Self-Esteem Predicting Changes in Friendship Quality for Adolescents with Autism Spectrum Disorder: The UCLA PEERS® for Adolescents Program

Background: The Program for the Education and Enrichment of Relationship Skills (PEERS^®) is a 14-week evidence-based social skills intervention for adolescents with ASD that targets friendship development and maintenance (Laugeson & Frankel, 2010).  Previous research has revealed a relationship between higher self-esteem and fewer autism spectrum behaviors in adolescents with ASD following participation in PEERS^®(Bagrodia et al., 2013). However, the link between self-esteem at baseline as it relates to friendship quality post-treatment has yet to be studied.   

Objectives: This study examines how adolescent-reported self-esteem at baseline predicts changes in friendship quality in adolescents with ASD following a 14-week evidence-based social skills intervention. 

Methods: Participants included 125 adolescents (male=105; female=20) ranging from 11-18 years of age (M=14.00; SD=1.80), with an ASD diagnosis.  Participants and their parents attended weekly 90-minute group treatment sessions over the course of 14 weeks focusing on skills related to making and keeping friends and handling peer rejection and conflict. In order to examine the relationship between self-esteem and the change in friendship quality over the course of treatment, each adolescent participant completed the Piers Harris Self-Concept Scale Second Edition (PH2; Piers, Harris, and Herzberg, 2002) at baseline, and the Friendship Qualities Scale (FQS; Bukowski, Hoza, & Boivin, 1994) prior to and following treatment.  Pearson correlations were calculated to examine the relationship between PH2 subscales at baseline and change in FQS subscale scores from pre- to post-treatment.           

Results: Results indicate that lower baseline self-esteem in the areas of behavioral adjustment (p<.05) and happiness (p<.05) significantly predict greater increase in overall friendship quality, with freedom from anxiety (p<.10) at a trend level, following the PEERS^® intervention.  In particular, less happiness at baseline predicts greater increases in companionship (p<.05) and helpfulness in friendships (p<.05) following treatment. Moreover, lower self-esteem with regard to physical appearance at baseline predicts greater improvements in security (p<.05) and helpfulness in friendships (p<.01) after treatment.

Conclusions: These findings suggest adolescents with ASD who report lower self-esteem related to behavioral adjustment and happiness prior to treatment may exhibit significantly greater improvement in overall friendship quality than teens that initially report higher self-esteem in these areas.  Specifically, less happiness prior to intervention may be more likely to result in increased self-perceived companionship and helpfulness from friends following PEERS^®. Additionally, adolescents who perceive themselves as less physically attractive prior to treatment may feel more secure and perceive greater helpfulness from their friendships after intervention. These findings suggest that teens with lower self-esteem in certain areas are more likely to experience greater improvement in friendship quality following a 14-week evidence-based social skills intervention.