Using a CBT Approach to Teach Social Skills to Adolescents with Autism Spectrum Disorder and Other Social Challenges: The PEERS® Method

Validation of key components in designing a social skills training content using virtual reality for high functioning autism youth-A Fuzzy Delphi method

The use of virtual reality in social skills training for high functioning autism spectrum disorder (HFASD) youth has been found to be engaging and enjoyable. Despite the promising results, previous literature indicates that there has been no consensus on the social skills target in the training content. There is also limited research on how evidence-based strategies like cognitive and behaviour techniques are instantiated into the VR environment to teach social skills. The aim of this study is to determine the key components to design a social skills training content using virtual reality for youths with HFASD. The Fuzzy Delphi method (FDM) was used to obtain expert consensus on social skills difficulties and cognitive behavioral techniques included in the content in three phases. In phase 1, a questionnaire was developed from in-depth interviews and scientific literature review. The in-depth interviews were conducted with 13 HFASD youth, 7 parents and 6 experts. In phase 2, 3 experts rated the relevance of the items in the questionnaire using an item-level content validity index (I-CVI) assessment. In phase 3, the questionnaire was distributed to 10 experts to rate their level of agreement on each component using a 7-point Likert scale. Components that received a value above 75%, threshold value (d) ≤ 0.2, fuzzy score (A) ≥ α - cut value = 0.5 and higher rank based on defuzzification score were prioritized to be included in the content. Items that received higher expert consensus on social skills difficulties included assessing non-verbal responses, initiating, maintaining, and leaving conversations, emotional difficulties and difficulties in perspective taking. Cognitive and behavioral techniques that received higher expert consensus were psychoeducation, modelling, relaxation techniques, reinforcements, and perspective-taking questions. These key components can be used as a framework for the development of virtual learning content for social skills training in future studies.

A systematic review of the efficacy of group social skills interventions on social functioning and social participation in children with acquired brain injury or cerebral palsy

AIM

The aim of this study was to evaluate the efficacy of Group social skills interventions (GSSIs) versus any comparator on social functioning in children aged 5-12 years with acquired brain injury or cerebral palsy.

BACKGROUND

GSSIs are an evidence-based approach to foster social skills development in children with autism spectrum disorder. Currently, limited literature exploring GSSIs in children with acquired brain injury and cerebral palsy is available.

RESULTS

MEDLINE, SCOPUS, Embase, CINAHL, Cochrane Library, PsycINFO, clinicaltrials.gov, ICTRP and ProQuest Dissertations and Theses were systematically searched. Study screening, risk-of-bias, Grading of Recommendations Assessment, Development and Evaluation and data extraction were performed in duplicate. Six studies were included in the narrative synthesis (one randomised controlled trial and five nonrandomised studies). Results indicate that GSSIs may increase children's social skills as measured on the Social Skills Rating System and Social Skills Questionnaire. Very low certainty evidence was found for improvements in social functioning and competence.

CONCLUSIONS

There is low certainty evidence that participation in GSSI may lead to gains in social functioning for children with acquired brain injury or cerebral palsy. Given the certainty of the evidence, these results must be interpreted with caution. Only one randomised controlled trial of GSSIs for children with acquired brain injury was identified, underscoring the need for additional high-quality studies.

Cognitive behavioural therapy to improve social skills in children and adolescents with autism spectrum disorder: A meta-analysis of randomised controlled trials

BACKGROUND

Cognitive behavioural therapy (CBT) is effective in treating various neurological and psychiatric diseases. It improves anxiety symptoms in children with autism spectrum disorder, gaining considerable empirical support. However, social skills results are mixed, leading to debate over its effectiveness, highlighting the need for further development. While the Social Responsiveness Scale (SRS) is a secondary indicator to measure anxiety symptoms, it primarily evaluates social skills, which are essential for rehabilitating children with autism. Therefore, evaluating social disorder improvement in children with autism is imperative. Social impairment is a core autism symptom. Therefore, we conducted a systematic review of randomised controlled trials assessing the effects of CBT on social skills in this population.

