61,66 Meta-analytic work, not specific to ASD, suggests that the alliance may be

the most important common sellekchem factor across psychotherapies.67 Recent work suggests that the alliance may be effective in improving social-communicative function in youth with nonspecific behavior problems68 and ADHD.69 However, almost no research has considered the therapeutic alliance among youth with ASD, with some suggesting that it may even be counterproductive in effectively Inhibitors,research,lifescience,medical addressing treatment goals with this population.70,71 Meanwhile, some psychosocial interventions theoretically posit the importance of developing a warm, collaborative relationship with youth with ASD as a component Inhibitors,research,lifescience,medical of the treatment process,72,73 and some authors have begun to consider its utility in CBT for adults with ASD.74 However, no published research has examined this impact of relationship empirically. In an initial promising unpublished study, Lerner and Anthony75 demonstrated that self-reported alliance early in a group-based SST predicted significant improvements in blinded peer nominations of reciprocated friendships. Thus, there is both

ample literature from other populations—as well as preliminary theoretical and empirical literature with ASD populations—to Inhibitors,research,lifescience,medical suggest Inhibitors,research,lifescience,medical that the alliance should be explored as a common mechanism in psychosocial interventions for ASD. In particular, research should first

consider ASD populations (eg, higher-functioning teens and young adults) and contexts (eg, individual psychotherapy treatment) in which traditional self- and observer-report measures of alliance65 may be most validly and effectively implemented. Likewise, as many interventions (eg, SSTs) are delivered in group Inhibitors,research,lifescience,medical formats, group processes such as group cohesion62 should be explored as well. As it is indeed likely that the process of establishing and defining rapport may differ Dacomitinib for populations with else social-communication difficulties,74 future research should carefully consider the construct validity of alliance in this population. Social knowledge Social knowledge refers to the awareness of the appropriate range of responses in a given social situation. In lay, clinical, and research arenas, it has long been presumed that a deficit in social knowledge is central to problems with social functioning in ASD.20,76 That is, youth with ASD are uniquely thought to “not know what to do” in social situations, even if they have otherwise intact cognitive ability. Because of this presumption, the majority of psychosocial interventions for ASD (especially SSTs) tend to include modules designed to increase social knowledge.