Using Multiple Informants to Assess Social Functioning and Treatment Outcome for Adolescents with ASD Following the UCLA PEERS® Program

Background: Assessment of social functioning of youth with social challenges consistent with Autism Spectrum Disorder (ASD) is complicated by conflicting informant perceptions. For youth with ASD, self-report of symptoms of psychiatric diagnoses should be interpreted with caution (Mazefsky et al. 2011), as this population has shown poor diagnostic agreement with parents (Storch et al. 2012), underscoring the need for multiple informants, including teachers and therapists. Research shows concordance rates between parent and adolescent report are widely heterogeneous, dependent upon the instrument, the disorders under investigation, and the informant characteristics (Mazefsky et al. 2011). Understanding the discrepancy between parent, teacher, and self-report of social functioning and treatment outcome among youth with social challenges is critical for determining the most reliable informants.

Objectives: The current study examines perspectives from multiple informants following a 14-week evidence-based social skills intervention for adolescents with ASD in order to investigate perceptual differences of social skills functioning and changes over time.

Methods: Participants included 239 adolescents with ASD referred for social skills training in outpatient and school settings. Among the clinic sample, participants included 133 adolescents (males=110; females=23) 11-18 years of age (M=14.02, SD=1.79) with ASD who attended 14 sessions of a weekly 90-minute social skills group with their parents using the Program for the Education and Enrichment of Relational Skills (PEERS^®; Laugeson & Frankel 2010). Within the school sample, participants included 106 adolescents (males=86; females=20) 11-18 years of age (M=15.08, SD=1.82) with ASD who received daily teacher-facilitated social skills instruction in the classroom using the PEERS^®school-based curriculum (Laugeson 2014). In order to assess perceptual differences of social functioning, adolescents and parents completed the Social Anxiety Scale (SAS; La Greca 1999), Quality of Socialization Questionnaire (QSQ; Frankel & Mintz 2008), and Empathy Quotient (EQ; Baron-Cohen & Wheelwright 2004) at pre and post-test. Parents and teachers also completed the Social Skills Improvement System (SSIS; Gresham & Elliott 2008) and Social Responsiveness Scale (SRS; Constantino 2005) pre and post-treatment. Paired sample T-tests and Pearson product-moment correlations were conducted to examine informant perceptions of adolescent social functioning across settings, and Bonferroni adjustments were made.

Results: Results reveal moderate and significant correlations between parent, adolescent and teacher report for measures of social functioning. However, there were significant differences (p’s<.001) between parent and adolescent report of social anxiety and engagement, and parent and teacher report of social skills and autism symptoms at baseline and post-treatment. These differences decrease at post-treatment across measures in both samples, signifying increased agreement between informants following intervention. Conversely, differences in adolescent and parent report of social engagement measured by the QSQ significantly (p<.001) increase at post-treatment in the school-based sample.

Conclusions: This study highlights the complexity of using multiple informants in the assessment of social skills across settings. Although significant differences between reporters decreased over time in the outpatient sample following treatment, the increase in differences in the school-based sample may be explained by less parent involvement in this setting. The results demonstrate the need for multiple informants in social skills assessments.