Three-Character Training of Question-Asking (TCT-Q) for Children with High-Functioning Autism Spectrum Disorder: A Randomized Controlled Trial

Question-asking is a key component of social communication, and interventions targeting this skill may be able to improve social functioning in children with high-functioning autism spectrum disorder (HFASD). This study introduced a novel intervention method called the three-character training of question-asking (TCT-Q), aimed at teaching children with HFASD how to appropriately use 11 questions in social interactions. The effectiveness of TCT-Q was tested through a randomized controlled trial. Thirty-seven children were assigned to TCT-Q group (<i>n</i> = 19) or treatment as usual (TAU) group (<i>n</i> = 18). Children and their caregivers received two 60 min sessions weekly. Outcome variables were measured before training (T1), after training (T2), and three months after training (T3). Results showed that the question-asking frequency in the TCT-Q group increased significantly after the intervention (<i>p</i>s < 0.001), and the increase was significantly greater than that in the TAU group (<i>η_p</i>² = 0.089-0.370). Although the TCT-Q group showed greater numerical improvements in social communication and autistic mannerisms (<i>p</i>s < 0.05), the group-by-time interaction did not reach statistical significance. In conclusion, TCT-Q is a promising method for enhancing question-asking behaviors and social skills in children with HFASD.