Embed Size (px)
Citation preview
1
The Science of Making Friends:The UCLA PEERS® Program
Aarti Nair, Ph.D.Postdoctoral Fellow & Clinical Instructor
UCLA PEERS ClinicSemel Institute for Neuroscience & Human BehaviorDepartment of Psychiatry & Biobehavioral Sciences
Social Deficits Among Youth with ASD
§ Poor social communication§ Problems with topic initiation § Use repetitive themes
§ Perseverate on restricted interests§ Disregard the other person�s interests
§ One-sided conversations § Elicit fewer extended responses§ Give fewer reciprocal responses§ Fail to identify common interests
§ Difficulty providing relevant information § Make unexpected leaps in topics§ Pedantic style of speaking§ Poor speech prosody§ Highly verbose§ Difficulty interpreting verbal and nonverbal
social cues§ Voice tone§ Sarcasm§ Gestures§ Social touch
(Volkmar & Klin, 1998; Bauminger & Kasari, 2000; Orsmond, Krauss, & Seltzer, 2004; Koning &
Magill-Evans, 2001; LeCouteur et al., 1989; Marks, Schrader, Longaker, & Levine, 2000;
Ghaziuddin & Gerstein, 1996; Twatchman-Cullen, 1998; Hemphill & Siperstein, 1990; Church,
Alisanki, Amanullah, 2000; Constantino, 2005)
Photo of PEERS® courtesy of Associated Press
Social Deficits Among Youth with ASD
§ Poor social awareness § Poor eye-contact§ Difficulty understanding social cues
and social landscape§ Poor social motivation
§ Less involvement in social activities§ Extra-curricular activities§ Clubs§ Sports
§ Lack of peer entry attempts § Fewer social initiations
§ Poor social cognition§ Difficulty understanding the
perspectives of others§ Poor theory of mind§ Lack of cognitive empathy
(Volkmar & Klin, 1998; Bauminger & Kasari, 2000; Orsmond, Krauss, & Seltzer, 2004; Koning & Magill-Evans, 2001; LeCouteur et al.,
1989; Marks, Schrader, Longaker, & Levine, 2000; Ghaziuddin & Gerstein, 1996; Twatchman-Cullen, 1998; Hemphill & Siperstein,
1990; Church, Alisanki, Amanullah, 2000; Constantino, 2005)
2
Consequences of Social Deficits forYouth with ASD
§ Social neglect and isolation§ Withdrawn§ Seen as shy by others § Go unnoticed § Not engaging others socially
§ Peer rejection§ Teased and bullied§ Unsuccessful attempts to socially
engage others§ Bad reputation
§ Peer conflict§ Arguments may result in
termination of friendship§ Lack of close reciprocal
friendships§ Poor friendship quality
(Volkmar & Klin, 1998; Bauminger & Kasari, 2000; Orsmond, Krauss, & Seltzer, 2004; Koning & Magill-Evans, 2001; LeCouteur et al., 1989; Marks, Schrader, Longaker, & Levine, 2000; Ghaziuddin & Gerstein,
1996; Twatchman-Cullen, 1998; Hemphill & Siperstein, 1990; Church, Alisanki, Amanullah, 2000)
Photo of PEERS® courtesy of Associated Press
Poor Quality of FriendshipsAmong Individuals with ASD
• Poor overall quality of friendships – Less companionship– Less help from
friends– Less security within
friendships
• Greater loneliness(Bauminger & Kasari, 2000)
Why Target Friendships?
