Social skills group training in adolescents with disabilities: A systematic review

Telehealth Programme for the Education and Enrichment of Relational Skills (PEERS) for adolescents with acquired and congenital brain injuries: a protocol for mixed-methods randomised trial

INTRODUCTION

For adolescents with brain injury, challenges with social function often persist into adulthood, impacting social participation and quality of life. The Programme for the Education and Enrichment of Relational Skills (PEERS) is a manualised group-based intervention with preliminary evidence demonstrating improved social knowledge and participation for adolescents with acquired brain injury or cerebral palsy when delivered face to face. The recent COVID-19 pandemic and challenges for families living outside metropolitan centres to access the programme suggest a telehealth delivered PEERS should be explored. This study aims to compare telehealth PEERS to usual care in a mixed-methods randomised waitlist-controlled trial to determine preliminary efficacy to improve social functioning and secondarily to determine acceptability, feasibility, cost and contextual factors impacting the implementation.

METHODS AND ANALYSIS

In this single-centre mixed-methods randomised waitlist-controlled trial, 32 adolescents with brain injury, aged 11-17 years attending mainstream high school and their caregivers will be randomised to receive either (a) telehealth PEERS once/week for 1.5 hours for 14 weeks or (b) usual care (UC). UC is highly variable in Australia but often comprises fortnightly occupational therapy, physiotherapy or speech therapy. The waitlist group will then receive PEERS following the 26-week retention time point. Measures will be administered at baseline, 14 weeks (immediately post) and then 26 and 52 weeks post baseline. The primary outcome is self-reported performance and satisfaction with social goals on the Canadian Occupational Performance Measure at 14 weeks. Secondary outcomes include self and parent-reported social competence, frequency of get-togethers with peers, self-report knowledge of social skills, frequency of peer victimisation and quality of life. An implementation evaluation will be done to determine acceptability, feasibility, cost and identify barriers and facilitators in the implementation of the intervention and map these against the Consolidated Framework for Implementation Research. This study will assess the unit costs of implementing the PEERS from an Australian health system perspective.

ETHICS AND DISSEMINATION

The Children's Health Queensland Hospital and Health Service and The University of Queensland Human Research Ethics Committees have approved this study. Findings will be disseminated in peer-reviewed journals and conference presentations.

TRIAL REGISTRATION NUMBER

ACTRN1263000082606.

Investigating a caregiver-assisted social skills group programme for primary and early high school-aged children with acquired brain injury or cerebral palsy: protocol for a pilot mixed-methods, two-group randomised trial of PEERS Plus

INTRODUCTION

Reaching social milestones is an important goal of childhood. Children with acquired brain injury (ABI) and cerebral palsy (CP) frequently experience challenges with social functioning and participation. The Programme for the Education and Enrichment of Relational Skills (PEERS) is a group-based social skills programme for adolescents. This study will compare an adapted PEERS programme with usual care in a pilot randomised waitlist-controlled trial for primary and early high school-aged children with brain injuries.

METHODS AND ANALYSIS

This single-centre study will be conducted at the Queensland Cerebral Palsy and Rehabilitation Research Centre at the Centre for Children's Health Research in Brisbane, Australia. Thirty-two school-aged children (grades 3+; 8-13 years) with an ABI or CP and their caregiver(s) will be recruited and randomly assigned to either 12 week PEERS Plus or waitlist usual care. The waitlist group will then participate in PEERS Plus after the 3 month retention time point. The primary outcome will measure individualised social participation goals on the Canadian Occupational Performance Measure immediately postintervention at the primary endpoint (12 weeks). Secondary outcomes include the Social Skills Improvement System Social-Emotional Learning Edition Rating Forms and Quality of Play Questionnaire immediately postintervention, 12 weeks postintervention (26 weeks postbaseline), 36 weeks postintervention (52 weeks postbaseline) for retention. Following completion of the PEERS Plus programme, semistructured focus group interviews will be conducted separately with caregivers and children to explore the lived experience of PEERS. Interpretive description will be used to identify patterns and themes related to participants' experiences. Analyses will follow standard principles for randomised controlled trials using two-group comparisons on all participants on an intention-to-treat basis. Comparisons between groups for primary and secondary outcomes will be conducted using regression models. This study will estimate the unit costs of providing PEERS Plus at different levels of public health facilities in Australia.

