Secret Agent Society Research Articles

Using the FRAME Framework to Understand Therapist-Led Adaptations to the Secret Agent Society Program for Autistic Children

Autistic children often receive support for mental health and emotional challenges through community-based group-format cognitive behavioural therapy (CBT). CBT is manualized, but in community settings, interventions tend to not be delivered as intended. Inherent individual preferences and behavioural challenges in autistic children often lead to intervention adaptations that better suit individual client needs. This study used the FRAME framework to categorize and understand adaptations made to the Secret Agent Society: Small Group (SAS: SG) CBT program for autistic children (8-12 years). Interviews were conducted with therapists and then transcribed, analyzed and thematically coded using the framework. Results indicate that adaptations were primarily unplanned, content-based, and modifications were made based on clients' cognitive capacity. These results can provide useful information to help identify adaptations that do not interfere with the effectiveness of programming.

Utility of a virtual small group cognitive behaviour program for autistic children during the pandemic: evidence from a community-based implementation study

BackgroundAutistic children often experience socioemotional difficulties relating to emotion regulation and mental health problems. Supports for autistic children involve the use of adapted interventions that target emotion regulation and social skills, alongside mental health symptoms. The Secret Agent Society Small Group (SAS: SG), an adapted cognitive behavioural program, has demonstrated efficacy through lab-delivered randomized control trials. However, research is still needed on its effectiveness when delivered by publicly funded, community-based autism providers under real-world ecologically valid conditions, especially within the context of a pandemic. The COVID-19 pandemic has disrupted access to community-based supports and services for autistic children, and programs have adapted their services to online platforms. However, questions remain about the feasibility and clinical utility of evidence-based interventions and services delivered virtually in community-based settings.MethodsThe 9-week SAS: SG program was delivered virtually by seven community-based autism service providers during 2020–2021. The program included the use of computer-based games, role-playing tasks, and home missions. Caregivers completed surveys at three timepoints: pre-, post-intervention, and after a 3-month follow-up session. Surveys assessed caregivers’ perception of the program’s acceptability and level of satisfaction, as well as their child’s social and emotional regulation skills and related mental health challenges.ResultsA total of 77 caregivers (94% gender identity females; Mean = 42.1 years, SD = 6.5 years) and their children (79% gender identity males; Mean = 9.9 years, SD = 1.3 years) completed the SAS: SG program. Caregivers agreed that the program was acceptable (95%) and were highly satisfied (90%). Caregivers reported significant reduction in their child’s emotion reactivity from pre- to post-intervention (-1.78 (95% CI, -3.20 to -0.29), p = 0.01, d = 0.36), that continued to decrease after the 3-month booster session (-1.75 (95% CI, -3.34 to -0.16), p = 0.02, d = 0.33). Similarly, improvements in anxiety symptoms were observed (3.05 (95% CI, 0.72 to 5.36), p = 0.006, d = 0.39).ConclusionsAs online delivery of interventions for autistic children remains popular past the pandemic, our findings shed light on future considerations for community-based services, including therapists and agency leaders, on how best to tailor and optimally deliver virtually based programming.Trial registrationThis study has been registered with ISRCTN Registry (ISRCTN98068608) on 15/09/2023. The study was retroactively registered.

The Effect of the Secret Agent Society Group Program on Parent-Teacher Agreement Regarding Children’s Social Emotional Functioning

Differences in social-emotional processing and functioning characterize children with Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Anxiety Disorders. These can contribute to difficulties forming friendships and secondary challenges such as academic underachievement, depression, and substance use in adolescence. To be optimally successful, interventions typically require parents and teachers to have a shared understanding of a child's social-emotional needs and use consistent support strategies across home and school environments. However, research is yet to examine the effect that clinic-based programs have on parent-teacher agreement regarding children's social-emotional functioning. To the authors' knowledge, this is the first published study to explore this. A sample of eighty-nine youth (aged 8 to 12 years) with ASD, ADHD, and/or an Anxiety Disorder participated in the Secret Agent Society Program. The Social Skills Questionnaire and Emotion Regulation and Social Skills Questionnaire were administered to parents and teachers at pre-program, post-program, and six-month follow-up. Parent-teacher agreement was assessed at each time point. Pearson Product Moment correlations and intraclass correlations indicated that parent-teacher agreement on the measures of children's social-emotional functioning improved over time. These findings suggest that clinic-based programs can contribute to key stakeholders developing a shared understanding of children's social-emotional needs. The implications of these findings and directions for future research are discussed.

Brief Report: Feasibility of Delivering the Secret Agent Society Group Social Skills Program via Telehealth During COVID-19: A Pilot Exploration.

