Clinical impact of the Development of Communication Skills in Autism (DHACA) on the development of social skills in children with autism

Silva, Letícia Cristiny Arcanjo da; Silva, Fádja Auxiliadora Alves e; Lima, Rafaela Asfora Siqueira Campos; Montenegro, Ana Cristina de Albuquerque

doi:10.1590/2317-1782/e20250202pt

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Original Article • CoDAS 38 (5) • 2026 • https://doi.org/10.1590/2317-1782/e20250202en linkcopy

Clinical impact of the Development of Communication Skills in Autism (DHACA) on the development of social skills in children with autism

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose To evaluate the clinical impact of the DHACA® method on the development of social skills in children with Autism Spectrum Disorder (ASD).

Methods This longitudinal quantitative intervention study conducted with 23 children with ASD, aged 3 to 6 years, who were nonverbal or minimally verbal. Individual intervention sessions using the DHACA® method were held weekly for 20 weeks. Social skills were assessed before and after the intervention using the ACOTEA-R protocol. Data were statistically analyzed using the Wilcoxon test.

Results There was a significant improvement (p < 0.05) in ten of the sixteen skills assessed, including “responds to name,” “eye contact,” “shared attention,” and “symbolic play.” Other skills, such as “responds to ‘no’” and “takes turns,” showed a tendency toward clinical improvement, although not statistically significant. Only three skills did not show relevant progress.

Conclusion The DHACA® method proved effective in promoting social skills in children with ASD, contributing to greater autonomy and social participation. The results reinforce its clinical potential as a therapeutic resource in both educational and healthcare settings.

Keywords:
Autism Spectrum Disorder; Social Skills; Augmentative and Alternative Communication; Language; Speech Therapy

Skill	1. Before, N = 23	2. After, N = 23	p-value1
Responds to the name			0.003
Mean (SD)	1.52 (0.95)	2.52 (0.95)
Median [IQI]	2.00 [1.00. 2.00]	2.00 [2.00. 3.00]
Eye contact			0.001
Mean (SD)	1.91 (0.95)	2.74 (0.96)
Median [IQI]	2.00 [1.50. 2.00]	3.00 [2.00. 3.00]
Shared attention			0.003
Mean (SD)	1.52 (0.79)	2.43 (1.20)
Median [IQI]	2.00 [1.00. 2.00]	3.00 [1.50. 3.00]
Understands and executes simple commands.			0.003
Mean (SD)	1.74 (1.18)	2.78 (1.09)
Median [IQI]	2.00 [1.00. 3.00]	3.00 [2.00. 4.00]
Imitation			0.008
Mean (SD)	1.39 (1.03)	2.13 (1.22)
Median [IQI]	1.00 [1.00. 2.00]	2.00 [1.00. 3.00]
Expresses affection			0.014
Mean (SD)	0.87 (1.06)	1.48 (1.38)
Median [IQI]	1.00 [0.00. 1.00]	1.00 [0.00. 3.00]
Symbolic play			0.005
Mean (SD)	1.35 (1.23)	2.26 (1.48)
Median [IQI]	1.00 [0.00. 2.00]	3.00 [1.00. 3.00]
Offers or shares something			0.046
Mean (SD)	0.57 (0.79)	1.22 (1.41)
Median [IQI]	0.00 [0.00. 1.00]	0.00 [0.00. 2.50]
Social smile			0.047
Mean (SD)	2.00 (1.24)	2.48 (1.20)
Median [IQI]	2.00 [1.00. 2.50]	2.00 [2.00. 3.50]
Executes social productions.			0.005
Mean (SD)	0.48 (0.99)	1.52 (1.41)
Median [IQI]	0.00 [0.00. 0.00]	2.00 [0.00. 2.00]

Skill	1. Before, N = 23	2. After, N = 23	p-value	Notes
Engaged play			0.053	Substantial increase
Mean (SD)	1.22 (1.13)	2.00 (1.45)
Median [IQI]	1.00 [0.00; 2.00]	2.00 [1.00; 3.00]
Responds to "no"			0.095	Mild improvement
Mean (SD)	1.52 (1.16)	1.96 (1.07)
Median [IQI]	2.00 [0.50; 2.00]	2.00 [2.00; 2.00]
Respects turns			0.095	Trend towards improvement
Mean (SD)	0.26 (0.86)	1.00 (1.60)
Median [IQI]	0.00 [0.00; 0.00]	0.00 [0.00; 2.00]

Skill	1. Before, N = 23	2. After, N = 23	p-value	Notes
Starts activities			0.35	Slight increase
Mean (SD)	2.13 (1.52)	2.43 (1.24)
Median [IQI]	2.00 [0.50; 3.00]	2.00 [1.50; 3.50]
Does not throw tantrums			0.638	Subtle difference
Mean (SD)	2.17 (1.53)	2.43 (1.38)
Median [IQI]	2.00 [1.00; 4.00]	2.00 [2.00; 4.00]
Asks questions			0.371	Initial average = 0
Mean (SD)	0.00 (0.00)	0.22 (0.74)
Median [IQI]	0.00 [0.00; 0.00]	0.00 [0.00; 0.00]

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[1] Caption: SD – Standard Deviation; IQI – Amplitude Interquartile