STUDY DESIGN STUDY DESIGN STRUCTURE OF THE SESSIONS STRUCTURE OF THE SESSIONS 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) BACKGROUND 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. 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) Young Adult Sessions Review of homework from the previous week – troubleshoot homework problems Review of homework from the previous week – troubleshoot homework problems Didactic presentation of social skills lessons Didactic presentation of social skills lessons Behavioral rehearsal with performance feedback from coaches Behavioral rehearsal with performance feedback from coaches Reunification with caregivers and young adults to negotiate homework assignment Reunification with caregivers and young adults to negotiate homework assignment Caregiver Sessions Review of homework from the previous week – troubleshoot homework problems Review of homework from the previous week – troubleshoot homework problems Didactic presentation of the young adult social skills lesson Didactic presentation of the young adult social skills lesson Assign socialization homework for the coming week Assign socialization homework for the coming week Reunification with caregivers and young adults to negotiate homework assignment Reunification with caregivers and young adults to negotiate homework assignment 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 PARTICIPANTS PARTICIPANTS 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 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 OVERVIEW OF INTERVENTION OVERVIEW OF INTERVENTION OUTCOME MEASURES 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 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 get- togethers 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). PRELIMINARY STUDIES PRELIMINARY STUDIES REFERENCESREFERENCES 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), 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), 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), 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: or contact us at: 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). _______________________________________________________________________ VariableGroup TreatmentDelayed Treatment Control n = 17n = 16 Pre PostPre Post p< Teen measures TASSK13.3 (2.4) 19.6 (1.4) 12.6 (3.6) 13.3 (3.8).001 QPQ Host1.1 (1.4) 3.2 (2.2) 0.6 (0.9) 1.1 (1.3).025 FQS16.8 (3.4) 17.2 (4.0) 18.1(3.9) 16.6 (4.6).05 Parent Measure SSRS Social Skills80.2 (8.8) 89.7 (12.1) 77.9 (12.1) 79.8 (11.7).05