During the Coronavirus Pandemic, many have worried about the adverse impact on the social functioning of children with autism spectrum disorder. Telehealth delivered group social skills programs offer one way to address this concern. This brief report describes modifications made to the telehealth delivery of the Secret Agent Society group social skills program to five children on the Autism Spectrum aged eight to nine years and their caregivers. It also presents parent-, child- and clinician- feedback on the pros and cons of the telehealth program format, and describes how the intervention helped children to transition to more in-person contact at a time when social distancing restrictions were lifted. Recommendations for telehealth delivery of future social skills group interventions are also discussed.

Secret Agent Society: A Randomized Controlled Trial of a Transdiagnostic Youth Social Skills Group Treatment.

Group programs are key for targeting social skills (SS) for children with developmental disorders and/or mental illness. Despite promising evidence regarding efficacy of group treatments, there are several limitations to current research regarding generalizability and effectiveness across diagnoses. This randomized control trial assessed whether the Secret Agent Society (SAS) group program was superior to treatment as usual (TAU) in improving social-emotional functioning for children with Attention Deficit-Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and/or anxiety. Eighty-nine youth (8-12) with ADHD, ASD, and/or an anxiety disorder receiving treatment at hospital-based outpatient clinics were randomized to receive SAS (n = 47) or TAU (n = 42) over a three-month period, at which point TAU participants were offered the SAS intervention. Parent report showed significant improvement in Emotion Regulation (ER) and Social Skills (SS) for youth in SAS vs. TAU (Fs ≥ 6.79, ps ≤ 01). Gains for the SAS condition were maintained at 6-months. Intent-to-treat analysis of teacher report indicated youth in SAS had positive gains in SS (F = 0.41, p = 0.475) and ER (F = 0.99, p = 0.322), though not significantly better than youth in TAU. Clinically reliable improvement rates were significantly higher for SAS participants than TAU for parent and teacher reported SS and ER. Improvements were significant for youth with single and comorbid diagnoses. Results suggest that SAS was superior to TAU in improving SS and ER for youth aged 8-12 with ADHD, ASD, and/or anxiety. Gains maintained in the medium-term. Trial registration number NCT02574273, registered 10/12/2015.

Adaptation of Cognitive Behavior Therapy for Autistic Children During the Pandemic: A Mixed-Methods Program Evaluation

ABSTRACT Distancing requirements due to the pandemic have halted many in-person therapeutic programs, including cognitive behavior therapy (CBT), increasing the likelihood that autistic children with mental health problems will struggle without adequate access to evidence-based care. Policies meant to limit the spread of COVID-19 have inadvertently exacerbated the difficulties experienced by autistic children and further exposed them to vulnerabilities that will impact their mental health. In response, interventions have been adapted for remote delivery. There is limited evidence of the acceptability, feasibility, and clinical utility for treating mental health challenges in autistic children through an online medium, within the context of a pandemic. The current study used an explanatory sequential mixed methods design to assess parents’ experience as they participated in an adapted manualized CBT program (Secret Agent Society: Operation Regulation, SAS:OR; Beaumont, 2013) with their autistic child. Parents reported child-related behavioral changes in pre- and post-program surveys, and both parents and therapists were interviewed about their experience through the program. The quantitative findings suggest that children learned new emotion regulation through online participation, and parents were satisfied with the program. The qualitative data supported the quantitative findings and provided new insight into factors that facilitated child engagement or made participation challenging. Overall, the findings suggest that adapted online CBT programs for autistic children can have clinical utility, and further research is needed to determine their efficacy.

Randomized Controlled Trial of a Video Gaming-Based Social Skills Program for Children on the Autism Spectrum.

Families often face financial and geographical barriers to services for children with autism. The current study explored the effectiveness of a parent-supported adaptation of the computer game-based social skills program Secret Agent Society (SAS). Seventy child-parent dyads were randomized to SAS (n = 35) or a caregiver-supported cognitive skills training game (CIA—control comparison; n = 35), both completed over 10 weeks. Child participants were on the autism spectrum and aged seven to 12 years (60 boys, 10 girls). SAS participants improved more than CIA participants on parent-rated social skills and problem behaviors and teacher-rated social skills. Findings suggest the intervention may be a convenient, cost-effective therapeutic approach, especially during times of restricted face-to-face service access, such as COVID-19.

Adapting an emotional regulation and social communication skills group programme to teletherapy, in response to the COVID-19 pandemic.