Having one or two close friends:
• Predicts later adjustment in life
• Can buffer the impact of stressful life events
• Correlates positively with:– Self-esteem– Independence
• Correlates negatively with:– Depression– Anxiety
(Buhrmeister, 1990; Matson, Smiroldo, & Bamburg, 1998; Miller & Ingham, 1976)
3
Limitations of Social Skills Training
• Do not include adolescents in treatment
• Do not teach ecologically valid social skills
• Fail to tailor teaching methods to shared strengths and weaknesses
• Do not include homework assignments
• Skills do not generalize to other settings
• Do not include caregivers in the treatment
• Do not assess treatment outcome
Background about PEERS®
• International program– Developed at UCLA in 2004– Adolescent program has been
translated into over a dozen languages– Used in over 25 countries
• Evidence-Based Social Skills Programs:– PEERS® for Preschoolers– PEERS® for Adolescents– PEERS® for Young Adults
PEERS® for Mental Health ProfessionalsProgram for the Education & Enrichment of Relational Skills
(Laugeson & Frankel, 2010)
• Parent-assisted– Concurrent parent and teen sessions– Parents are trained as social coaches
• Appropriate for socially motivated teens• Addresses core social deficits in ASD • Focuses on relationship skills• Teaches ecologically valid social skills• 14-week curriculum
– 90 minute weekly sessions • Evidence-based:
– Teens in middle and high school with ASD– Young adults (18-24 years of age) with ASD– Teens with ADHD– Teens with FASD– Teens with ID
4
PEERS® for EducatorsProgram for the Education & Enrichment of Relational Skills
(Laugeson, 2014)
• Teacher-facilitated in the classroom
• 16-week curriculum • 30-60 minute daily lesson plans • Focuses on friendship skills • Strategies for handling peer
rejection/conflict• Includes weekly comprehensive
parent handouts– No parent group
• Evidence-based treatment for ASD– Middle school– High school
PEERS® for Young AdultsWeekly Caregiver-Assisted Manual
(Laugeson, 2017)
• Caregiver-assisted– Concurrent social coaching and young adult
sessions• Appropriate for socially motivated adults• Addresses core social deficits in ASD • Focuses on relationship skills
• Friendships, dating, conflict, rejection• Teaches ecologically valid social skills• 16-week curriculum
– 90-minute weekly sessions – Library of video role play demonstrations
• Evidence-based:– Young adults (18-24 years of age) with ASD
The Science of Making Friends:Helping Socially Challenged Teens and Young Adults
(Laugeson, 2013)
• Parent book• Friendship skills• Handling peer
rejection and conflict• Parent section
– Narrative lessons– Social coaching tips
• Chapter summaries for teens and young adults
• Chapter exercises / homework• Companion DVD
– Role-play videos• Mobile App: FriendMaker
– Virtual social coach
5
Evidence-Based Methods for Teaching Social Skills
§ Small class format§ 10-14 students
§ Didactic lessons§ Concrete rules and steps of social etiquette§ Ecologically valid social skills
§ Role-play demonstrations§ Model social behavior§ Appropriate and inappropriate
demonstrations§ Perspective taking questions
§ Behavioral rehearsal exercises§ Practice with coaching
§ Homework assignments§ Practice in natural social settings§ Helps generalize skills
§ Parent and/or teacher coaching
(Matson, 1984; Davies & Rogers, 1985; Fleming & Fleming, 1982; Mesibov, 1984; Gresham, Sugai, & Horner, 2001; Gralinski &
Kopp, 1993; Rubin & Sloman, 1984, Frankel & Myatt, 2003; Rao, Beidel, & Murray, 2008; Laugeson et al., 2008)
