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A Randomized Controlled Trial of the Korean Version of the PEERSĀ® Parent-Assisted Social Skills Training Program for Teens with ASD

Friday, 3 May 2013: 09:00-13:00
Banquet Hall (Kursaal Centre)
H. J. Yoo1,2,3, E. Laugeson4, G. Bahn5,6, I. H. Cho7,8, E. K. Kim9, J. H. Kim1, J. W. Min10, W. H. Lee11, S. S. Jun9, J. S. Seo8, G. Y. Bong3, B. N. Kim12,13 and S. C. Cho12,13, (1)Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea, Republic of (South), (2)Seoul National University College of Medicine, Seoul, Korea, Republic of (South), (3)Seongnam Child and Adolescent Community Mental Health Center, Seongnam, Korea, Republic of (South), (4)UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, (5)Psychiatry, Kyung Hee University Medical Center, Seoul, Korea, Republic of (South), (6)Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea, Republic of (South), (7)Psychiatry, Gacheon University of Mecine and Science, Incheon, Korea, Republic of (South), (8)Psychiatry, Gacheon University Ghil Hospital, Incheon, Korea, Republic of (South), (9)Special Education, Dankook University, Yongin, Korea, Republic of (South), (10)Younghwa Hospital, Incheon, Korea, Republic of (South), (11)Seoul National Hospital, Seoul, Korea, Republic of (South), (12)Psychiatry, Seoul National University College of Medicine, Seoul, Korea, Republic of (South), (13)Child and Adolescent Psychiatry, Seoul National University Hospital, Seoul, Korea, Republic of (South)
Background:  Impaired social functioning is a hallmark feature of Autism Spectrum Disorders (ASD), often requiring treatment throughout the lifespan. PEERS® (Program for the Education and Enrichment of Relational Skills) is a parent-assisted social skills training for teens with ASD (Laugeson and Frankel, 2010). Although PEERS®has an established evidence-base in improving the social skills of adolescents (Laugeson et al., 2009; 2012) and young adults (Gantman et al., 2012) with ASD in North America, the efficacy of this treatment has yet to be established in cross cultural validation trials.

Objectives:  The objective of this study is to examine the feasibility and treatment efficacy of a Korean version of PEERS®for enhancing social skills through a randomized controlled trial.

Methods:  The English version of PEERS® Treatment Manual (Laugeson & Frankel, 2010) was translated into Korean and reviewed by 21 child mental health professionals. Items identified as culturally sensitive were surveyed by 445 middle school students and material were modified accordingly. Participants included 41 teens between 12-18 years of age with a previous diagnosis of ASD and verbal IQ≥70. ASD diagnosis was confirmed using the ADOS (Lord et al., 2003) and the ADI-R (Lord et al., 1994). IQ and adaptive functioning were assessed using the KEDI-WISC (Park et al., 1991) and K-VABS (Kim & Park, 1992). Eligible teens were randomly assigned to a Treatment Group (TG; n=23) or Delayed Treatment Control Group (CG; n=18). TG participants completed outcome measures on the first and last session of the intervention, while CG participants completed outcome measures upon entering the study, and at the first and last session of the treatment. Primary outcome measures included the ADOS, K-VABS, Social Skills Rating System (SSRS; Gresham & Elliot, 1990), and Test of Adolescent Social Skills Knowledge (TASSK; Laugeson & Frankel, 2010). Secondary outcome measures included scales for depression and anxiety.

Results:  There were no significant differences in age (14.04±1.64 & 13.78±1.48 years), IQ (99.26±15.38 & 99.28±18.60), parental education, SES, or autism symptoms between groups (p>.05). Treatment efficacy was analyzed by ANCOVA, controlling pre-treatment scores as covariates. Results suggest that the TG showed significant improvement in Interpersonal Relationship and Play/Leisure Time on the subdomain scores of K-VABS (p’s<0.01) and total scores of the TASSK (p<0.01) following treatment. The TG also showed significant improvement in Language and Communication and Reciprocal Social Interaction Domain scores on the ADOS (p’s<0.01) following intervention. Secondary outcome analyses reveal weak but significant differences in state anxiety in the two groups after intervention (p=0.045), and a significant decrease in maternal state anxiety in the TG after controlling for baseline level (p<0.01).

Conclusions:  Despite cultural and linguistic differences, the PEERS® social skills intervention appears to be efficacious for teens with ASD in Korea with modest cultural adjustment. In a randomized controlled trial, participants receiving the PEERS® treatment showed significant improvement in social skills knowledge, interpersonal skills, play/leisure skills, and state anxiety, as well as a decrease in autism symptoms. This study represents one of only a few cross-cultural validation trials of an established evidence-based treatment for adolescents with ASD.

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