Portrait of an African American mother and her daughter.

Parent and Adolescent Outcomes Following Participation in the PEERS© Program

As youth with autism spectrum disorder (ASD) navigate the complex social world of adolescence, they frequently have difficulty forming and maintaining friendships. Past research indicates that adolescents with ASD report lower quality friendships than their typically-developing peers (Bauminger & Kasari, 2000). Adolescents with ASD also report higher rates of loneliness and social isolation (Locke, Ishijima, Kasari, & London, 2010). In addition, compared to parents of typically-developing adolescents, parents of adolescents with ASD report higher levels of stress during this period, partly attributed to the social difficulties experienced by their children (Barker, Mailick, & Smith, 2014). In recent years, the development of social skills programming targeted specifically at adolescents with ASD has shown promising results for both adolescents (Laugeson, Frankel, Gantman, Dillon, & Mogil, 2012) and their parents (Karst et al., 2015).

Among available social skills programs for children and adolescents with ASD, the Program for the Education and Enrichment of Relational Skills (PEERS©; Laugeson & Frankel, 2010) has garnered the largest evidence base (e.g., Laugeson et al., 2012; Schohl et al., 2014). The PEERS© program is a group-based, parent-assisted social skills program created for the purpose of enhancing social skills among adolescents with ASD. Parents and adolescents attend weekly, 90 minute sessions over the course of 14 weeks. Adolescent sessions cover social skills including having conversations, entering and exiting conversations, electronic communication, use of humor, sportsmanship, and handling teasing, bullying, and gossip. Adolescent sessions follow a consistent format that includes homework review, didactic presentations from group leaders, modeling of appropriate social skills, and opportunities for adolescents to practice new skills with one another while receiving coaching and feedback from group leaders. Concurrent parent sessions meet in a separate room and focus on strategies to support adolescent social skill development and practice. Weekly homework for adolescents provides opportunities to practice social skills between sessions.

The goal of the present study was to replicate prior findings from the PEERS© program and extend research on parent outcomes of participation in the program. Past research on PEERS© has reported positive outcomes for adolescents including increased social skills knowledge, social responsiveness, and social skills such as cooperation and responsibility (Laugeson et al., 2012). Initial research on family outcomes indicates that PEERS© also has broader impacts on parents and families, including reducing family chaos and enhancing parenting self-efficacy (Karst et al., 2015). Given the stress that parents of adolescents with ASD often report, parenting stress has also been examined among parents participating in PEERS©. Initial research by Karst et al. (2015) indicated no change in parenting stress following the program. However, this research assessed parenting stress broadly. It is possible that PEERS© may have an impact on specific parenting stressors. Thus, a key aim of the present study was to further examine parenting stress prior to and following participation in the PEERS© program.

Data for the present study were collected from adolescents with ASD and parents participating in PEERS©. Group leaders for the present study received training in the PEERS© program and were certified PEERS© providers. Prior to and following participation in PEERS©, adolescents and their parents were asked to complete a series of questionnaires. Parents completed several measures assessing adolescent social skills, adolescent ASD symptoms, and parenting stress. The Social Skills Improvement System (SSIS; Gresham & Elliot, 2008) assesses adolescent social skills and interfering problem behaviors. The Social Responsiveness Scale, Second Edition (SRS-2; Constantino & Gruber, 2012) measures ASD symptoms, with subscales assessing social awareness, social cognition, social motivation, social communication, and restricted, repetitive behaviors. The Stress Index for Parents of Adolescents (SIPA; Sheras, Abidin, & Konold, 1998) assesses parenting stress. This particular measure was chosen because it provides separate scores for stress related to adolescent characteristics, parent characteristics, and characteristics of the parent-adolescent relationship. Adolescents completed the Test of Adolescent Social Skills Knowledge (TASSK; Laugeson & Frankel, 2010), a curriculum-based measure created to assess knowledge of the skills taught in PEERS©. Finally, both parents and adolescents reported the number of get-togethers adolescents had organized or been invited to over the past month.

Findings from the present study both replicated and extended past research on PEERS©. Paired-samples t-tests were used to assess differences in scores prior to and following participation. Adolescents achieved higher knowledge scores on the TASSK following the program (m = 21.70, SD = 2.45) than prior to participation (m = 12.00, SD = 2.06; t = 14.07, p < .01). This indicates that adolescents successfully learned many of the social rules presented during the course of the program. In addition, adolescents reported organizing more get-togethers during the course of the program (m = 2.33, SD = 1.58) than prior to their participation (m = 0.56, SD = 1.01; t = 2.6, p = .03). Parents reported higher rates of adolescent social skills on the SSIS following the program (m = 90.33, SD = 8.03) than prior to participation (m = 79.44, SD = 14.01; t = 3.19, p = .01). Similarly, problem behaviors were reportedly lower following the program (m = 21.00, SD = 8.57) than prior to attendance (m = 28.89, SD = 10.18; t = -5.60, p < .01). In addition, parents reported adolescent ASD symptoms to be lower following the program (m = 64.00, SD = 7.26) than prior to participation (m = 73.00, SD = 10.01; t = -3.67, p <.01). Prior to the program, scores on the SRS-2 fell in the moderate range, which indicates the presence of clinically significant social deficits that interfere with everyday interactions (Constantino & Gruber, 2012). Following the program, scores on the SRS-2 fell within the mild range, indicating mild to moderate interference of ASD symptoms in social interactions.