METHODS

We reviewed articles published in several databases through October 2022 and relevant reference lists. We used the standardised mean difference (SMD) as the main effect size indicator and focused on SRS metrics from baseline to endpoint. We analysed subgroups, heterogeneity, bias risk, and publication bias.

RESULTS

Our meta-analysis included 214 children from seven randomised controlled trials with nine datasets. Forest plot analysis shows CBT improved social skills in children with autism compared to controls. Subgroup analysis revealed parents' and teachers' SRS scores for children, SRS scores of CBT versus waitlist controls, and those of CBT versus non-waiting-list controls.

LIMITATIONS

Most randomised controlled CBT trials for children with autism have explored anxiety symptom improvement. Further, social skill assessment was a secondary outcome or not assessed. Thus, social skills data are insufficient.

CONCLUSIONS

CBT is effective in improving social impairment in children with autism.

REGISTRATION

This meta-analysis was registered with the International Prospective Register of Systematic Reviews (CRD42022363423).

Investigating Social Competence in a Pilot Randomized Clinical Trial of a Theatre-Based Intervention Enhanced for Adults with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is characterized by challenges in social competence that persist in adulthood, yet few treatment options exist. A pilot randomized clinical trial (RCT) of a peer-mediated, theatre-based intervention with established efficacy in youth with ASD was examined in autistic adults. The final sample consisted of forty-seven 18-to-40-year-old participants randomized to the experimental (EXP N = 23) or waitlist control (WLC N = 24) condition. A multimodal, social interdependent model was employed to examine social competence changes in brain (incidental face memory (IFM) using event-related potentials), cognition (Wechsler Memory Scale-III), behavior (Contextual Assessment of Social Skills) and function (Social Responsiveness Scale (SRS); Adaptive Behavior Assessment Scale (ABAS) Social Composite). Using analysis of covariance in which pretest was controlled in the model, posttest between-group differences were observed on IFM (p = 0.016, η2 = 0.139, d = 0.79) and several social and adaptive functional (SRS, ABAS) outcomes in social communication and interaction (SCI) (p = 0.019, η2 = 0.121, d = -00.45), communication (p = 0.044 η2 = 0.09, d = -00.31), and motivation (p = 0.001, η2 = 0.229, d = -0.79) domains. At two-month follow-up, gains in social motivation remained (p = 0.041, η2 = 0.100, d = -0.77). The results offer preliminary support for a unique theatre-based social skills intervention for autistic adults who have few treatment options to enhance social competence. The trial was pre-registered with ClinicalTrials.gov (Identifier: NCT04349644).

PEERS® for Preschoolers preliminary outcomes and predictors of treatment response

PEERS® for Preschoolers (P4P) is a social skills group program for young autistic children and their caregivers, which provides everyday tools for interacting and communicating with others. Twenty-two caregiver-child dyads participated and completed pre-treatment, post-treatment, and follow-up measures (4-16 weeks after). Using single-subject analyses to examine social skills, 60% demonstrated post-treatment improvement, and 53.85% demonstrated follow-up improvement. Regarding a secondary outcome of behavioral difficulties, 33.33% demonstrated post-treatment reduction, and 7.69% demonstrated follow-up reduction. Using regressions, autistic traits predicted outcomes; fewer social communication difficulties predicted both greater social skills and fewer behavioral difficulties at post-treatment, while fewer repetitive behaviors predicted fewer post-treatment and follow-up behavioral difficulties. These results preliminarily demonstrate the benefits of P4P and how autistic traits may impact P4P outcomes.

