The Influence of Cognitive Empathy in Predicting Changes in Social Skills Improvement for Adolescents with ASD Following the UCLA PEERS® Program

Background:  Empathy involves the capacity to recognize, identify, understand, and experience the emotional states of others, and is essential to the development and maintenance of meaningful relationships (Davis, 1980). In particular, empathy requires both the ability to share the emotional experience of the other person (affective component) and an understanding of the other person’s experience (cognitive component) (Decety & Jackson, 2004; Eisenberg & Eggum, 2009; Hodges & Klein, 2001). Baron-Cohen and Wheelwright (2004) characterize high functioning autism spectrum disorder (ASD) as an empathy disorder, arguing that those with ASD often lack empathy and are unresponsive to socio-emotional cues. The Program for the Education and Enrichment of Relational Skills (PEERS^®) is an evidence-based, caregiver-assisted social skills training program (Laugeson & Frankel 2010), which has been shown to improve social skills and empathy in youth with ASD without intellectual disabilities. While improvements in empathy have been observed, the extent to which empathy at post-treatment is related to improvement in social skills following PEERS^®  has yet to be examined.  

Objectives:  The present study examines the relationship between post-treatment levels of empathy and the improvement in social skills for adolescents with ASD following the PEERS^® social skills intervention.

Methods:  Participants in this study included 90 adolescents (67 males, 23 females) with ASD ranging from 11-18 years of age (M=13.86, SD= 1.76) and their parents who presented for social skills treatment through the UCLA PEERS^® Clinic. Adolescents and parents attended weekly 90-minute group treatment sessions over a 14-week period. Skills related to making and keeping friends and handling peer conflict and rejection were taught through didactic instruction using concrete rules and steps of social etiquette, role-play demonstrations of targeted skills, in-session behavioral rehearsal activities, and parent-assisted weekly socialization homework assignments.

In order to understand the relationship between empathy and social skills improvement following treatment, parents completed the Social Skills Improvement System (SSIS; Gresham & Elliot, 2008) pre-and-post intervention. Empathy was assessed at post- intervention through parent reports on the Empathy Quotient (EQ; Baron-Cohen & Wheelwright, 2004), which assesses empathy levels among adolescents with ASD. Pearson correlation coefficients were calculated to examine the relationship between parent-reported EQ following treatment and the change in parent reported SSIS from pre- to post-test. 

Results:  Results indicate that cognitive empathy on the EQ following treatment was associated with improvement in Communication (p<.05), Assertion (p<.01), and Internalizing Problem Behaviors (p<.05) on the SSIS. No statistically significant correlations were observed between total scores on the EQ, SSIS, or other subscales.

Conclusions:  These findings suggest that adolescents with ASD whose parents reported higher cognitive empathy following the PEERS^® program were more likely to have better communication skills, assertion, and exhibit less internalizing problem behaviors following treatment. These findings are useful in understanding the relationship between empathy and improvement in social skills following treatment, and distinguishing those who may be more likely benefit from targeted social skills treatment.