Photo of PEERS courtesy of Associated Press
Overview of Teen PEERS®
Curriculum§ Conversational skills
§ Trading information§ Finding common interests§ Having a reciprocal two-way
conversation§ Non-verbal communication
§ Electronic communication§ Voicemail, email, IM, text
messaging, social networking sites
§ Online safety§ Choosing appropriate friends
§ Identifying a peer group / crowd§ Identifying extracurricular
activities
(Laugeson & Frankel, 2010; Laugeson, 2013; Laugeson, 2014)
Photo of PEERS® courtesy of Associated Press
Overview of Teen PEERS®
Curriculum§ Appropriate use of humor
§ Paying attention to humor feedback
§ Peer entry strategies§ Starting individual conversations§ Entering group conversations
§ Peer exit strategies§ Exiting conversations
§ Good sportsmanship§ Playing nicely during games and
sports§ Get-togethers
§ Being a good host or guest during get-togethers with friends
(Laugeson & Frankel, 2010; Laugeson, 2013; Laugeson, 2014)
Photo of PEERS® courtesy of Associated Press
6
Overview of Teen PEERS®
Curriculum
§ Peer conflict§ Handling arguments with friends
§ Peer rejection§ Handling teasing§ Utilizing embarrassing feedback§ Handling physical bullying § Managing rumors and gossip§ Minimizing cyber bullying§ Changing a bad reputation
§ Graduation§ Where to go from here§ Graduation party & ceremony
(Laugeson & Frankel, 2010; Laugeson, 2013; Laugeson, 2014)
Photo of PEERS® courtesy of Associated Press
Weekly Lesson Format
§ Homework review (30 min)§ Troubleshoot homework
problems§ Individualize treatment
§ Didactic instruction (30 min)§ Concrete rules / steps for social
etiquette § Role-play / modeling
§ Socialization activity (30 min)§ Behavioral rehearsal for teens§ Performance feedback through
coaching
PEERS® Evidence-Base: Parent-Assistance with Teens and Adults
7
PEERS® Evidence-Base: Replication Studies with Teens & Adults
PEERS® Evidence-Base
PEERS® Research Snapshot: Parent-Assisted for Teens with ASD
(Laugeson, Frankel, Gantman, Dillon, & Mogil 2012)
Improvement in Social Responsiveness (Total)
02468101214
Condition
Mean
Cha
nge i
n Sco
res
Treatment
Waitlist
Improvement in Social Skills
0
2
4
6
8
10
12
Condition
Mean
Chan
ge in
Score
s
TreatmentWaitlist
Hosted Get-togethers
0
1
2
3
4
5
Condition
Mean
Change
in Scor
es
TreatmentWaitlist
(p < .01)
(p < .01)
(p < .01)
8
PEERS® Research Snapshot: 14-week Follow-up with
Parent-Assisted for Teens with ASD(Laugeson, Frankel, Gantman, Dillon, & Mogil 2012)
Social Responsiveness Scale T1-T3 (p < 0.01)
606570758085
T1 T2 T3
Testing Time
Mea
n Sc
ores
Treatment Group
Social Skills Scale T1-T3 (p < 0.01)
70
75
80
85
90
95
T1 T2 T3
Testing Time
Mea
n Sc
ores
Treatment Group
Hosted Get-Togethers - Adolescent ReportT1-T3 (p < 0.05)
012345
T1 T2 T3
Testing Time
Mea
n Sc
ores
Treatment Group
80859095
100105110
T1 T2 T3
Me
an
Sco
res
Testing Time
Social SKills Scale T1-T3 (p < 0.03) *
Treatment Group
Problem Behaviors Scale T1-T3 (p < 0.01) *
102104106108110112114116
T1 T2 T3
Testing Time
Mean
Sco
res
Treatment Group
Parent Report Teacher Report
PEERS® Research Snapshot: New Findings at 14-week Follow-up with
Parent-Assisted for Teens with ASD(Laugeson, Frankel, Gantman, Dillon, & Mogil 2012)
PEERS® Research Snapshot: School-Based Curriculum for Teens with ASD
(Laugeson, Ellingsen, Sanderson, Tucci, & Bates 2014)
(p < .01)
9
PEERS® Research Snapshot: School-Based Curriculum for Teens with ASD
(Laugeson, Ellingsen, Sanderson, Tucci, & Bates 2014)
-2-101234
Mea
n C
hang
e in
Sco
res
Condition
Improvement in Social Awareness