ETHICS AND DISSEMINATION

This study has been approved by the Medical Research Ethics Committee of The University of Queensland (2022/HE002031) and the Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/22/QCHQ/87450). Recruitment and participant informed consent process will be completed in accordance with institutional ethic procedures. Dissemination plans include peer-review publication of study results, presentations, and instructional workshops at national and international conferences.

TRIAL REGISTRATION NUMBER

ACTRN12623000515695.

Feasibility and cross-cultural validation of an adapted social skills group training programme (KONTAKTTM CHILD) for Chinese autistic children: a waitlist RCT protocol

INTRODUCTION

School-age autistic children commonly experience social communication and interaction challenges in their everyday lives. While international evidence suggests that social skills group training (SSGT) programmes can support autistic children, improving their psychosocial functioning, to date there is no standardised evidence-based SSGT tailored towards the needs of autistic children aged 8-12 years living in the Chinese Mainland. Therefore, the primary objective of this study will be to evaluate the feasibility and acceptability of a culturally adapted 16-session version of the social skills programme KONTAKT in Chinese autistic children. Additionally, preliminary efficacy and cost-effectiveness will be assessed to inform a future definitive trial.

METHODS AND ANALYSIS

This study will employ a randomised, single-blinded, waitlist-controlled feasibility design with 36 Chinese autistic children aged 8-12 years with IQ over 70 referred to the Child Development and Behavior Center in Guangzhou, China. Participants will be randomly assigned to either the immediate training group or the delayed training group stratified by sex. Feasibility will be assessed using quantitative and qualitative data obtained from the KONTAKT CHILD participants, their parents and facilitators of the programme. Preliminary efficacy and cost-effectiveness are assessed via quantitative data obtained at five time points. The primary efficacy outcome is participants' improvement in social skills as measured by the Contextual Assessment of Social Skills. Other outcomes include parents and teachers' reports of participants' autistic traits and adaptive functioning, participants' self-report and projective tests for self-assertiveness and psychosocial functioning, and parent reports on parental reflective functioning and perceived school support. Common process factors and their effects on outcomes will also be explored. Cost-effectiveness will consider from both societal and healthcare perspectives.

ETHICS AND DISSEMINATION

The current study protocol has been reviewed and ethics approval has been obtained from the Ethical Board Committee at the Third Affiliated Hospital of Sun Yat-sen University (II2023-119-01). The trial was pre-registered in Chinese Clinical Trials (ChiCTR2300072136) on 5 June 2023. The results of this trial will be actively disseminated through peer-reviewed publications and conference presentations. Any identifiable personal information will be anonymised to protect confidentiality.

PROTOCOL VERSION

2.0, 31 July 2024.

TRIAL REGISTRATION NUMBER

ChiCTR2300072136.

Adaptation and Feasibility of the Mandarin Version of PEERS® for Autistic Adolescents

PURPOSE

The Program for the Education and Enrichment of Relational Skills (PEERS®) is a group-based social skills training program for adolescents on the autism spectrum. Although the program has been shown to be effective in improving social skills in autistic adolescents, evidence of its effectiveness from the Mandarin-speaking Chinese population is sparse. The present study used a non-randomized, pre- and post-intervention research design to investigate the feasibility and cultural validity of the program, as well as examine the moderators of intervention outcomes.

METHODS

Thirty-three autistic adolescents with intelligence quotient above 70 (Mage = 13.57, SDage = 1.43; Male: Female 25:8) and their parents received 14 concurrent 90-minute sessions. Adolescents' autistic traits, challenging behaviors, emotional functioning, socio-cognitive process, social environment factors (school support), and caregivers' well-being were evaluated.

RESULTS

The findings suggest that with minor adjustments, the Mandarin version of PEERS® was generally acceptable and feasible for autistic adolescents and their parents. PEERS® may improve the social skills knowledge, reciprocal communication abilities, and emotional well-being of autistic adolescents. Also, participants with a higher level of school support, and parents with lower perceived subjective well-being at baseline may gain more benefits from PEERS®. The cultural adaptation and acceptability of the Mandarin Version of PEERS® were discussed.

CONCLUSION

This feasibility study (Chinese Clinical Trial Registry: ChiCTR2200061417, 2022-06-23, retrospectively registered) provides a basis for further randomized control trials of the Mandarin version of PEERS®.

