Adolescent and Parent Factors That Contribute to Non-Completion of the PEERS® Intervention

Background: Although the Program for the Education and Enrichment of Relational Skills (PEERS^®) has been shown to be well-accepted and feasible (Laugeson, Frankel, Gantman, Dillon, & Mogil, 2012), some adolescents are still prone to withdrawing from treatment. Little is known regarding factors that may interfere with social skills intervention success among adolescents with ASD (though factors predicting success have been examined; Chang et al., 2014).

Objectives: The primary objective of this study was to examine adolescent and parent factors thought to interfere with intervention completion. It was hypothesized that high levels of anxiety, depression, and arousal, and, conversely, low levels of problematic behaviors common to ASD on behalf of the adolescent, as well as parenting stress on behalf of the parent were likely predictors of withdrawal. Each of these factors was examined from data collected prior to the outset of the intervention.

Methods: One-hundred fifty-four adolescents with ASD (N=154) aged 11 to 16 participated in this study. The adolescents completed the Youth Self Report (YSR), Social Anxiety Scale for Adolescents (SAS-A), and Children’s Depression Inventory (CDI) to account for anxiety and depression. Parents completed the Social Responsiveness Scale (SRS), Child Behavior Checklist (CBCL), Social Anxiety Scale for Adolescents, Parent (SAS-P) and Stress Index for Parents of Adolescents (SIPA) to gauge autism-related behaviors, anxiety, depression, social anxiety, and parenting stress, respectively. Adolescents completed a resting-state paradigm wherein respiratory sinus arrhythmia (RSA) was collected as a measure of arousal. Adolescents who completed the intervention (completers, n=134), both experimental and waitlist participants, were compared to those who withdrew (non-completers, n=20).

Results: Significant correlations with the binary completer variable were uncovered for SRS Motivation (r=-.157, p=.047), CDI Total (r=-.316, p=.009), and SIPA Delinquency/Antisocial (r=.159, p=.049). No other subscales, FSIQ, ADOS Total, or RSA, were significantly correlated with completion status. Logistic regression analyses were conducted separately for each measure as a predictor related to completion status (SRS Motivation, CDI Total, and SIPA Delinquency/Antisocial). SRS Motivation reliably distinguished completers and non-completers (chi square=3.995, p=.046, df=1), Nagelkerke’s R² of .046 indicated a relationship between prediction and grouping. Prediction success overall was 87.7% (100% completer, 0% non-completer). CDI Total reliably distinguished completers and non-completers (chi square=7.019, p=.008, df=1), Nagelkerke’s R² of .157 indicated a relationship between prediction and grouping. Prediction success overall was 82.4% (98.2% completer, 15.4% non-completer). SIPA Delinquency/Antisocial did not reliably distinguish completers and non-completers (chi square=3.538, p=.060, df=1).

Conclusions: Results suggest that low social motivation, low depressive symptoms, and high delinquency may contribute to withdrawal from PEERS^®, however results are limited. General anxiety, autism-related behaviors, most parent stressors, and arousal were not related to, nor predictive of, dropout. It is possible that there is too much variability for what contributes to withdrawal from PEERS^® for one family compared with another. The present study was also comprised of a small sample of participants who withdrew; future studies with larger samples may be better able to deduce contributors that interfere with completion of PEERS^®.