A Multi-Site Implementation of a Social Skills Training Program (PEERS) to Improve Friendships for Adolescents with Autism Spectrum Disorders

Background: In general, friendships in adolescents with Autism Spectrum Disorder (ASD) differ in quantity and quality from the friendships of their typically developing peers (Bauminger et al., 2008).   There are both practical and clinical implications supporting friendship development in adolescents with ASD, taking into account socio-cognitive characteristics and difficulties related to affect.   Exploring the mechanisms that assist friendship development in adolescents with ASD may provide insight into how this population learns and applies social behaviour.

Adolescents with ASD exhibit significant social skill deficits that contribute to academic, behavioural and emotional difficulties.  Typically developing adolescents often learn basic social norms by observing others; however, adolescents with ASD often require planned, explicit instruction in order to acquire pro-social behaviours (Gralinski & Kopp, 1993).  The UCLA-based Program for the Education and Enrichment of Relational Skills (PEERS; Laugeson, Frankel, Mogil & Dillon, 2008) employs evidence-based practice for the instruction of social skills to adolescents with ASD (Gresham et al., 2001).

Objectives: The present study will explore the mechanisms of friendship development in adolescents with ASD, taking into account ASD symptomatology, social skills knowledge and social anxiety while participating in the PEERS program.  To date, two groups have been assessed (n = 16); however, three groups (n = 25) will have completed the PEERS program by December, 2013.                                   

Methods: The present study assesses adolescents with high-functioning ASD between the age of fourteen and seventeen across the province of Ontario, Canada.  Over fourteen sessions, adolescents and their parents work with group leaders to learn social skills and behaviours that promote friendship development.  Data has been collected from both parent and adolescent groups using a battery of standardized and non-standardized assessments.

Results: Data from two groups (n = 16) indicate that adolescents are initiating significantly more social activities and have improved their social skills knowledge.  Supplementary analyses reveal an inverse relationship between ASD symptoms and social anxiety, suggesting that adolescents with fewer ASD symptoms are expressing heightened anxiety (r = - 0.81 < 0.05).  This relationship may indicate that adolescents who are aware of their social and communicative deficits are experiencing anxiety during social activities.  Finally, a significant relationship between adolescents’ friendship qualities and social stress was also found (r = .65 < 0.05), suggesting there is a level of anxiety associated with social interactions.

Conclusions: High-functioning adolescents with ASD are initiating more social gatherings as a result of participating in the PEERS program.  There is a level of social anxiety associated with engaging social situations, coinciding with exploring, making and maintaining friendships.  It is relevant to address the presence of social anxiety as high-functioning adolescents with ASD attempt to build and maintain meaningful relationships.  There are clinical and practical implications supporting the management of social stress in high-functioning adolescents while they form friendships.  With increased emphasis on social relationships, adolescent participants may become more comfortable engaging social behaviour; however, additional research is needed to explore this.