A preliminary randomized controlled study of the PEERS® program for Taiwanese autistic adolescents: The effectiveness on reducing school bullying and enhancing social function

Individuals with autism spectrum disorder (ASD) often experience lifelong social communication challenges and are more vulnerable to school bullying. Addressing their social difficulties and school bullying requires evidence-based interventions. PEERS® (Program for the Education and Enrichment of Relational Skills) was adapted and translated for Taiwanese adolescents. This randomized controlled study aimed to examine the effectiveness of the Taiwanese version of PEERS® in reducing school bullying and enhancing social function among autistic adolescents. Twenty-one autistic adolescents (mean age 14.29 ± 1.67 years; female n = 733.33%) were randomized to a treatment group (TG, n = 10) or a delayed treatment control group (DTG, n = 11). The outcome measures (school bullying, social challenges, social skills knowledge, and social skills performance) were assessed at baseline, post-treatment, and follow-up. The group and time interaction analyses revealed greater magnitudes of reduction in general school bullying (p < 0.001), victimization (p < 0.001), perpetration (p = 0.012), social challenges (p = 0.001), and peer conflicts (p < 0.001), and improvement in social knowledge (p < 0.001) in the TG group than the DTG group. The findings suggest that the PEERS® program tailored for Taiwanese adolescents is effective in reducing school bullying, decreasing social challenges, and enhancing social skills among autistic adolescents, with very large effect sizes (Cohen's d ranging from 1.19 to 2.88). Consequently, participation in the PEERS® program is recommended for adolescents with social difficulties to improve their social communication and interactions to offset school bullying and other social challenges related to adverse outcomes.

Evidence-Based Interventions in Autism

Pediatricians have a critically important role in the care of children with autism, including conducting developmental screening to support early diagnosis and intervention, advising families about evidence-based treatments for autism spectrum disorder, and supporting families' emotional health as they care for a child with a developmental disability. The purpose of this article is to provide pediatricians with information about evidence-based autism treatments and how to determine which interventions are appropriate for children across the autism spectrum at different ages and developmental stages.

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.

Parent perspectives on treatment: A mixed methods analysis of PEERS® for Preschoolers

LAY ABSTRACT

Autistic children have social communication differences that can contribute to difficulties making and keeping friends, as well as poor mental health (e.g. anxiety, depression). Social skills training programs for preschoolers on the spectrum have been shown to increase social functioning and improve outcomes. Parent involvement in these programs is essential, as parents are able to use the intervention strategies outside of sessions. Teaching parents skills to help their children is also thought to reduce parenting stress through empowerment, knowledge, and social support. However, we still do not know much about how parents experience social skills treatments and whether there are specific parts that are especially helpful to them. This study examined parent perspectives on the University of California, Los Angeles Program for the Education and Enrichment of Relational Skills (PEERS®) for Preschoolers, an evidence-based, group social skills intervention for autistic young children who are struggling socially. Twenty-four parents reported on their child's progress through questionnaires and participated in semi-structured interviews that asked about their experiences and perspectives 1-5 years after completing (PEERS®) for Preschoolers. Parents reported that their children displayed increased social skills and confidence after (PEERS®) for Preschoolers, while parents described feeling more positive, supported, and having greater understanding of their child and their development. Those parents who continued to use strategies taught in (PEERS®) for Preschoolers, particularly priming and preparing their child for social activities, showed greater improvements in long-term child outcomes and parenting stress. Overall, findings show that parents had a positive experience during and after PEERS® for Preschoolers, finding the program helpful in multiple ways to both their child and to themselves as a parent.

Pushed Out and Drawn In: Exclusionary Discipline, Mental Health, and Protective Factors Among Youth in Public Schools

BACKGROUND

Exclusionary discipline (ED) has long been an educational equity concern, but its relationship with student health and protective factors is less understood.

METHODS

Using population-based public school student data (N = 82,216), we examined associations between past-month ED and positive depression and anxiety screening instrument results. We also assessed whether each of 9 potential protective factors moderated the ED-mental health relationship by testing interaction effects.