PEERSSuper Skills
-1012345
Mea
n C
hang
e in
Sco
res
Condition
Improvement in Social Motivation
PEERSSuper Skills
-3-2-101234
Mea
n C
hang
e in
Sco
res
Condition
Decrease in Autistic Mannerisms
PEERSSuper Skills
(p < .03) (p < .03)
(p < .03)(p < .02)
PEERS® Research Snapshot: School-Based Curriculum for Teens with ASD
(Laugeson, Ellingsen, Sanderson, Tucci, & Bates 2014)
-505
10
Mea
n C
han
ge
in S
core
s
Condition
Social Anxiety
PEERSSuper Skills
02468
Mea
n C
han
ge
in S
core
s
Condition
Adolescent Social Skills Knowledge
PEERSSuper Skills
-3-2-10123
Me
an
Ch
an
ge
in S
co
res
Condition
Number of Hosted Get-togethers in Previous Month
PEERSSuper Skills
-3-2-10123
Me
an
Ch
an
ge
in S
co
res
Condition
Number of Invited Get-togethers in Previous Month
PEERSSuper Skills
(p < .01)
(p < .02)
(p < .06, trend)(p < .01)
PEERS® School-Based Teacher-Facilitated and Parent-Assisted Study for Teens with ASD
(Laugeson, Tucci, Bolourian, Gantman, & Ellingsen, in preparation)
N = 146
Parent Assistancen = 49
Pre-test
Post-test
No Parent Assistancen = 97
Pre-test
Post-test
10
6970717273747576
Pre-Test Post-test
SRS
-P T
otal
T S
core
s
Social Responsiveness Scale – Total
787980818283848586
Pre-Test Post-testSSIS
-P S
ocia
l Ski
lls S
tand
ard
Scor
es
SSIS Overall Social Skills
46
47
48
49
50
51
52
53
Pre-Test Post-test
SAS-
P So
cial
Anx
iety
Raw
Sc
ores
SAS Social Anxiety
0
1
2
3
4
5
6
Pre-Test Post-test
Hos
ted
Get
-Tog
ethe
rs in
Pas
t M
onth
Hosted Get-Togethers
p = .002
PEERS® Research Snapshot: School-Based Curriculum for Teens with ASD
(Laugeson, Tucci, Bolourian, Gantman, & Ellingsen, in preparation)
0
5
10
15
20
25
Pre-Test Post-test
TASS
K R
aw S
core
s
Adolescent Social Skills Knowledge
43.5
44
44.5
45
45.5
46
46.5
Pre-Test Post-test
PHS-
2 Se
lf-Es
teem
T S
core
s
Overall Self-Esteem
PEERS® Research Snapshot: School-Based Curriculum for Teens with ASD
(Laugeson, Tucci, Bolourian, Gantman, & Ellingsen, in preparation)
58
60
62
64
66
68
70
72
Pre-Test Post-test
SRS-
P So
cial
Aw
aren
ess
T Sc
ores
SRS-P Social Awareness
Parent
No Parent
5860626466687072
Pre-Test Post-test
SRS-
P To
tal T
Sco
res
Social Responsiveness Scale - Total
Parent
No Parent
626466687072747678
Pre-Test Post-test
SRS
-P S
ocia
l Cog
ntiio
n T
Scor
es
SRS-P Social Cognition
Parent
No Parent
626466687072747678
Pre-Test Post-test
SRS-
P So
cial
Com
mun
icat
ion
T Sc
ores
SRS-P Social Communication
Parent
No Parent
PEERS® Research Snapshot: School-Based Curriculum for Teens with ASD
(Laugeson, Tucci, Bolourian, Gantman, & Ellingsen, in preparation)
11
1.551.6
1.651.7
1.751.8
1.851.9
1.95
Pre-Test Post-test
FQS
Con
flict
Raw
Sco
res
FQS Conflict
Parent
No Parent
3
3.1
3.2
3.3
3.4
3.5
3.6
Pre-Test Post-test
FQS
Com
pani
onsh
ip R
aws
Scor
es
FQS Companionship
Parent
No Parent
33.13.2
3.33.4
3.53.63.7
Pre-Test Post-test
FQS
Hel
pful
ness
Raw
Sc
ores
FQS Helpfulness
Parent
No Parent
PEERS® Research Snapshot: School-Based Curriculum for Teens with ASD
(Laugeson, Tucci, Bolourian, Gantman, & Ellingsen, in preparation)
PEERS® Research Snapshot: Long-term Follow-up Study
(Mandelberg, Laugeson, Cunningham, Ellingsen, Bates, & Frankel 2013)
• Data was collected 1-5 years post-treatment– T1 – Pre-test– T2 – Post-test – T3 – 1-5 year follow-up
• 53 of 82 potential subjects– 64% response rate
• No significant differences between participants and non-participants at baseline
• Mean age at follow-up:– 17.5 years old– 11.4 grade level
• Mean time to follow-up:– 29 months
PEERS® Research Snapshot: Long-term Follow-up Study
