Efficacy of Community-Delivered PEERS® for Adolescents: Increases in Social Skills and Decreases in Social Anxiety and Loneliness

The following is an abstract from a study conducted on the effeciency of the PEERS® program in community settings such as schools and clinics.

The original full article was published in the Journal of Autism and Developmental Disorders at

https://doi.org/10.1007/s10803-024-06433-z

Abstract

Purpose

PEERS® for Adolescents is an evidence-based social skills training program developed for individuals with autism spectrum disorder (ASD), which is now widely implemented by community providers in clinics and schools. However, majority of past efficacy studies on PEERS® were conducted in controlled research settings, with limited information about its effectiveness when delivered in the community. We sought to examine the effects of PEERS® on social functioning and mental health outcomes when delivered in an outpatient autism specialty clinic.

Methods

Clinical data from 45 adolescents with social challenges (age range: 11–18 years old; 31.1% female assigned at birth) were extracted for secondary analyses. Paired t-tests were performed to examine the pre- to post-intervention changes in social and mental health outcomes. Correlations between pre- and post-change scores of outcome measures were examined.

Results

Self-reported social skills knowledge, caregiver-reported social skills (measured by the Social Skills Improvement Systems) and the number of get-togethers hosted, increased significantly from pre- to post-intervention. Additionally, caregiver-reported anxiety and self-reported loneliness significantly decreased from pre- to post-intervention. Exploratory analyses showed that increases in caregiver-reported social skills were associated with decreases in self-reported loneliness.

Conclusions

Our findings provide evidence supporting the efficacy of PEERS® for improving social knowledge and skills of adolescents with social challenges when delivered in the community. The current study also showed the potential benefit of PEERS® for improving adolescent mental health.

Introduction

Individuals diagnosed with autism spectrum disorder (ASD) and other neurodevelopmental disorders (NDDs) commonly face difficulties in developing and maintaining social relationships (Cresswell et al., 2019). Social difficulties are often especially pronounced during adolescence, as this is a time marked by the emergence of new social contexts and expectations, as well as changes in identity development and independence (Baczewski & Kasari, 2021).

The Program for the Education and Enrichment of Relational Skills (PEERS®) for Adolescents, is designed to promote social functioning in adolescents who face challenges initiating and maintaining friendships, and it is one of the most widely implemented and empirically supported group-based social skills interventions for individuals with autism (Zheng et al.,2021). Multiple efficacy and replication studies across different countries have shown that participation in PEERS® is associated with improvements in social knowledge and social skills, and frequency of get-togethers (Zheng et al.,2021).

Besides its benefit on social functioning for adolescents with autism, emerging evidence suggests that adolescents who participated in PEERS® also report improvements in mental health. For example, studies composed of samples ranging from 5 to 58 autistic adolescents found decreases in feelings of loneliness on the Revised UCLA Loneliness Scale (Matthews et al., 2018), depressive symptoms on the Children’s Depression Inventory-2 (CDI-2; Schiltz et al., 2018; Yoo et al., 2014) and the Social Skills Improvement Scale (SSiS)- Internalizing Subscale (Hill et al., 2017 ; Marchica & D’Amico, 2016). Additionally, reductions were observed in anxiety on the Social Interaction Anxiety Scale (Schohl et al., 2014), the Screen for Child Anxiety Related Disorders (Hill et al., 2017 ), and the Social Anxiety Scale (Factor et al., 2022 ) following participation in PEERS®.

These findings raise the possibility that targeting social skills may provide another avenue for decreasing loneliness and promoting psychological well-being in adolescents with ASD and other NDDs (Adams et al., 2023 ). While multiple studies support the efficacy of PEERS® when delivered in research settings, only one pilot study to our knowledge, with a sample size of five, has examined outcomes of PEERS® when delivered in the community (Hill et al., 2017 ).

Considering the well-known implementation challenges when moving from a highly controlled experimental setting to a community setting (Odom et al., 2020 ), it is imperative to study the effectiveness of the PEERS® intervention also in a community setting. Therefore, to begin to fill this gap, this secondary data analysis was undertaken to examine the outcomes of the PEERS® intervention delivered as part of clinical care at an outpatient autism specialty clinic.

Specifically, we investigated (1) whether a community-delivered PEERS® program is effective in improving social knowledge and social skills, (2) whether adolescents reported reductions in mental health symptoms after participation in PEERS®, and (3) whether improvements in social skills are associated with reductions in mental health symptoms. Results Adolescents showed significant positive improvements in caregiver-reported social skills (SSiS), caregiver-reported number of get-togethers hosted (QSQ), and self-reported social skills knowledge (TASSK).

Additionally, significant decreases in self-reported feelings of loneliness (LSDQ) and caregiver-reported anxiety (SAS) were observed (see Table 1 for descriptive statistics and paired t-test results). Furthermore, increases in caregiver-reported social skills (SSiS) were moderately associated with decreases in self-reported loneliness ( r = − 0.41, p = 0.04; see Table 5 for correlation matrix).  

Authors: China I. Parenteau · Jessica Floyd · Katy Ankenman · Tara Glavin · Julia Charalel · Enjey Lin · Whitney Ence ·Young Shin Kim · Somer Bishop · Shuting Zheng11

Accepted: 31 May 2024

© The Author(s), under exclusive licence to Springer Science

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