RESULTS

Over 1 in 10 youth experienced past-month ED, with variation by sex, gender identity, special education status, poverty, region, race/ethnicity, and adverse childhood experiences. Net of sociodemographic factors, youth who experienced ED had higher likelihood for current depression (adjusted odds ratio [AOR]: 1.64, 95% confidence interval [CI]: 1.55, 1.73) and anxiety (AOR: 1.49, 95% CI: 1.41, 1.58) symptoms. Significant associations were robust across 5 racial/ethnic groups, except for anxiety among American Indian/Alaska Native youth. Individual, interpersonal, and school-level protective factors appeared to mitigate depression and anxiety regardless of disciplinary experience.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Our findings document ED disproportionality and possible ramifications for emotional well-being.

CONCLUSIONS

In concert with structural efforts to reduce reliance on ED, strategies that bolster protective factors may support youth already impacted by ED and/or mental health problems.

Understanding School Anxiety in Italian Adolescence through an Artificial Neural Network: Influence of Social Skills and Coping Strategies

School anxiety depends on multiple factors that occur directly or indirectly in the teaching-learning process, such as going to the blackboard in class or reporting low grades at home. Other factors that influence school climate are social skills and coping strategies. That said, the aim of this research was to analyze the sources of school anxiety, coping strategies, and social skills in Italian secondary school students through an artificial neural network. For this purpose, a quantitative and ex post facto design was used in which the Inventory of School Anxiety (IAES), the Coping Scale for Children (EAN), and the Questionnaire for the Evaluation of Social Skills student version (EHS-A) were administered. The results showed that cognitive avoidance and behavioral avoidance coping strategies, together with the lack of social skills in students, are the variables that contributed the most to school anxiety scores in the artificial neural network. The conclusions revolve around the need to develop primary prevention programs.

Improving parents' ability to advocate for services for youth with autism: A randomized clinical trial

Youth with autism face challenges accessing services as they transition to adulthood. Improving parents' ability to advocate for services on behalf of their youth may be an effective way to improve service access and ultimately transition outcomes in this group. In this study, we tested whether participating in an advocacy intervention improved parents' ability to advocate for services for their transition-aged youth with autism. One hundred and eighty-five parents of youth with autism ages 16-26, recruited across three states in the U.S., were randomized to one of two experimental conditions. The treatment condition received the ASSIST program, a 12-week (24-h) group-based intervention. The control condition received the same written materials as the treatment condition. Primary outcomes for this report-parent advocacy ability-were collected at baseline (prior to randomization) and post-test (immediately after the treatment group finished the 12-week program) by survey. After taking ASSIST, the treatment condition had greater gains than controls in knowledge of adult services (B = -1.62, CI = -2.33 to -0.90) and perceived advocacy skills (B = -0.19, CI = -0.33 to -0.04). Participants who had less knowledge, lower perceived advocacy skills, and less active coping styles at baseline had the greatest treatment gains. Findings suggest that ASSIST is effective in improving parent advocacy ability and may be most beneficial for parents who experience greater challenges advocating for their son/daughter with autism. Future research will examine whether gains in parent advocacy ability leads to improvements in service access and post-school outcomes for transition-age youth with autism.

Social and executive functioning in individuals with autism spectrum disorder without intellectual disability: The case-control study protocol of the CNeSA study

Several studies suggest that children and adolescents with autism spectrum disorder (ASD) often present deficits in executive functions (EFs). The research on cold EF shows a high heterogeneity across different cohorts of patients as well as different study designs, while studies investigating hot EF and their relationship with different ASD phenotypes are still limited and related only to specific domains, although this concept could contribute to clarify the phenotypical variability by explaining the difficulties encountered by individuals with ASD in daily life, where stimuli are often emotionally charged. With the aim to identify specific neuropsychological profiles in children and adolescents with ASD without intellectual disability, we designed a study protocol comparing a clinical sample of individuals with ASD to aged-matched (10-17 years) typically developing controls (TDC) on a neuropsychological test battery investigating both "cold" and "hot" EF with the purpose of further investigating their relationships with ASD symptoms. Autonomic measures including heart rate, heart rate variability, skin conductance, and salivary cortisol were also recorded before/during/after the neuropsychological testing session. This paper describes the case-control study protocol named "Caratterizzazione NEuropsicologica del disturbo dello Spettro Autistico, senza Disabilità Intellettiva, CNeSA study," its rationale, the specific outcome measures, and their implications for the clinical management of individuals with ASD and a precision medicine approach.