Depression As a Predictor of Decreased Social Engagement for Adolescents with Autism Spectrum Disorder Following the UCLA PEERS® Intervention

Background: Adolescents with Autism Spectrum Disorder (ASD) are known to have deficits in social skills relating to social communication and reciprocity. Impairment in social skills often leads to negative social experiences with peers, including self-reported victimization, which may be associated with greater anxiety and depression (Pouw et al., 2013). In fact, depression is one of the most prevalent comorbidities shown to significantly impair functioning among individuals with ASD (Strang et al., 2011). The Program for the Education and Enrichment of Relational Skills (PEERS^®) is an evidence-based, parent-assisted social skills intervention for adolescents with ASD without intellectual disabilities. Previous research indicates that PEERS^® is effective in improving social skills and increasing social engagement amongst teenagers on the spectrum (Laugeson et al., 2009; Laugeson et al., 2011). Although PEERS^®has a well established evidence-base, there is a lack of research identifying predictors that may impact treatment outcome. In particular, the impact of comorbid depression on social engagement following treatment has yet to be investigated among adolescents with ASD.

Objectives: The present study examines baseline depression as a predictor of social engagement in adolescents with ASD following the completion of a 14-week parent-assisted social skills intervention program.

Methods: Participants included 137 adolescents (113 males and 24 females) with ASD ranging from 11-18 years of age (M=13.98, SD=1.78) and their parents who presented for social skills treatment through the UCLA PEERS^® Clinic. Adolescent and parent participants attended weekly 90-minute group treatment sessions over a 14-week period. In order to assess baseline depression, adolescents completed the Children’s Depression Inventory (CDI; Kovacs, 1992) prior to treatment. The CDI includes a total depression score and five subscales including: negative mood, interpersonal problems, ineffectiveness, anhedonia, and negative self-esteem. In order to assess change in social engagement following treatment, adolescents and parents completed the Quality of Socialization Questionnaire (QSQ; Frankel & Mintz, 2008) pre- and post-intervention. The QSQ measures social engagement with peers through frequency counts of hosted and invited get-togethers in the previous month. Pearson correlations were calculated to examine the relationship between baseline depression on the CDI and change in social engagement on the QSQ from pre- to post-treatment.

Results: Results indicate that participants significantly increased their social engagement following treatment for both hosted get-togethers (p<.01) as well as invited get-togethers (p<.01) according to adolescent and parent reports on the QSQ. However, higher baseline CDI total scores significantly predict a decrease in the frequency of adolescent-reported invited get-togethers (p<.05) following treatment. Results did not reveal a significant relationship between baseline CDI total scores and adolescent-reported hosted get-togethers or parent-reported hosted or invited get-togethers on the QSQ.

Conclusions: These findings suggest that although adolescents with ASD generally improve in their frequency of peer engagement following the PEERS^® intervention, those experiencing comorbid depressive symptoms prior to intervention may actually report being invited on fewer get-togethers by their peers following treatment.  This finding suggests the need for further intervention to decrease depressive symptoms in those scoring high on the CDI at baseline in order to gain the full benefit of PEERS^®.