The Influence of Self-Esteem in Predicting Social Anxiety in Adolescents with ASD Following the UCLA PEERS® School-Based Curriculum

Background: As a result of social skill deficits and heightened social demands common to adolescence, teens with Autism Spectrum Disorder (ASD) are particularly susceptible to feelings of anxiety. In fact, 11% to 84% of adolescents with ASD report feelings of impairing anxiety (White et al., 2010). In typically developing adolescents, self-esteem has been linked to peer acceptance and social activity, which in turn impedes feelings of social anxiety. However, research has yet to explore the impact of self-esteem on social anxiety in this population. The Program for the Education and Enrichment of Relational Skills (PEERS®) School-Based Curriculum is a 16-week evidence-based social skills intervention that addresses social skill deficits by teaching students how to make and keep friends. While this program has been shown to improve social functioning, and decrease social anxiety in some cases, the relationship between self-esteem and social anxiety has yet to be explored.

Objectives: The present study seeks to examine how baseline self-esteem predicts changes in levels of self-reported social anxiety following a school-based social skills intervention for adolescents with ASD.

Methods: Participants included 106 adolescents, ranging from 11-18 years of age (M=15.08, SD=1.82). Participants received 30 minutes of daily social skills instruction in the classroom over a 16-week period. Teachers provided instruction on the PEERS® curriculum through didactic presentation, role-play demonstrations, behavioral rehearsal activities, and review of socialization homework assignments. In order to understand the relationship between self-esteem and social anxiety, students completed the Piers Harris Self-Concept Scale Second Edition (PHS2; Piers, Harris, and Herzberg, 2002) at pre-test to measure self-esteem, and the Social Anxiety Scale for Adolescents (SAS-A; La Greca, 1993) at post-test to measure social anxiety. Regressions were calculated to examine the relationship between PHS2 sub-scales and the SAS-A. T-tests were calculated to compare pre/post measures of overall self-esteem and social anxiety.

Results: Results indicated that higher youth-reported self-esteem on the PHS2 at baseline significantly predicted social anxiety as measured by the SAS-A (p<0.001) post-treatment. A two-factor model accounting for Intellectual Status (p<0.001) and Popularity (p<0.001) were able to account for 33% of the variance in social anxiety post-treatment. Results also indicated that overall self-esteem significantly increased from pre-test to post-test, t(105)=-3.06,p=0.003.

Conclusions: These findings suggest that adolescents with ASD who report higher levels of self-esteem prior to receiving the PEERS® intervention are less likely to report feelings of social anxiety following treatment. Specifically, adolescents who endorse more confidence in social functioning and intellectual ability prior to treatment are less likely to experience anxiety brought on by social interactions following the intervention. In addition, overall self-esteem improved, while overall social-anxiety decreased, following the PEERS® School-Based Curriculum. These findings provide useful information about who is most likely to benefit from treatment, allowing for more targeted intervention.