Predictors of expert providers' familiarity with intervention practices for school- and transition-age youth with autism spectrum disorder

LAY ABSTRACT

School-age children, adolescents, and young adults with autism spectrum disorder encounter many different types of providers in their pursuit of treatment for anxiety, behavior problems, and social difficulties. These providers may all be familiar with different types of intervention practices. However, research has not yet investigated patterns in expert providers' familiarity with different practices nor how these patterns are related to the characteristics of providers (years in practice, academic discipline, setting) and the youth (age and intellectual disability) they typically support. A panel of 53 expert transdisciplinary providers rated their familiarity with 55 intervention practices (derived from research and expert nominations) via an online Delphi poll. Advanced statistical methods were used to identify types of intervention practices with which providers were familiar, which included two approaches (cognitive and behavioral) and two strategies (engagement and accessibility). Providers who practiced outside a school setting or treated clients without intellectual disability were more familiar with cognitive approaches. Clinical psychologists, behavior analysts, and school-based providers were more familiar with behavioral approaches. Providers practicing outside school settings were also more familiar with engagement strategies, and providers with more years in practice were more familiar with accessibility strategies. These results may help families and researchers to better anticipate how services may vary depending on the types of autism spectrum disorder providers seen and work to reduce disparities in care that may result.

Soft skills for success for job seekers with autism spectrum disorder

BACKGROUND: Direct Skills Teaching (DST) is a method for distilling a skill into digestible components for ease of teaching and learning of a new skill. Job retention is a complex phenomenon requiring numerous social competencies that include verbal and non-verbal fluency among others. Individuals with Autism Spectrum Disorder (ASD) often struggle with social communication and therefore are at a disadvantage in employment settings; even when otherwise qualified for the position. OBJECTIVE: This preliminary pilot study tested the feasibility of a DST group intervention to assist individuals with ASD with work-related soft skills, with a particular focus on informal conversational skills. METHODS: Eight master’s level Rehabilitation Counseling students facilitated groups of adults with autism spectrum disorder seeking employment. Student facilitators followed the Conversing with Others manualized curriculum, designed to teach workplace based informal conversational soft skills. Participant feedback was sought both pre and post intervention, and student facilitators recorded their observations of each group session. RESULTS: The initial findings support the feasibility of soft-skills training for work-related conversational skills teaching for job seekers with ASD. The results also supported the need for significant adjustments to the intervention as well as any future studies of the small group intervention Conversing with Others. CONCLUSIONS: Workplace conversational skills can be facilitated in a small group setting. Master’s level counselors-in-training, were able to follow a manualized DST soft-skills small group.

Variables Associated With Successful Treatment Outcomes of Autistic Youth Enrolled in PEERS

This study sought to examine how certain variables of autistic youth who completed a formal social intervention program (PEERS) predicted social skill improvement post intervention. Specifically, this research aimed to determine if age, gender, emotional intelligence, intellectual ability, and/or autism symptomatology predicted social skill outcomes. Using extant data from parent and self-report batteries, change scores and multiple regressions were employed to examine which variables accounted for social skill improvement. Only intellectual ability (FSIQ), specifically perceptual reasoning, significantly predicted social skill outcomes based upon teen self-report, suggesting that autistic youth with specific cognitive profiles may be benefit more from PEERS. This research also exemplifies the heterogeneous nature of autism symptomology and the continued need for research examining social skill interventions. Limitations and future directions are discussed.

Iterative Development of a Daily Living Skills Intervention for Adolescents with Autism Without an Intellectual Disability

Daily living skill deficits commonly co-occur in individuals with autism spectrum disorder (ASD). These deficits in adolescence are associated with poor outcomes, in both employment and independent living skills as adults. Currently, there are no interventions that directly target daily living skill acquisition in adolescents with ASD without an intellectual disability to facilitate a successful transition to adulthood. In this paper, we discuss the development, refinement, and initial efficacy studies of Surviving and Thriving in the Real World (STRW), a 14-session group treatment for both adolescents with ASD and their parent/caregiver that promotes attainment of critical daily living skills. We summarize initial feasibility studies that have been instrumental in the iterative development of STRW. The structure, core treatment elements, and content of STRW are described in detail. Lastly, we discuss the transition of the in-person STRW intervention to STRW-telehealth, which allows for adolescents with ASD to work on daily living skills in their own home with support from a therapist.

