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PSYCHOSOCIAL TREATMENT EFFECTS OF THE PEERS SOCIAL SKILLS INTERVENTION
FOR YOUNG ADULTS WITH AUTISM SPECTRUM DISORDERS
Alexander Gantman, Steven K. Kapp, Kaely Orenski & Elizabeth A. Laugeson
UCLA Semel Institute for Neuroscience and Human Behavior
Conflict of Interest: The authors have been funded by NIH T32 (MH17140, Leuchter PI) and Organization for Autism Research (20093336, Gantman PI)
BACKGROUND
Research on Autism Spectrum Disorders (ASD) has been extensive in the child and
adolescent literature. Difficulties in social skills acquisition and generalization are often
the most significant challenges for both children and adults with ASD. Among young
adults, social deficits can lead to significant impairment in daily living, vocational skills,
and social relationships (Klin & Volkmar, 2003; Roy, 2009) and psychological well being
(Hofvander, 2009). Such deficits may also lead to symptoms of depression, anxiety,
and/or behavior disorders (Barnhill, 200; Hofvander, 2009).
Despite all we know about these deficits and symptom clusters, there is a tremendous
void in the treatment research which encompasses transitional youth and young adults
with ASD. Only a few studies have examined the difficulties these young adults endure
during this highly socially, emotionally, and physically demanding period of their lives;
yet, research suggests that the effects of social deficits are greatest in adolescence and
young adulthood (Tantam, 1991). This period encompasses school transition, finding
employment, building a social network, increasing contributions to household
responsibilities, greater involvement in the community, and the development of romantic
relationships. Research reveals that only about 15 percent of adults with ASD have
friendships with shared enjoyment, and even fewer adults are married (Howlin et al.,
2004; Hofvadner, 2009). It is suggested that lack of social skills in young adults with
ASD may lead to more isolation and thus a lack of personal and romantic relationships,
vocational difficulties, and increased psychopathology, such as higher rates of
depression and generalized anxiety (Hofvadner, 2009), possibly due to higher rates of
victimization.
Numerous studies have shown that social skills are an important factor in long term
adjustment of individuals with ASD. Consequently, improving social functioning in young
adults with ASD would be expected to also have a positive impact on the psychosocial
functioning of these individuals. However, to date there do not appear to be any
evidence-based treatment interventions focused on improving social skills for young
adults with ASD. The purpose of the current study was to investigate the effectiveness of
a caregiver-assisted social skills intervention for young adults with ASD.
PARTICIPANTS
• Inclusion criteria for this study were that all young adults must:
1) Be between 18 to 23 years of age.
2) Have an IQ Composite on the K-BIT-2 > 70.
3) Have a previous diagnosis of autism, Asperger's Disorder or PDD-NOS.
4) Have social deficits as defined by a Vineland Adaptive Behavior Scale – Second
Edition (VABS-II) Socialization Standard Score below 1 SD (< 85).
5) Be fluent in English.
6) Have a caretaker who is a fluent English speaker and who is willing to participate
in the study.
• Exclusion criteria for this study were that young adults could not have a:
1) History of a diagnosis of major mental illness (e.g., schizophrenia, bipolar disorder).
2) Physical disability or a medical condition that would prevent them from participating
in the group.
STUDY DESIGN
• The purpose of this study was to investigate the effectiveness of PEERS for Young
Adults, a 14-week caregiver-assisted social skills training program for transitional
youth between 18-23 years of age with Asperger’s Disorder, High Functioning Autism
or Pervasive Developmental Disorder NOS.
• The intervention was adapted for use with transitional youth from a pre-existing
evidence-based social skills intervention known as PEERS (Program for the
Education and Enrichment of Relational Skills), developed at UCLA by Laugeson &
Frankel (2010).
• The study used a randomized delayed treatment control group design.
• The intervention consisted of fourteen 90-minute sessions, delivered once a week
over the course of 14-weeks at The Help Group community mental health agency.
• Young adults with ASD attended small group sessions with other peers with similar
social delays.
• Caregivers attended separate concurrent sessions that instructed them on key
features of the young adult intervention and methods for supporting the development
of skill acquisition through social coaching.
• Ecologically valid skills were taught through didactic instruction, role-playing,
behavioral rehearsal with performance feedback, and weekly caregiver-assisted
socialization homework assignments.
• The project assessed outcomes at pre- and post-test looking at caregiver-reported
social skills, social skills knowledge, social responsiveness, empathy, frequency of
social get-togethers, and family/friendship/romantic loneliness.
OVERVIEW OF TREATMENT
Conversational skills
Nonverbal communication
Electronic communication
Entering and exiting conversations
Appropriate use of humor
Choosing appropriate peer groups
Having successful get-togethers
Being a good sport
Handling teasing and bullying
Handling disagreements
Handling peer pressure
Dating etiquette
MEASURES
Caregiver Measures:
Social Skills Rating System (SSRS)
Social Responsiveness Scale (SRS)
Empathy Quotient (EQ)
Quality of Socialization Questionnaire (QSQ)
Young Adult Measures:
Test of Young Adult Social Skills Knowledge (TYASSK)
Social and Emotional Loneliness Scale for Adults (SELSA)
Difficulties in Emotion Regulation Scale (DERS)
RESULTS
DISCUSSION
Findings suggest that the use of PEERS for Young Adults, a caregiver-assisted
manualized social skills intervention for young adults with ASD, is effective in improving
social skills. An overall improvement in social skills was reported by caregivers in the
treatment group as compared to the delayed controls. Results from caregiver reports
also suggest that young adults’ social responsivity significantly increased and socially
relevant ASD symptoms significantly decreased by the end of the treatment. Similarly,
empathic abilities and emotional awareness, which are thought to function as a marker
of ASD symptoms, improved at the end of treatment. Social skills knowledge as well as
the frequency of invited and hosted get-togethers significantly improved. Finally, young
adults reported a significant decrease in loneliness as a result of the intervention. Thus,
PEERS for Young Adults appears to be effective in improving social skills and the
development of social relationships; a much needed intervention for young adults with
ASD.
References:
Barnhill, G. P. (2001). Social attribution and depression in adolescents with Asperger
Syndrome. Focus on Autism and other Developmental Disabilities, 16, 46–54.
Hofvander, B., Delorme, R., Chaste, P., Nyde´n, A., Wentz, E., Stahlberg, O., et al.
(2009). Psychiatric and psychosocial problems in adults with normal-intelligence
autism spectrum
disorders. BMC Psychiatry, 9, 1-9.
Howlin, P., Goode, S., Hutton, J., & Rutter, M. (2004). Adult outcome in children with
Autism. Journal of Child Psychology and Psychiatry, 45, 212–29.
Klin, A., & Volkmar, F., R. (2003). Asperger Syndrome: Diagnosis and external validity.
Child and Adolescent Clinics of North America, 12(1), 1-13.
Laugeson, E.A. & Frankel, F. (2010). Social skills training for teenagers with
developmental and autism spectrum disorders: The PEERS Treatment Manual. New
York, NY: Routledge.
Tantam, D. (1991). Asperger’s syndrome in adulthood. In U. Frith (Ed.) Autism and
Asperger syndrome pp.147–83). Cambridge: Cambridge University Press.