Social skills training for adolescents and adults

What a training contains

According to the guideline, the groups work with fixed rules, education about autism, everyday situations and the participants’ wishes. Typical contents are greetings and small talk, conversation techniques including volume and closeness–distance, recognising one’s own and others’ feelings and wishes, making contact and friendships, joint activity with peers, action planning, emotion regulation and dealing with conflicts. Methods are guided conversation rounds, conveying knowledge about (unwritten) social rules, role plays with video feedback, homework and elements of acceptance and commitment therapy. ^{[2, Rec. 14]} For adults, according to the guideline, identity aspects, dealing with stress and loneliness and wishes for relationships and sexuality were added, among other things. ^{[2, Rec. 17]}

What the 2021 guideline recommended

For school children and adolescents without intellectual disability, the guideline recommended (grade of recommendation A) a manualised, scientifically tested group therapy limited to 3 to 6 months in a fixed group of about 4 to 5 children or adolescents with two therapists, 12 to 18 double sessions of 90 minutes each, with information evenings for parents and homework in everyday life. ^{[2, Rec. 14]} If a group is not possible, a time-limited individual training with many exercises for transfer into everyday life can be offered (consensus-based). ^{[2, Rec. 15]}

For adults without intellectual disability, it likewise recommended a time-limited group therapy (6 to 8 adults, 12 to 18 double sessions); as an alternative, an individual training with exercises and support from the personal environment. ^{[2, Rec. 17, 19]} With intellectual disability, daily-living skills are in the foreground, and individual therapy to promote social interaction with peers should not take place. ^{[2, Rec. 13, 16]}

Several professional associations and Autismus Deutschland submitted dissenting votes on these recommendations: group formats had mostly only been studied in randomised trials in very time-limited form, had shown a “certain added benefit” and should, where possible, stand alongside individual therapy and parent and institutional counselling. ^{[2, Rec. 14, 17]} More on putting therapies in context: Autism-specific therapy and support.

What studies showed

The guideline summarised two reviews with meta-analysis. In the first (5 randomised trials, children and adolescents aged 8 to 17 years with IQ above 84), a medium effect on social competence and on the quality of friendships was found, as well as a decrease in feelings of loneliness; no undesirable effects were reported. ^{[2, Ch. C.4.2, pp. 106 f.]} In the second (18 studies, age 5 to 20 years, IQ above 85), a medium effect across all measurements was seen, a medium effect in the unblinded parent rating, a non-significant effect in the teacher rating, a large effect in the unblinded self-rating and a small to medium effect in blinded behavioural observation. ^{[2, Ch. C.4.2, p. 107]}

On the German programme SOSTA-FRA (study with 228 people aged 8 to 20 years, IQ above 70, 12 weeks), the guideline reported a small effect in the unblinded parent rating that persisted three months later; it rated the risk of bias as unclear. ^{[2, Ch. C.4.2, pp. 108 f.]} For another programme (69 children aged 8 to 11 years), an effect on parent-reported social behaviour was seen directly after therapy, not any more after three months in a greatly reduced subgroup. ^{[2, Ch. C.4.2, p. 109]} For the best-studied programme PEERS (adolescents, 12 to 14 weeks, parallel parent group), a meta-analysis calculated for the guideline showed more knowledge of social skills and better quality of interaction with peers, with high variability between studies. ^{[2, Ch. C.4.2, pp. 110–112]} On psychosocial interventions overall, the guideline stated that, when carried out correctly, no undesirable effects are known, but that these have rarely been studied systematically. ^{[2, Statement 2]}

What you can pay attention to

These are suggestions from the editorial team that follow the recommendations:

• Have a say in the goals yourself. The guideline required that people with autism (for children also the legal guardians) be involved in formulating the therapy goals. ^{[2, Rec. 1]}
• Time limit and review: How long does the training run, how is the benefit measured, what happens afterwards? ^{[2, Rec. 1]}
• Keep everyday life in view: Homework and feedback should support transfer into everyday life. ^{[2, Rec. 14]}
• Your own pace and limits: A training should not aim for you to put on a front permanently. How burdensome adapting can become is described in Masking: when adapting is exhausting. Note: this is an assessment by the editorial team; the guideline itself named no warning here.

What else you should know

• Where such groups exist: In autism outpatient clinics, autism therapy centres and with psychotherapists; notes on contact points: Finding independent advice: what the EUTB does.
• Costs: Whether and how a therapy is paid for depends on the individual case: Financing autism therapy: who pays, who is responsible?.
• Professionals: Adapting therapy and counselling in autism: notes for professionals describes how counselling and therapy can be adapted to people with autism.

Sources and literature

1. DGKJP. Aktuelle Leitlinien (Einträge 028-018 „Gültig bis 04.04.2021“ und 028-047 „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)
2. DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Stand Text 02.05.2021. – Guideline (in German); expired on 23 March 2026