Translating Social Skills Interventions for Autism into Public Health Practice: Lessons from a Randomized Controlled Pilot Trial

Maria Angeles Mairena^1,2Carlota Alcover^3,4*Eulàlia Arias-Pujol⁵María Díez-Juan^1,2Marcela Mezzatesta Gava²Neus Elias^1,2Ares Sentenach²Maria Elias²Eulàlia Piera²Mireia González²Marjorie Solomon⁶Aritz Aranbarri^1,2

• ¹Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
• ²Department of Child and Adolescent Mental Health, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
• ³Social Determinants and Health Education Research Group (SDHEd), Hospital del Mar Research Institute, Barcelona, Balearic Islands, Spain
• ⁴Hospital del Mar Nursing School (ESIHMar), Universitat Pompeu Fabra-affiliated, Barcelona, Spain, Barcelona, Balearic Islands, Spain
• ⁵Faculty of Psychology, Education and Sports Sciences, Ramon Llull University, Barcelona, Catalonia, Spain
• ⁶Department of Psychiatry and Behavioral Sciences and the MIND Institute UC Davis, Sacramento, California, United States

Background: Autism Spectrum Disorder (ASD) is marked by significant challenges in social communication and interaction, often accompanied by comorbid neurodevelopmental and mental health conditions such as anxiety and depression (American Psychiatric Association, 2013). These social difficulties can interfere with the development of pragmatic language use, social problem-solving abilities and quality of life. Social skills interventions have shown promising results in addressing these challenges, yet there is a need to adapt such programs for broader, publicly funded settings to enhance accessibility and effectiveness. Objective: This study reports on a randomized, waitlist-controlled pilot efficacy trial evaluating an adapted version of the Social Adjustment Enhancement Intervention Program (Solomon et al., 2004) implemented in a university-affiliated public mental health hospital. Methods: A 10-session group-based intervention was delivered to 79 autistic participants aged 8–17 years. Social behaviors were assessed before and after the intervention using structured observational methodology, and comorbid internalizing symptoms were measured via parent-report standardized questionnaires. Results: Significant improvements were observed in the subgroup of children and in participants with higher verbal IQ, particularly in eye contact and functional communication, as measured through observational methodology. Additionally, a reduction in internalizing symptoms was found among children in the experimental group. In the full sample, no statistically significant effects were observed, although trends in the same direction were noted. Conclusions: Findings support the feasibility and pilot evidence of intervention effects of this adapted social skills program, particularly for younger autistic individuals and those with higher verbal abilities. The results underscore the importance of tailoring interventions to age and cognitive profiles, and highlight the value of accessible, evidence-based approaches in public mental health systems. Further research is needed to optimize intervention design and evaluate long-term outcomes.