Considerations and Perspectives on Interventions to Improve Social Cognition in Adolescents With ASD Without ID: Involving Parents in Social Skills Groups

Improving social cognition and social skills is a challenge faced by individuals with Autism Spectrum Disorder without Intellectual Disability at any age. This process is particularly critical during late adolescence (15-18 years), a developmental phase generally characterized by rich social experiences that usually foster the development of friendships. Nevertheless, for youth with ASD, lingering difficulties in social cognition often hinder their ability to generate responses considered socially appropriated. These social deficits can contribute to isolation that has a detrimental effect on mental health. In adulthood, deficits of social skills are strongly associated with an overall lack of support, characterized by a failure to integrate into the labor market, a high unemployment rate, social isolation, and a higher suicide rate. In clinical settings, social skills groups are well-established therapeutic means to improve social cognition and social skills. Nevertheless, these interventions vary greatly regarding their objectives, contents and duration. Moreover, few have been validated and replicated by research. Our aim is to bring certain perspectives to a type of intervention that are widely used in care settings. After reviewing its positive aspects for increasing social cognition, and its limitations, we will discuss strategies to facilitate the generalization of social skills in an ecological context. In particular, we will base our reflection on our clinical experience and on our current project to adapt the PEERS model for adolescents into French. We will consider the current trend of involving parents as "social coaches" to generalize the social knowledge acquired in the social skills groups.

Modified CBT for social anxiety and social functioning in young adults with autism spectrum disorder

BACKGROUND

There is a strong research imperative to investigate effective treatment options for adolescents and adults with autism spectrum disorder (ASD). Elevated social anxiety, difficulties with social functioning and poor mental health have all been identified as core treatment targets for this group. While theoretical models posit a strong bidirectionality between social anxiety and ASD social functioning deficits, few interventions have targeted both domains concurrently. Of the two group interventions previously conducted with adolescents and adults with ASD, significant results have only been observed in either social anxiety or social functioning, and have not generalised to changes in overall mood. The aim of this study was to evaluate the potential benefit, tolerability and acceptability of a group cognitive-behaviour therapy (CBT) intervention in young adults with ASD. Primary treatment outcomes were social anxiety symptoms and social functioning difficulties; secondary outcomes were self-reported mood and overall distress.

METHOD

Ten groups of participants completed an eight-week, modified group CBT intervention targeting both social anxiety and social functioning, that included social skills training, exposure tasks and behavioural experiment components. Seventy-eight adolescents and young adults with ASD, without intellectual impairment, aged between 16 and 38 (M = 22.77; SD = 5.31), were recruited from the community, Headspace centres and the Autism Clinic for Translational Research at the Brain and Mind Centre, University of Sydney. Outcomes (social anxiety, social functioning and mood) were measured pre- and post-intervention via self-report questionnaires (administered either online or through the return of hard-copy booklets), and participants were invited to provide anonymous feedback on the intervention (at the mid-point and end of the intervention).

RESULTS

Participants demonstrated statistically significant improvements on all outcome measures in response to the intervention. Specifically, social anxiety symptoms decreased (p < .001), and specific subdomains of social functioning improved post-intervention, particularly in social motivation (p = .032) and restricted interests and repetitive behaviours (p = .025). Self-reported symptom improvements also generalised to mood (depression, anxiety and stress; p < .05). All improvements demonstrated small effect sizes. Participant feedback was positive and indicated strong satisfaction with the program.

LIMITATIONS

The absence of a control group and follow-up measures, reliance on self-report instruments as outcome measures and the exclusion of those with intellectual disability represent significant limitations to this study.

