RCT examining the effect of treatment intensity for a psychosocial treatment for high-functioning children with ASD

• Reducing the intensity of the treatment did not reduce feasibility or efficacy.
• Fidelity and satisfaction were similar in the high and lower intensity groups.
• Improvements in skills, behaviors, and symptoms were comparable across conditions.

This randomized controlled trial evaluated the effect of treatment intensity (high intensity vs. lower intensity) on the feasibility and efficacy of a comprehensive psychosocial treatment for 47 high-functioning children, ages 7–12 years with ASD (HFASD). All participants received the comprehensive 5-week summer treatment (summerMAX), with half receiving the previously validated high-intensity (HI) program (2:1 child-to-staff ratio) and half receiving a lower intensity (LI) version of the same program (4:1 child-to-staff ratio). Results of the primary analyses indicated significant improvements on non-literal language and emotion recognition (decoding) child testing and parent ratings of targeted and broad social skills, ASD-related symptoms, withdrawal, and behavioral symptoms for the overall group (HI and LI combined) and no significant difference between the conditions (HI vs. LI). Secondary staff clinician ratings corroborated parent ratings. No significant cross-condition differences were observed in fidelity of implementation or in parent, child, or staff clinician satisfaction ratings indicating no reduction in feasibility for the LI group. Overall, results suggested that similar positive outcomes can be achieved when the summerMAX program is administered at a lower intensity level.