The COVID-19 pandemic created an unprecedented situation, whereby essential services within child and adolescent mental health services (CAMHS) were suspended. This created a need to modify regular methods of treatment at a rapid pace, to avoid cessation of clinical intervention and prevent potential regression in mental health. Eighteen children with moderate-to-severe mental health disorders and their parents were attending weekly group cognitive behaviour therapy-based sessions ('The Secret Agent Society' programme) when the Irish Department of Health suspended face-to-face intervention. This report describes how the group sessions were adapted to individualised, online therapeutic triads between each child, his/her parent and their clinician. Whilst internet technology has emerged as a promising solution to shortfalls in therapy services, in-depth exploration is needed to confirm the efficacy of telehealth for children attending CAMHS.

The Association Between Parent Engagement and Child Outcomes in Social Skills Training Programs: Discovering the Secret Agent Society in Partnership

AbstractPrevious research in clinical, community, and school settings has demonstrated positive outcomes for the Secret Agent Society (SAS) social skills training program. This is designed to help children on the autism spectrum become more aware of emotions in themselves and others and to ‘problem-solve’ complex social scenarios. Parents play a key role in the implementation of the SAS program, attending information and support sessions with other parents and providing supervision, rewards, and feedback as their children complete weekly ‘home mission’ assignments. Drawing on data from a school-based evaluation of the SAS program, we examined whether parents’ engagement with these elements of the intervention was linked to the quality of their children’s participation and performance. Sixty-eight 8–14-year-olds (M age = 10.7) with a diagnosis of autism participated in the program. The findings indicated that ratings of parental engagement were positively correlated with children’s competence in completing home missions and with the quality of their contribution during group teaching sessions. However, there was a less consistent relationship between parental engagement and measures of children’s social and emotional skill gains over the course of the program.

6.42 THE EFFECTS OF A CHILD SOCIAL SKILLS TRAINING INTERVENTION ON PARENT-TEACHER AGREEMENT REGARDING CHILDREN’S SOCIAL AND EMOTIONAL FUNCTIONING

Research shows mostly poor inter-rater rater agreement between parents (P) and teachers (T) on measures of children’s social-emotional functioning (SEF). The lack of P-T agreement on children’s SEF can contribute to poor goal clarity and inconsistency of child support across home and school environments. This study examined whether P-T agreement on child SEF improved as a result of participation in the gaming-based Secret Agent Society Program (SAS). SAS consisted of 9 weekly child group sessions, parent-coaching sessions, teacher tip sheets, and a home-school diary to track and reward children’s social-emotional skill use at home and at school. Nonsignificant correlations between P-T-ratings of children’s SEF at pretreatment were hypothesized, whereas significant correlations were hypothesized at posttreatment.

A Novel Intervention for Child Peer Relationship Difficulties: The Secret Agent Society

This study evaluated the effectiveness of the Secret Agent Society (SAS) small group program in improving children’s social skills, social competence and anxiety. Participants included 27 children aged seven to 12 years (20 boys, seven girls) whose parents identified them as experiencing peer relationship difficulties or social anxiety. SAS featured a computer game and other spy-themed activities that children played during nine weekly 90 minute club meetings that were facilitated by University psychology clinic interns. The program also included weekly parent group training sessions, home missions (skills practice tasks) and weekly tip sheets that informed school staff about the skills that children were learning, and how they could support them in applying these skills in the classroom and playground. Program outcomes were evaluated using a range of parent- and child-report measures administered at pre-intervention, post-intervention and at six-week follow-up. Results suggested that SAS led to significant improvements in children’s social skills as reported by parents (Fs (2, 25) ≥ 21.91, ps < 0.0001, partial ɳ2s ≥ 0.46), children’s social competence as reported by parents (F(2, 25) = 17.12, p < 0.001, partial ɳ2 = 0.58), children’s overall anxiety as reported by parents (F(2, 25) = 8.57, p = 0.001, partial ɳ2 = 0.41), and children’s social anxiety as reported by themselves (F(2, 25) = 7.14, p = 0.004, partial ɳ2 = 0.36). All significant treatment effects were maintained at six-week follow-up. These findings suggest that the program holds promise as a community-based resilience program for children, although larger scale controlled trials of the intervention are needed.

Online Interventions for Youth and Parents

This Clinical Perspectives will enhance attendees’ knowledge and understanding of a range of online mental health programs and tools for youth and their parents, including those used to prevent and treat youth anxiety, depression, substance use, explosive outbursts, emotion-regulation difficulties, and social skill deficits. These programs include MoodGYM, SPARX-R, Secret Agent Society, Climate Schools, and the Brake Shop. Findings from empirical evaluations of each program will be presented.