CONCLUSIONS

These findings indicate that a group CBT intervention appears to be a beneficial intervention for self-reported social anxiety, social functioning and overall mental health in adolescents and young adults with ASD. The stand-alone nature of the intervention combined with positive participant feedback indicates it was well tolerated, has potential clinical utility and warrants further study in a randomised-controlled, follow-up design.

Improving Social Knowledge and Skills among Adolescents with Autism: Systematic Review and Meta-Analysis of UCLA PEERS® for Adolescents

UCLA PEERS® for Adolescents is a widely applied program among a number of social skills training programs developed over the years. We synthesized current research evidence on the PEERS program to evaluate the treatment effect on four commonly used outcome measures. 12 studies met inclusion criteria for the review and nine met the criteria for meta-analysis. Results showed moderate to large pooled effects across measures and informants in favor of the PEERS program, with the largest effect seen in social knowledge improvement and the smallest effect in the frequency of get-togethers. The heterogeneity of effects across studies were examined and the limitations of the current evidence were discussed.

Social Skills Training in Autism Spectrum Disorder Across the Lifespan

Social skills training programs for individuals with autism spectrum disorder are effective in improving social competence, although effects are frequently not robust across all outcomes measured. When aggregating across the social skills training programs with the strongest evidence, common elements can be identified in both the treatment delivery method and the social skills content targeted. However, social skills training programs continue to remain limited in their generalizability and scope. Existing research has primarily tested programs designed for school-aged children with autism spectrum disorder, who have average or above average intellectual functioning.

Building Skills, Confidence, and Wellness: Psychosocial Effects of Soft Skills Training for Young Adults with Autism

Recognizing that social functioning and mental health are linked to social participation and employment outcomes, this pilot study examined the preliminary outcomes of an eight-session, work-related social skills training program designed for young adults with high-functioning autism (HFASD). Results indicate statistically significant improvements in social cognition, social function, and social confidence. Furthermore, participants (n = 26) reported statistically significant reductions in anxiety, and a trend toward lessening depressive symptoms. These results suggest that: (1) social skills training is suitable for individuals with HFASD and clinically-significant levels of anxiety and/or depression, and (2) bolstered social functioning may have broader, cyclical impacts on social confidence, psychological wellness, and social and vocational participation in this population.

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

This study examines the efficacy of the Japanese version of the Program for the Education and Enrichment of Relational Skills (PEERS), which focuses on improving social functioning through making friends and maintaining good relationships for adolescents with autism spectrum disorder (ASD) without intellectual disabilities. Originally developed in the United States, PEERS is one of the few evidence-based social skills training programs for youth with ASD. The present study shows that with linguistic and cultural modifications, PEERS is effective in improving social functioning for adolescents with ASD in Japan. Positive results were found specifically in the areas of socialization, communication, knowledge of social skills, autistic mannerisms, and behavioral and emotional problems. In addition, most treatment gains were maintained at a 3-month follow-up assessment. These findings suggest that the Japanese version of PEERS is beneficial across multiple socio-emotional and behavioral domains for adolescents with ASD.

Social Skills Training in Autism Spectrum Disorder Across the Lifespan

Social skills training programs for individuals with autism spectrum disorder are effective in improving social competence, although effects are frequently not robust across all outcomes measured. When aggregating across the social skills training programs with the strongest evidence, common elements can be identified in both the treatment delivery method and the social skills content targeted. However, social skills training programs continue to remain limited in their generalizability and scope. Existing research has primarily tested programs designed for school-aged children with autism spectrum disorder, who have average or above average intellectual functioning.

