Evaluation of the PEERS Play Intervention for Preschoolers with Autism Spectrum Disorder (ASD)

Background:  

Children with ASD have documented impairments in social communication skills that are related to concurrent language and predictive of later language abilities, adaptive functioning, and academic performance (Toth, Munson, Meltzoff, and Dawson, 2006; McGovern and Sigman, 2005; Sigman and Ruskin, 1999). Even before impairments in social interaction and communication are evident, however, parents of infants who later receive an autism diagnosis often describe their children as having difficulty controlling their attention, affect, and behavior (Dawson, 2008). Difficulties with self regulation in children with ASD can persist into adulthood, impacting relationships, attention, problem solving, and communication (Bradley & Isaacs, 2006; White, Oswald, Ollendick, & Scahill, 2009). Most of the interventions targeting social skills in children with ASD have focused on short term treatments (e.g., 8-12 weeks) and children older than 5 years (Ozonoff & Miller, 1995; Taras, Matson, & Leary, 1998). To our knowledge, only one published study has examined a social skills intervention for preschool aged children with ASD delivered in a group vs. one-to-one setting (Dykstra et al., 2012). Further, self regulation skills have not been the primary focus in prior studies of social skills group interventions for young children with ASD. 

Objectives:  

To evaluate the effectiveness of the PEERS Play intervention, assess change in self regulation skills and social functioning, and manualize the PEERS Play curriculum.

Methods:  

The PEERS Play intervention targets social and self regulation skills in preschool aged children with ASD. The curriculum is based on extensive experience with this population, age, principles of applied behavior analysis, and self regulation techniques drawn from The Alert Program. The intervention follows a weekly group format consisting of structured (e.g., circle time, art) and unstructured (e.g., free play, choice time with a peer) activities. Pilot data were collected on 6 children with ASD ages 3 and 4 years. Pre-treatment baseline assessment included standardized cognitive and adaptive measures; parent, teacher, and clinician ratings; and videotaped behavioral observations. The intervention phase consisted of 6 months of videotaped, weekly, 60-minute social groups using the PEERS Play curriculum. Post-treatment assessment duplicated the pre-treatment battery.  

Results:  

Two analytic plans are underway: 1) A multiple time point, single case design analyzing weekly behavioral codes from videotape across multiple domains (social initiation, joint attention, play level, cooperative play and emotion regulation); and 2) pre- and post-treatment parent, teacher, and clinician ratings on a variety of measures. Results from analytic plan 2, using paired difference t-tests, indicated significant positive change on measures of parent rating of social skills (t=2.755, p=0.04), teacher rating of social skills (t=4.284, p=0.05), and parent ratings on the Temperament and Atypical Behavior Scale (TABS; t=2.86, p=0.035), a measure of atypical self-regulatory behavior intended for use with infants and young children. Additionally, on the BRIEF-P, most children showed positive change on most domains.

Conclusions:  

The present findings indicate that the PEERS Play intervention can effect change in multiple domains including self regulation in preschool age children with autism. Future research will include an RCT design and a parent-mediated adjunct to this intervention.