School-based social skills training for young people with autism spectrum disorders

ABSTRACTBackground: The Secret Agent Society (SAS) Program, an intervention to enhance social–emotional skills, was provided by schools for children with autism spectrum disorder (ASD). The program was assessed to determine if it improved social skills at school and home, and whether improvements were maintained.Methods: Eighty-four students participated. Key outcomes were parent and teacher ratings of emotion regulation, social skills, and direct child social problem-solving measures. The standard school curriculum served as the control condition. Phase 1 was a two-group waitlist-control comparison of SAS versus the standard curriculum. Phase 2 was a follow up of all participants before and after the intervention and at 12-months post-intervention.Results: Parent and child measures improved after the intervention but not in the waitlist condition. Improvements in parent, child, and teacher measures were apparent at 12 months.Conclusions: The SAS Program warrants further research as a potential program for schools that serve children with ASD.

32.1 THE SECRET AGENT SOCIETY: A GAMING-BASED SOCIAL SKILLS INTERVENTION

This presentation will provide an overview of the theoretical framework underlying the Secret Agent Society (SAS) Program, together with the program content, format, resources, evidence base, and practical program delivery considerations and recommendations.

The Secret Agent Society Social-Emotional Skills Program for Children With a High-Functioning Autism Spectrum Disorder

This study evaluated a parent-delivered social and emotional skills intervention—the Secret Agent Society (SAS) for children with high-functioning autism spectrum disorders (HF-ASD). The study was a pre–post follow-up design with an 8-week baseline period and 6-week follow-up period. Participants were 38 parents and 41 children recruited from regional/rural Queensland and metropolitan Brisbane, Australia. Child participants completed measures of social skills and emotion management, and parents completed measures related to child behavioral problems, parent self-efficacy, child anxiety, and parent emotional distress at pre-intervention, post intervention, and 6-week follow-up. Analyses of outcomes were conducted with a series of repeated-measures MANOVAs and one-way ANOVAs at post intervention and 6-week follow-up. There were significant improvements in child social skills reported by parents with gains maintained at 6-week follow-up with large effect sizes. Parent self-efficacy, child behavior, and child anxiety levels also improved significantly. In addition, outcomes from the SAS self-directed program were compared with the original clinic-based program conducted by Beaumont and Sofronoff. Results indicated greater changes in social skills outcomes in the clinic-based program and no difference between groups on emotional management strategies. The limitations of the study and clinical implications are discussed.

An Evaluation of Individually Delivered Secret Agent Society Social Skills Program for Children with High-Functioning Autism Spectrum Disorders: A Pilot Study

High-functioning children with autism spectrum disorders display social skill deficits that can have a debilitating impact on their daily lives. The Secret Agent Society (SAS) program has been shown to be effective in improving the social skills of these children when delivered in a group setting. This pilot study evaluated whether individually delivered SAS would yield similar outcomes. Three participants were recruited for the 9-week intervention. Measures of social competence were administered at four points: pretest 1, pretest 2, post-intervention, and 6-week follow-up. Participants showed significant improvement in half of the measures assessing social competence. On a third of these measures, two participants demonstrated improvements to within the range of their typically developing peers. Follow-up results suggested that improvements were maintained at 6 weeks’ post-intervention. Limitations of this study and directions for future research are discussed.

THE SECRET AGENT SOCIETY SOCIAL SKILLS PROGRAM FOR CHILDREN WITH HIGH‐FUNCTIONING AUTISM SPECTRUM DISORDERS: A COMPARISON OF TWO SCHOOL VARIANTS

School is often considered an ideal setting for child social skills training due to the opportunities it provides for skills teaching, modeling, and practice. The current study evaluated the effectiveness of two variants of the Secret Agent Society social skills program for children with high‐functioning autism spectrum disorders (HFASD) in a mainstream school context. Sixty‐nine students aged 7–12 took part in one of two different 10‐week versions of the program (structured versus unstructured) to determine their relative effectiveness. Results suggested that both program variants led to improvements in emotion regulation abilities, social skills, and behavior at school and home, maintained at 6‐week follow‐up. However, the structured intervention generally led to superior treatment outcomes. These results suggest that improvements in social–emotional functioning can be achieved for students with HFASD through time‐limited school‐based interventions. Limitations of this study and directions for future research are discussed.

The Unusual Narrator’s Threshold Position in the Secret Agent Society of Samuel Beckett’s The Unnamable

The current study covers topics ranging across The Unnamable’s narrative, its unusual narrative methodology, its use of storytelling and sense making, and also in an interdisciplinary manner focuses on post-modern philosophy. It positions The Unnamable’s narrative largely at the doorstep of both deconstructive and constructive paradigms and via this approach aims to explore the potential of narrative and narrator in conveying different tacit understandings. This study will be suited for readers because it provides special form of discourse for perceiving the implications of narrator’s experience and also textual analysis. In this regard, the study underlines subjects such as unusual narrator’s threshold position, narrator’s lingual games, predetermined principles and also the concept of panopticon in the Secret Agent Society of the narrative.