A randomized controlled trial evaluating the Hebrew adaptation of the PEERS^® intervention: Behavioral and questionnaire‐based outcomes

Abstract

Social interaction deficits form a core characteristic of ASD that is commonly targeted through social-skill groups. The Program for the Education and Enrichment of Relational Skills (PEERS ) is a well-established parent-assisted intervention for adolescents, which addresses key areas of social functioning. PEERS has been mainly studied in North-America and its evaluations were mostly questionnaire based. The aim of the current study was to test the effectiveness of the adapted and translated Hebrew version of the PEERS intervention in a randomized controlled trial, using behavioral measures of peer interaction, in addition to self, parent, and teacher reports. Forty-one participants with ASD and no intellectual impairment, aged 12-17 years, were randomly assigned to an immediate intervention or a delayed-intervention group. All participants were assessed before and after the immediate intervention, and again at follow up, after the delayed intervention took place. Results revealed intervention-related behavioral improvements on adolescents' engagement, question-asking, and physical arousal. Parental reports indicated improved social skills, and reduced ASD symptoms. Adolescents reported on more social encounters, greater empathy, and scored higher on social-skill knowledge. Most of these effects maintained at a 16-week follow-up. Teacher reports' yielded effects only on pre-post intervention analysis. Adolescents' improvement on behavioral engagement predicted parent-reported social skills improvement. Our findings support the effectiveness of the adapted Hebrew version of PEERS for adolescents with ASD, through significant behavioral and questionnaire-based outcomes, which maintained at follow-up. Autism Res 2018, 11: 1187-1200. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Social-skills groups, which facilitate key social deficits characteristic of ASD, are a popular intervention for adolescents with ASD. Indeed, many treatment protocols have been published, and some have also been research validated. However, there have been inconsistent findings regarding the effectiveness of different protocols, in addition to limited findings of improvement beyond questionnaire reports. This study evaluated the Hebrew adaptation of the PEERS intervention, a 16-weeks long program, which involves the parents as their adolescents' social coaches. Following the intervention, adolescents improved their social-skills, participated more in social encounters, reported greater empathy, and demonstrated higher social-skill knowledge. A live play-role assessment with an unfamiliar peer indicated that adolescents showed greater involvement, asked more questions and were more physically relaxed during the conversation. Improvements maintained 16 weeks after the intervention was completed.

Parent–Adolescent Reciprocity in a Conflictual Situation Predicts Peer Interaction in Adolescents With ASD

“…In other words, the relationship adolescents with ASD have with their parents may still give them an opportunity to practice important perspective taking, exchanging information, negotiation, and conflict resolution skills in a secure and enabling environment. These findings support the inclusion of parents as social coaches to their adolescents with ASD, which have shown to be effective in various social skills training studies [Karst & Van Hecke, ; Laugeson, Frankel, Mogil, & Dillon, ; Yoo et al, ; Rabin, Israel‐Yaacov, Laugeson, Mor‐Snir, & Golan, ]. However, our findings also highlight the importance of pre‐intervention screening of parent–adolescent dyads, based on their level of reciprocity.…”

The ACCEPT-study: design of an RCT with an active treatment control condition to study the effectiveness of the Dutch version of PEERS® for adolescents with autism spectrum disorder

“…Earlier studies focused mainly on children with ASD aged 7 to 12 with average or above average cognitive ability, and were mostly carried out in the US [6]. More recently, research focused on assessing the effectiveness of treatment approaches for adolescents with ASD [8][9][10][11][12]. In these studies, empirical support was found for The Program for the Education and Enrichment of Relational Skills (PEERS®), which is a parent-assisted, manualized social skills training program specifically developed for cognitively able adolescents with ASD at the University of California, Los Angeles (UCLA) [13].…”

“…a) mediators and b) moderators. Finally, the study uses an observational and behavioral measure of social competence, the CASS [21] similar to previous studies [10,18], but extended with reports on the social skills of the participants by the participants and the confederates. Thus, besides investigating whether the Dutch PEERS® intervention is effective, we extend previous studies by implementing an active treatment control group and exploring which moderators and mediators influence the effectiveness of the intervention.…”

“…As a sign of this potential bias, studies that collected ratings of social skills from teachers indeed showed fewer effects, but these studies were limited by small sample sizes (largest n = 41 [14];). To overcome this methodological obstacle, recent research [10,18], used a behavioral observation measure to more objectively assess social skills. These studies utilized the Contextual Assessment of Social Skills (CASS), an observational measure of social conversational skills, specifically developed for adolescents and young adults with ASD.…”

“…This measure makes use of an observation of the adolescent's social behavior, scored by a rater who is blinded for condition and time-point, and was validated as an outcome measure of social skills [21]. Intervention related improvements were found [10,18] in this observational measure of social skills, providing evidence that the CASS probably is a useful tool to determine whether social skills targeted in treatment generalize beyond the treatment context.…”