Examining the Treatment Efficacy of the PEERS in Japan: Towards Improving Social Skills of Children with Autism Spectrum Disorder

Background:  Children with autism spectrum disorder (ASD) are characterized by social communication and interpersonal disabilities, repetitive behaviors, and restricted interests. These characteristics affect important aspects of their lives, like making friends and maintaining good relationships. As a result, these individuals experience difficulties in social adjustments, especially because adolescents focus more on themselves and social relationship with others.

Objectives:  The need for social skill training programs to support social adjustment is increasing, but many of these programs are targeted at young children. PEERS (Program for the Education and Enrichment of Relational Skills) is parent-assisted social skills training organized as a group session. PEERS utilizes the principles of cognitive behavior therapy to improve social functioning for teens with ASD. For both teens and parents, each session (once a week) lasts 90 min and continues for 14 weeks. Although PEERS has been shown to improve the social skills of adolescents with ASD in North America, cross-cultural trials have only just started. The objective of this research was thus to examine the treatment efficacy of PEERS in Japan for improving social skills. 

Methods: The PEERS treatment manual was translated into Japanese, and the curriculum contents necessary for cultural adjustments were modified with the permission of the developer of PEERS. Modifications included examples of peer groups, places where teens can find new friends, humorous material that could be understood in terms of Japanese culture, and activities teens enjoy together. Participants included 28 teens between 6^th and 9^th grade diagnosed with ASD and a verbal intelligence score >70 on WISC-IV. Eligible teens were assigned to a treatment group (TG) or a delayed control group (CG). Primary outcome measures included questionnaires quantifying social ability and communication skills and behaviors related to ASD. Secondary outcome measures included depressive symptoms and behavioral problems. All participants including their mothers and teachers completed these outcome measures three (pre-treatment, post-treatment, follow-up) or four times (a baseline assessment was added for the delayed control group).

 Results:  Comparison of pre- and post-intervention questionnaires indicated that teens receiving PEERS showed improved social skill knowledge according to the Test of Adolescent Social Skills Knowledge (TASSK) and social skills in the area of social communication. The measures parents reported suggested that teens showed decreased ASD symptoms relating social responsiveness by the end of the 14-week intervention, according to the Social Responsiveness Scale. Also, in the social skills area of Vineland II, interpersonal relationship, play/leisure time, and coping skills scores differed significantly before and after treatment. According to Vineland II, scores in the area of maladaptive behaviors also decreased. Besides these scores, high levels of parent, child, and staff satisfaction were reported, in addition to high attendance rates. 

Conclusions:  Teens receiving the PEERS treatment showed increased social skills knowledge and improved interpersonal relationship skills. The PEERS intervention appears effective for teens with ASD in Japan after small cultural adjustments.