Improving Emotional Competence in Children With Autism Spectrum Disorder and Mild Intellectual Disability in Schools: A Preliminary Treatment Versus Waitlist Study

This pilot study evaluated the effectiveness of delivering a new cognitive behavioural intervention package ‘Emotion-Based Social Skills Training (EBSST) for Children with Autism Spectrum Disorder (ASD) and Mild Intellectual Disability (ASD + MID)’ in schools. Fourteen school counsellors nominated 75 children (aged 7–13 years) with ASD + MID to receive 16 sessions of EBSST in groups of 3–8 children in their schools. Parent and teacher pre-post ratings of emotional competence (Emotions Development Questionnaire), social skills (Social Skills Improvement System Rating Scales) and mental health (Developmental Behaviour Checklist) were collected. Forty-three children received 16 sessions of EBSST and 32 children were allocated to the 9-month waitlist control group. Teachers and parents also received six EBSST training sessions in separate groups at school. Significant improvements in parent and teacher ratings of emotional competence were found at posttreatment among children in the EBSST group relative to controls; however, the results were not significant after the Bonferroni adjustment. Small to medium effect sizes were found. No difference in untrained social skills or mental health was observed. This study provides preliminary support for the utility of EBSST in teaching emotional competence skills for children with ASD + MID in schools and provides valuable pilot data for future research.

Learning How to Make Friends for Chinese Adolescents with Autism Spectrum Disorder: A Randomized Controlled Trial of the Hong Kong Chinese Version of the PEERS® Intervention

This study examined the treatment efficacy of PEERS® (Program for the Education and Enrichment of Relational Skills) among Chinese adolescents with autism spectrum disorder (ASD) in Hong Kong. The original PEERS® manual was translated into Chinese, and cultural adjustments were made according to a survey among 209 local adolescents in the general population. 72 high-functioning adolescents with ASD were randomly assigned to a treatment or waitlist control group. The 14-week parent-assisted training significantly improved social skills knowledge and social functioning, and also reduced autistic mannerisms. Treatment outcomes were maintained for 3 months after training and replicated in the control group after delayed treatment. The present study represents one of the few randomized controlled trials on PEERS® conducted outside North America.

How Do Parents Influence Child Disruptive Behavior After Acquired Brain Injury? Evidence From a Mediation Model and Path Analysis

OBJECTIVES

Children with acquired brain injury (ABI) can present with disruptive behavior, which is often a consequence of injury and parent factors. Parent factors are associated with child disruptive behavior. Furthermore, disinhibition in the child also leads to disruptive behavior. However, it is unclear how these factors interact. We investigated whether parental factors influence child disruptive behavior following ABI and how these factors interact.

METHODS

Parents of 77 children with ABI participated in the study. Parent factors (executive dysfunction, trait-anxiety), potential intervention targets (dysfunctional parenting practices, parental stress, child disinhibition), and child disruptive behavior were assessed. A hypothetical model based on the literature was tested using mediation and path analysis.

RESULTS

Mediation analysis revealed that child disinhibition and dysfunctional parenting practices mediated the association of parent factors and child disruptive behavior. Parents' executive dysfunction mediated the association of dysfunctional parenting practices, parental stress and parent trait-anxiety. Parenting practices mediated the association of executive dysfunction and child disruptive behavior. Path analysis indices indicated good model adjustment. Comparative and Tucker-Lewis Index were &gt;0.95, and the root mean square error of approximation was 0.059, with a chi-square of 0.25.

CONCLUSIONS

A low level of parental trait-anxiety may be required to reduce dysfunctional parenting practices and child disinhibition. Impairments in child disinhibition can be exacerbated when parents present with high trait-anxiety. Child disinhibition is the major contributor of disruptive behavior reported by parents and teachers. The current study provides evidence of parent anxiety and child disinhibition as possible modifiable intervention targets for reducing child disruptive behavior. (JINS, 2019, 25, 237-248).

