Teaching autistic teens to make friends
During the first week of class, the teens' eyes were downcast, their responses were mumbled and eye contact was almost nonexistent. By Week 12, though, these same kids were talkative, responsive and engaged.
That's the result of a special class designed at UCLA to help teens with autism spectrum disorders (ASD) learn to interact appropriately with their peers. ASD includes a range of pervasive developmental disorders characterized by problems with communication and socialization; it's estimated that one in 150 children born in the United States has some form of ASD.
In a study appearing in the April edition of the Journal of Autism and Developmental Disorders, UCLA clinical instructor of psychiatry Elizabeth Laugeson and colleagues report that in comparison with a control group, the treatment group taking the class significantly improved their overall social skills and interactions with their peers.
"Although, typically, developing teens often learn basic social rules through observation of peer behavior and specific instruction from parents," Laugeson said, "adolescents with autism spectrum disorders often require further instruction.
"It's hard enough to be a teenager," she said, "but it's harder still for adolescents with autism because they typically lack the ability to pick up on all the social cues most of us take for granted — things like body language, hand gestures and facial expressions, along with speech inflections like warmth, sarcasm or hostility.
"Lack of these basic social skills may lead to rejection, isolation or bullying from their peers. And sadly, that isolation can carry into their adult life."
Laugeson and her colleagues developed the class, called PEERS (Program for the Education and Enrichment of Relational Skills), to give high-functioning teens with ASD a set of specific social skills.
"How do you have a successful get-together with someone? How do you go up to a group of teens and join their conversation? What do you say as a comeback when someone teases you? Without these core social skills, it becomes very difficult for teenagers to make and keep friends," Laugeson said.
In the study, 33 teens with ASD — 28 males and five females — attended the PEERS classes. All the participants had a previous diagnosis of high-functioning autism, Asperger's Disorder or Pervasive Developmental Disorder–Not Otherwise Specified (PDD-NOS). The teens met once a week for 12 weeks; each session lasted 90 minutes. Instruction was conducted in a small-group format, with seven to 10 teens, using established strategies for teaching social skills to adolescents with ASD.
Parents were also required to attend separate, concurrent sessions where they were provided direct instruction and guidance to support their child's development.
"Parental involvement was mandatory and important," said Laugeson, who is also associate director of the UCLA Parenting and Children's Friendship Program and director of the Help Group–UCLA Autism Research Alliance. "Other research has shown us that parent involvement can have significant positive effects upon children's friendships, both in terms of direct instruction and supervision, as well as supporting a child's development of an appropriate peer network."
The class focused on teaching rules of social etiquette to the teens, while their parents were given information about how to supervise the implementation of these newly learned skills. These included: how to comfortably join and exit a group of peers; how to pick the right peer group (such as jocks, nerds or gamers); learning good sportsmanship; learning good host behavior during get-togethers; changing bad reputations by changing one's "look" and owning up to a previously bad reputation; and handling teasing, bullying and arguments.
Each class included brief didactic instruction, role-playing exercises in which appropriate social skills were modeled, behavioral rehearsal for teens to practice newly learned skills, coaching with performance feedback, and weekly "homework" assignments supervised by parents, such as inviting a friend over to the home for a get-together.
"The class is very structured, and the skills are broken into small steps that give the teens specific actions they can take in response to a social situation," Laugeson said. "This method of instruction is very appealing to teens with autism because they tend to think concretely and often learn by rote. So if they are teased, for example, we teach them to give a short comeback — like saying 'whatever' or 'so what?' They learn not to take the bait."
Results of testing show that teens who have been through the PEERS program were having more peer interactions with their friends outside of school, and parents reported significant improvement in overall social skills, as measured by a standardized test of social functioning.
Results were encouraging, as improvement was demonstrated on a number of outcome measures. Teens in the treatment group demonstrated improved knowledge of rules of social etiquette relevant to making and keeping friends. They and their parents also reported a significant increase in the frequency of hosted get-togethers and a significantly better quality of friendships at the end of treatment, in comparison with the control group.
"For me, the most important outcome of this research is that we're able to have a direct impact on the quality of lives for teenagers with ASD," Laugeson said. "Helping them to develop meaningful relationships and feel more comfortable within their social world — these are essential ingredients to living a happy life, and what could be more important than that?"
The classes are continuing and currently enrolling. For more information, visit www.semel.ucla.edu/socialskills/ or call the UCLA Parenting and Children's Friendship Program at 310-825-0142.
Other authors of the study were Dr. Fred Frankel, Dr. Catherine Mogil and Ashley Dillon, all of UCLA. Funding was provided by the National Institutes of Health and the National Institute of Mental Health. The authors report no conflict of interest.
The Program for the Education and Enrichment of Relational Skills (PEERS) is part of the UCLA Semel Institute for Neuroscience and Human Behavior, an interdisciplinary research and education institute devoted to the understanding of complex human behavior, including the genetic, biological, behavioral and sociocultural underpinnings of normal behavior, and the causes and consequences of neuropsychiatric disorders.