newly learned social skills with peer mentors or other group members before practicing these skills outside of the treatment setting. For example, in the case of peer pressure, adults would surely benefit from rehearsal of this newly learned skill in the protective setting of a social skills group, while receiving feedback from trained coaches on their application of the strategies during teachable moments.

There are multiple benefits to in-group behavioral rehearsal. For one, the individual can practice the new skill in a comfortable and supportive environment, thus easing the initial anxiety of using the skill outside of the group setting. Also, it is important for group facilitators to witness the individual’s understanding of and ability to implement the skills they have been taught to avoid misunderstanding or misuse of newly learned skills. Providing performance feedback through coaching during sessions is crucial to troubleshoot difficulty with acquisition and application of skills. Having multiple trainers or coaches in the group to prompt the individual and provide feedback is useful in ensuring that the adolescent or adult does not become dependent on any one person to provide social cues (White, 2011). Given that adolescents and adults with ASD have likely experienced fewer successes in their social lives, it can also be helpful to set up behavioral rehearsals early in the intervention that will guarantee at least some degree of achievement (White, 2011).

Another popular method for teaching social skills to younger children with ASD involves the use of social stories. This technique involves describing a social situation or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and format (Gray & Garand, 1993). The goal of social stories is not necessarily to change the individual’s behavior, but to improve understanding of events and social expectations, which may lead to more effective responses (Gray & Garand, 1993; Swaggart et al., 1995). While social stories are frequently used in social skills interventions for younger children with ASD, the utility of these approaches is fairly unknown for adolescents and adults with ASD. A review of social skills interventions by Reichow and Volkmar (2010) suggested that these visual supports can be effective methods for enhancing social skills in preschool and school-aged children, but the utility of using these approaches with older individuals with ASD is unknown. Thus, more research needs to be conducted on the use of these techniques with adolescents and adults on the autism spectrum.

Scientists are beginning to discover new ways to mesh advances in technology with the implementation and delivery of social skills treatment. For example, Golan and Baron-Cohen (2006) evaluated an interactive systematic guide to emotions, called Mind Reading for its effectiveness in teaching adults with ASD to recognize complex emotions in faces and voices. The multi-media software explores over 400 emotions through the use of video clip demonstrations delivered by a wide range of people, along with definitions and stories for each emotion. Results showed that following 10–20 h of software use over a period of 10–15 weeks, users significantly improved their ability to recognize complex emotions and mental states from both faces and voices. While improvement following the intervention was limited to faces and voices taken from the Mind Reading software, and not tasks of distant generalization, researchers suggest that longer exposure to the software might increase generalization (Golan & Baron-Cohen, 2006). This research illustrates the potential benefit of teaching particular aspects of social skills through augmentative interventions using multi-media software or other technology-based approaches.

While the use of video modeling as a type of intervention for younger children with ASD is becoming more popular as it is easy to incorporate into existing social skills interventions, the benefit of using this approach with older adolescents and adults is still unknown. Video modeling is a form of observational learning in which targeted behaviors are learned by watching a video demonstration and then imitating the behavior of the model. For instance, using the peer pressure example, the adult with ASD might watch a video of a person successfully handling peer pressure, then practice the skill in an imitative manner. Similarly, video self-modeling involves individuals observing themselves performing a targeted behavior successfully on video, and then imitating the targeted behavior. Although a review of video modeling research by Bellini and Akullian (2007) found this type of intervention to be most effective in teaching adaptive skills, they also noted some evidence for targeting social communication and problem behaviors. While visually based learning strategies used in video modeling may be more easily understood by individuals with ASD than material that is presented verbally (Buggey, 2005; Hodgdon, 1995; Quill, 1997), the true benefit and generalization of these strategies with adolescents and adults with ASD is uncertain as video modeling studies are often conducted using single subject designs, resulting in very small sample sizes. Moreover, the use of video modeling and video self-modeling has not been widely tested with older adolescents and adults with ASD. Therefore, assumptions regarding generalization of findings to the broader ASD population (particularly older individuals on the spectrum) are limited, and additional research on these interventions is warranted.