Development, feasibility, and preliminary efficacy of an employment-related social skills intervention for young adults with high-functioning autism

This article details the iterative development, feasibility, and preliminary efficacy of an 8-week work-related social skills intervention, Assistive Soft Skills and Employment Training, for young adults with high-functioning autism spectrum disorder. In this mixed-methods study, pre- and post-intervention surveys, interviews, and functional measures were used to gather information on the program's feasibility, user acceptability, practicality, and preliminary efficacy. Results indicate that Assistive Soft Skills and Employment Training graduates showed significant improvements in work-related social skills knowledge, social functioning, and social/empathy self-efficacy. Participants and group facilitators also reported high satisfaction with program activities, training modalities, frequency, and duration of the intervention. Results support expanded use of group-based, work-related, social skills interventions for young adults with high-functioning autism spectrum disorder. Moreover, these findings, though preliminary, suggest that manualized, empirically based programs like Assistive Soft Skills and Employment Training promote improved social functioning, self-confidence, engagement, and adherence to training, as well as broader impacts, including improved sense of belonging and greater employability in this traditionally underserved population.

A Randomized Controlled Trial to Improve Social Skills in Young Adults with Autism Spectrum Disorder: The UCLA PEERS(®) Program

Research suggests that impaired social skills are often the most significant challenge for those with autism spectrum disorder (ASD), yet few evidence-based social skills interventions exist for adults on the spectrum. This replication trial tested the effectiveness of PEERS, a caregiver-assisted social skills program for high-functioning young adults with ASD. Using a randomized controlled design, 22 young adults 18-24 years of age were randomly assigned to a treatment (n = 12) or delayed treatment control (n = 10) group. Results revealed that the treatment group improved significantly in overall social skills, frequency of social engagement, and social skills knowledge, and significantly reduced ASD symptoms related to social responsiveness following PEERS. Most treatment gains were maintained at a 16-week follow-up assessment with new improvements observed.

The ABC's of teaching social skills to adolescents with autism spectrum disorder in the classroom: the UCLA PEERS (®) Program

Social skills training is a common treatment method for adolescents with autism spectrum disorder (ASD), yet very few evidence-based interventions exist to improve social skills for high-functioning adolescents on the spectrum, and even fewer studies have examined the effectiveness of teaching social skills in the classroom. This study examines change in social functioning for adolescents with high-functioning ASD following the implementation of a school-based, teacher-facilitated social skills intervention known as Program for the Education and Enrichment of Relational Skills (PEERS (®) ). Seventy-three middle school students with ASD along with their parents and teachers participated in the study. Participants were assigned to the PEERS (®) treatment condition or an alternative social skills curriculum. Instruction was provided daily by classroom teachers and teacher aides for 14-weeks. Results reveal that in comparison to an active treatment control group, participants in the PEERS (®) treatment group significantly improved in social functioning in the areas of teacher-reported social responsiveness, social communication, social motivation, social awareness, and decreased autistic mannerisms, with a trend toward improved social cognition on the Social Responsiveness Scale. Adolescent self-reports indicate significant improvement in social skills knowledge and frequency of hosted and invited get-togethers with friends, and parent-reports suggest a decrease in teen social anxiety on the Social Anxiety Scale at a trend level. This research represents one of the few teacher-facilitated treatment intervention studies demonstrating effectiveness in improving the social skills of adolescents with ASD in the classroom: arguably the most natural social setting of all.

Peer-mediated theatrical engagement for improving reciprocal social interaction in autism spectrum disorder

The hallmark characteristic of autism spectrum disorder (ASD) is poor reciprocal social communication. Interventions designed to improve this core deficit are critically needed. Social skills interventions such as direct training, peer mediation, and video modeling have contributed to improvements in various social skills in children with ASD. This paper reviews existing social competence interventions available for children with ASD while highlighting hypothesized critical components for advancing, maintaining, and generalizing skills, which include (1) peer mediation, (2) active learning, and (3) implementation in supportive, natural contexts. As a framework for these approaches, this conceptual paper describes SENSE Theatre, a novel intervention that combines trained peers that facilitate the performance-based theatrical treatment delivered in a supportive, community-based environment. A review of previous research shows early feasibility, setting the stage for more rigorous studies to aid in developing a standardized intervention package.