Finally, consistent with previous research, overall parenting stress was not significantly different following the program (m = 168.00, SD = 33.31) than prior to parents’ participation (m = 194.00, SD = 26.90; t = -1.96, p = .09). However, parents did report significantly less stress specifically associated with adolescent characteristics following the program (m = 81.00, SD = 6.96) than prior to participating (m = 91.89, SD = 17.13; t = -2.25, p = .05). In particular, parents reported change in their stress levels related to adolescent social isolation and withdrawal. The subscale on the SIPA assessing social isolation and withdrawal measures parent concerns regarding adolescent social skills deficits, interpersonal development, and social responsiveness. Prior to beginning the PEERS© program, parent stress related to social isolation and withdrawal fell in the 90th percentile, on average. This indicates a clinically significant level of stress in this domain. Following the program, parent stress on the social isolation/withdrawal domain was in the 82nd percentile, on average, which falls within normal limits.

The results of the present study provide further evidence in support of the PEERS© program. Providing an evidence-based, manualized social skills curriculum to adolescents with ASD and their families has a variety of benefits. As previous research has documented, adolescents gain knowledge about appropriate social behavior, increase contact with peers outside of the program, and demonstrate increased social responsiveness. The present study provides additional evidence that the benefits of the PEERS© program extend to parents. Participating in PEERS© may alleviate some of the stress parents experience specifically related to adolescent social and interpersonal skills. Future research may continue to examine the impacts of the PEERS© program, with a particular goal of documenting lasting effects of the program.

Laura L. Corona, MA, is Graduate Assistant, Erica Davis, LMSW, is Training Program Coordinator, Jane Ann Worlock, MSEd, is Senior Trainer, Melissa L. Rinaldi, PhD, is Clinical Investigator, and Kristin V. Christodulu, PhD, is Director at the Center for Autism and Related Disabilities at the University at Albany. For more information about this research, contact Laura Corona at lcorona@albany.edu and visit http://www.albany.edu/autism/.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.

Barker, E. T., Mailick, M. R., & Smith, L. E. (2014). Chronic parenting stress in mothers of adolescents and adults with autism: Vulnerability and resilience. In Comprehensive Guide to Autism (pp. 207-222). New York: Springer.

Bauminger, N. & Kasari, C. (2000). Loneliness and friendship in high‐functioning children with autism. Child Development, 71(2), 447-456.

Constantino J.N. & Gruber C.P. (2012) The Social Responsiveness Scale, Second Edition (SRS-2). Los Angeles, CA: Western Psychological Services

Gresham, F. & Elliott, S. N. (2008). Social Skills Improvement System (SSIS) Rating Scales. Bloomington, MN: Pearson Assessments.

Karst, J. S., Van Hecke, A. V., Carson, A. M., Stevens, S., Schohl, K., & Dolan, B. (2015). Parent and family outcomes of PEERS: A social skills intervention for adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(3), 752-765.

Laugeson, E. A. & Frankel, F. H. (2010). Social skills for teenagers with developmental and autism spectrum disorders: The PEERS treatment manual. New York: Routledge.

Laugeson, E. A., Frankel, F., Gantman, A., Dillon, A. R., & Mogil, C. (2012). Evidence-based social skills training for adolescents with autism spectrum disorders: The UCLA PEERS program. Journal of Autism and Developmental Disorders, 42, 1025-1036.

Locke, J., Ishijima, E. H., Kasari, C., & London, N. (2010). Loneliness, friendship quality and the social networks of adolescents with high‐functioning autism in an inclusive school setting. Journal of Research in Special Educational Needs, 10(2), 74-81.

Schohl, K. A., Van Hecke, A. V., Carson, A. M., Dolan, B., Karst, J., & Stevens, S. (2014). A replication and extension of the PEERS intervention: Examining effects on social skills and social anxiety in adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(3), 532-545.

Sheras, P. L., Abidin, R. R., & Konold, T. (1998). Stress Index for Parents of Adolescents. Odessa, FL: Psychological Assessment Resources.

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