(Mandelberg, Laugeson, Cunningham, Ellingsen, Bates, & Frankel 2013)
12
PEERS® Research Snapshot: Long-term Follow-up Study
(Mandelberg, Laugeson, Cunningham, Ellingsen, Bates, & Frankel 2013)
PEERS® Research Snapshot: Long-term Follow-up Study
(Mandelberg, Laugeson, Cunningham, Ellingsen, Bates, & Frankel 2013)
PEERS® Research Snapshot: Long-term Follow-up Study
(Mandelberg, Laugeson, Cunningham, Ellingsen, Bates, & Frankel 2013)
13
UCLA PEERS® Research Partners• Seoul National University (South Korea)
– Randomized controlled trial (Yoo et al. 2014)– Teens with ASD– Korean manual published in 2013
• University of Calgary (Canada)– Adolescents and adults with ASD
• Cal Tech– Pre-post comparison of biomarkers– Predictors of treatment outcome
• Erasmus University (Holland)– Randomized controlled (Yulius Academy)– Teens with ASD– Dutch manual in preparation
• Bar Ilan University (Israel)– Manual translated into Hebrew– Randomized controlled trial– Teens with ASD
• Marquette University– Replication study – social anxiety and parenting
stress (Schohl et al. 2013; Karst et al. 2014)– EEG – first biomarker of treatment outcome
(Van Hecke et al. 2013)
Future ResearchACCEPTED
• PEERS dissemination project in the schools for teens with ASD
– Role-play videos (>100)– www.routledge.com/cw/laugeson
PROPOSED
• PEERS for Teens with Intellectual Disabilities
• Club PEERS – Maintenance program with booster
sessions• Camp PEERS• PEERS for Dating• PEERS for Careers
AcknowledgementsFunding Support
NIMH U54-MH-068172 (Sigman, PI) NIH T32 MH17140 (Leuchter, PI)Nathan & Lilly Shapell Foundation (Laugeson, PI)Semel Scholar Award (Laugeson, PI)Friends of the Semel Institute (Laugeson, PI)Organization for Autism Research (Gantman, PI)Shapell & Guerin Family Foundation (Laugeson, PI)Organization for Autism Research (Laugeson, PI)Lang Family Foundation (Laugeson, PI)
Research Collaborators
Fred Frankel, Ph.D., ABPP (co-developer)Andrew Leuchter, M.D. (post-doc mentor)Alex Gantman, Psy.D.Catherine Mogil, Psy.D.Helena Johnson, Ph.D.Josh Mandelberg, M.D.Mina Park, Ph.D.Enjey Lin, Ph.D.Jilly Chang, Ph.D.Jennifer Sanderson, Psy.D.
Administrative Support
Yasamine Bolourian, M.A.Jessica HopkinsShannon Bates, M.A.Lara Tucci, M.A.Ashley R. Dillon, Ph.D.Ruth Ellingsen, Ph.D.Clare GorospeJessie SanchezElina VeytsmanJames Yang
THG Research AssistantsMaria KrivStephen Kapp, Ph.D.Kaely Orenski, Psy.D.Georgia Yu, M.A.Dali TungJan StolpeDawn Mitchell, M.A.Rosanna Rivero, M.A.Mary Goodarzi, M.A.Alex FriedmanSarah Bohlman, M.A.Lindsay Henry, M.A.Summer VilkinsMaile Adolphson Horn, M.A.Michelle Jackson, M.A.Sarah Taylor, M.A.Melissa Wasserman, M.A.Lindsey Hughes, M.A.Ellie MellonDaniel Janulaitis, M.A.Rohini BagrodiaKathryn FitzpatrickTiana Bayrami, M.A.Jason TineroElizabeth Shipley, M.A.Khadija NoorbhaiCatherine WallaceMarlene CabreraRenee DoeAlexandra WalshMarina AvetisianMaria PizzanoEugene KutasevichMaricella CampuzanoLeijing Zhang
UCLA Research AssistantsJin Lee, Psy.D.Amanda LenvinCordelia RossKristine McGlennenJeff RudieNatalie ColichDana Lieberman, M.A.Siena Whitham, M.A.Allison VreelandLucy VoChloe KoefflerAlea Baron, M.A.Laura Knoll, M.A.Ahoo Karimian, M.A.Kathleen Jorgenson, M.A.Rebecca Fountain, M.A.Erin Cornack, M.A.Emily Chen, M.A.Kandyse ChristopherDevi Beck-PancerBen Schwartman, Ph.D.Elan Javanfard, M.A.Meredith Kalies, M.A.Meagan Cronin, M.A.Lyndsay Brooks, M.A.David Diaz, M.A.Cecilia Costa, M.A.Crystal Ferrendelli, M.A.Erin Santos, M.A.Danielle Missler, M.A.Cara LamFernanda SamaiaTony AbuyoAngela DahiyaJennifer Majdick
