Transcript Parent-Assisted Social Skills Training Program for

PARENT-ASSISTED SOCIAL SKILLS TRAINING PROGRAM FOR YOUNG ADULTS WITH
AUTISM SPECTRUM DISORDERS:
THE UCLA PEERS PROGRAM
Alexander Gantman, Psy.D. & Elizabeth A. Laugeson, Psy.D.
UCLA Semel Institute for Neuroscience and Human Behavior
Funded by NIH T32 MH17140 (Leuchter, PI)
PARTICIPANTS
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 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). Such deficits may also lead to symptoms
of depression, anxiety, and/or behavior disorders (Barnhill, 2001).
Despite all we know about these deficits and symptom clusters, there is a tremendous
void in the treatment research which encompasses transitional youth/young adults
(ages 18-22). Only a few studies have examined the difficulties these young adults
endure during this highly socially, emotionally, and physically demanding period of
their lives. Studies show 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 (Collins et al., 2000; Stokes & Kaur, 2005 ). Research indicates
that only about 15 percent of adults with ASD had friendships with shared enjoyment,
and even fewer adults were married. 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, possibly due to higher rates of
victimization (Shtayermman, 2007)
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.
PRELIMINARY STUDIES
In two recent clinical trials investigating the efficacy of a parent-assisted
manualized social skills intervention for teens with ASD, known as PEERS (Program
for the Education and Enrichment of Relational Skills), findings revealed significant
improvement in social functioning among adolescents (Laugeson et al., 2008;
Laugeson et al., 2009; see Table 1). In comparison with a delayed treatment control
group, the treatment group significantly improved their social skills knowledge,
improved the quality of their friendships, increased the frequency of hosted gettogethers with peers, and improved their overall social skills as reported by parents
(Laugeson et al., 2009); moreover, these social skills gains were maintained at a
three-month follow-up assessment (Laugeson et al., 2008).
Table 1. Mean Pre- and Post-Treatment Scores for Statistically Significant Outcome
Variables for Treatment and Delayed Treatment Control Groups
(Standard Deviations are in Parentheses).
_______________________________________________________________________
Variable
Group
Treatment
n = 17
Delayed Treatment Control
n = 16
Pre
Post Pre
Post
p<
Teen measures
TASSK
13.3 (2.4) 19.6 (1.4) 12.6 (3.6) 13.3 (3.8)
QPQ Host
1.1 (1.4) 3.2 (2.2) 0.6 (0.9) 1.1 (1.3)
FQS
16.8 (3.4) 17.2 (4.0) 18.1(3.9) 16.6 (4.6)
Parent Measure
SSRS Social Skills 80.2 (8.8) 89.7 (12.1) 77.9 (12.1) 79.8 (11.7) .05
.001
.025
.05
• Inclusion criteria for this study are that all young adults must:
1) Be between 18 to 22 years of age
2) Have an IQ Composite on the K-BIT-2 > 70
3) Have a diagnosis of autism, Asperger's Disorder or PDD-NOS
4) Have social skill deficits as measured by a Vineland Adaptive Behavior Scale –
Second Edition, Socialization Standard Score below –1 SD (< 85)
5) Be fluent in English
6) Have a caretaker who is a fluent speaker of English and who is willing to
participate in the study
• Exclusion criteria for this study are that young adults have:
1) A history of a diagnosis of major mental illness (e.g., schizophrenia, bipolar
disorder)
2) A physical disability or a medical condition that would prevent participation in the
group (i.e., prevent participation in outdoor activities)
STUDY DESIGN
• The purpose of this pilot study is to investigate the effectiveness of a 14-week
caregiver-assisted social skills training program for young adults between 18-22
years of age with Asperger’s Disorder, High Functioning Autism or Pervasive
Developmental Disorder NOS
• The study will use a randomized delayed treatment control group design
• The intervention consists of 14-weekly 90-minute sessions delivered at The Help
Group, a community mental health agency
• Young adults will attend small group sessions (n=10)
• Caregivers will attend separate concurrent sessions that will instruct them on key
features being taught to young adults
• Ecologically valid skills will be taught through didactic instruction, role-playing,
behavioral rehearsal with performance feedback, and weekly caregiver-assisted
socialization homework assignments
• The project will assess outcome at pre and post treatment
STRUCTURE OF THE SESSIONS
Young Adult Sessions
• Review of homework from the previous week – troubleshoot homework problems
• Didactic presentation of social skills lessons
• Behavioral rehearsal with performance feedback from coaches
• Reunification with caregivers and young adults to negotiate homework assignment
Caregiver Sessions
• Review of homework from the previous week – troubleshoot homework problems
• Didactic presentation of the young adult social skills lesson
• Assign socialization homework for the coming week
• Reunification with caregivers and young adults to negotiate homework assignment
OVERVIEW OF INTERVENTION
• Conversational skills: trading information, rules for having a two-way
conversation
• Electronic communication
• Entering and exiting conversations
• Appropriate use of humor
• Expanding social network
• Organizing social activities with friends
• How to handle social rejection
• Handling arguments and disagreements
• Dealing with peer pressure and exploitation (sex, drugs and alcohol, illegal
activities)
• Dating etiquette
OUTCOME MEASURES
Outcome Measures
• Young adult and caregiver reports of friendship quality, social skills
knowledge, psychosocial functioning (i.e., anxiety,
loneliness, empathy)
• Caregiver reports of social functioning
• Independent rater reports of social functioning
REFERENCES
Barnhill, G. P. (2001). Social attribution and depression in adolescents with Asperger’s
Disorder. Focus on Autism and other Developmental Disabilities, 16, 46–54.
Collins, D., Davis, M., & Vander Stoep, A. (2000). Transition, a time of developmental and
institutional clashes. In H. B. Clark & M. Davis (Eds.), Transition to adulthood: A
resource for young people with emotional or behavioral difficulties (pp. 3–27),
Baltimore, MD: Brookes.
Klin, A. & Volkmar, F., R. (2003). Asperger’s Disorder: Diagnosis and external validity. Child
and Adolescent Clinics of North America, 12(1), 1-13.
Laugeson, E. A., Frankel, F., Gantman, A., Dillon, A. R., & Mogil C. (2008). Evidence-Based
Friendship Training for Adolescents with Autism Spectrum Disorders: A Replication
Study of the UCLA PEERS Program. Invited paper at the Autism 2008 AWARES
Online Conference, Wales, UK.
Laugeson, E. A., Mogil, C. E., Dillon, A. R., & Frankel, F. (2009). Parent-assisted social skills
training to improve friendships in teens with autism spectrum disorders. Journal of
Autism and Developmental Disorders 39(4), 596-606.
Shtayermman, O. (2007). Peer victimization in adolescents and young adults diagnosed with
Asperger’s Disorder: A link to depressive symptomatology, anxiety symptomatology and
suicidal ideation. Issues in Comprehensive Pediatric Nursing, 30(3), 87-107.
Stokes, M., & Kaur, A. (2005). High functioning autism and sexuality: A parental perspective.
Autism, 9(3), 263–286.
Tantam, D. (1991). Asperger’s Disorder in adulthood. In U. Frith (Ed.) Autism and Asperger’s
Disorder (pp.147–83). Cambridge: Cambridge University Press.
For more information please visit our website: http://www.semel.ucla.edu/socialskills/
or contact us at:
[email protected]