Three-Character Training of Social Interaction (TCT-S) for Children with High-Functioning Autism Spectrum Disorder: A Pilot Randomized Controlled Trial

Children with high-functioning autism spectrum disorder (HFASD) often experience difficulties in social interaction, which affect both their daily functioning and well-being. This study introduced a novel CBT-based intervention called the Three-Character Training of Social Interaction (TCT-S), which aimed to teach children with HFASD how to appropriately initiate, maintain, and end social interactions as well as understand social cues and adjust their behavior accordingly. The effectiveness of TCT-S was tested through a pilot randomized controlled trial. Thirty-eight children (92% boys) aged six to ten years completed the study, including 18 children in the TCT-S group and 20 children in the treatment-as-usual (TAU) group. The trial demonstrated preliminary feasibility, with a low overall dropout rate (2.6%). Among TCT-S participants, intervention completion was 100%, with high implementation fidelity (95%) and positive parental acceptability ratings. Outcome variables, including social interaction skills and parenting stress, were measured before training (T1), after training (T2), and eight weeks after training (T3). The results showed that children in the TCT-S group demonstrated significant improvements in social interaction skills (ηp2 = 0.093, p = 0.030) compared to the TAU group. In addition, parenting stress decreased significantly in the TCT-S group compared to the TAU group (ηp2 = 0.166, p = 0.041). These findings provide preliminary evidence that TCT-S may be a promising intervention for enhancing social interaction skills among children with HFASD.