1 The Science of Making Friends: The UCLA PEERS ® Program Overview of Workshop • Social deficits among teens and young adults with ASD • Consequences of peer rejection • Limitations of existing social skills programs • Effective methods of social skills instruction • PEERS curriculum strategies • Summary of research findings • Research directions • Resources Social Deficits Among Individuals with ASD ! Poor social communication ! Problems with topic initiation ! Use repetitive themes ! Perseverate on restricted interests ! Disregard the other person’s interests ! One-sided conversations ! Elicit fewer extended responses ! Give fewer reciprocal responses ! Fail to identify common interests ! Difficulty providing relevant information ! Make unexpected leaps in topics ! Pedantic style of speaking ! Poor speech prosody ! Highly verbose ! Difficulty interpreting verbal and nonverbal social cues ! Voice tone ! Sarcasm ! Gestures ! Social touch (Volkmar & Klin, 1998; Bauminger & Kasari, 2000; Orsmond, Krauss, & Seltzer, 2004; Koning & Magill-Evans, 2001; LeCouteur et al., 1989; Marks, Schrader, Longaker, & Levine, 2000; Ghaziuddin & Gerstein, 1996; Twatchman-Cullen, 1998; Hemphill & Siperstein, 1990; Church, Alisanki, Amanullah, 2000; Constantino, 2005) Photo of PEERS® courtesy of Associated Press
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The Science of Making Friends: The UCLA PEERS® Program
Overview of Workshop
• Social deficits among teens and young adults with ASD
• Consequences of peer rejection
• Limitations of existing social skills programs
• Effective methods of social skills instruction
• PEERS curriculum strategies • Summary of research findings • Research directions • Resources
Social Deficits Among Individuals with ASD
! Poor social communication ! Problems with topic initiation ! Use repetitive themes
! Perseverate on restricted interests ! Disregard the other person’s interests
! One-sided conversations ! Elicit fewer extended responses ! Give fewer reciprocal responses ! Fail to identify common interests
! Difficulty providing relevant information ! Make unexpected leaps in topics ! Pedantic style of speaking ! Poor speech prosody ! Highly verbose ! Difficulty interpreting verbal and nonverbal
social cues ! Voice tone ! Sarcasm ! Gestures ! Social touch
Bullying and Peer Victimization Among Adolescents with ASD
• Teens with ASD are NINE times more likely to experience peer victimization than “non-disabled” peers
• 94% of teens with ASD report experiencing some form of peer victimization in the previous year
• Teens with ASD and comorbid ADHD are FOUR times more likely to engage in bullying behavior
– Teens with ASD without ADHD do not differ from typically developing teens in rates of engaging in bullying behavior
(Olweus,1973,1993; Rose et al., 2009; Dinkes et al., 2006; Poteat & Espelage, 2007; Nansel et al., 2001; Espelage & Swearer, 2003;
Hawker & Boulton, 2000; Schwartz, 2010; Perry et al., 2001; Doren et al., 1996; Little, 2001, 2002; Montes & Halterman,
2007; van Roekel et al., 2010; Whitney et al., 1992, Martlew & Hodson, 1991; O’Moore & Hillery, 1989)
Risk Factors for Peer Rejection Among Adolescents with ASD
High Risk Factors: • Less socially competent • Fewer friendships
• Less peer support
Protective Factors: • Friendships are known to
protect against victimization (Olweus,1973,1993; Rose et al., 2009; Dinkes et al., 2006; Poteat & Espelage, 2007; Nansel et al., 2001; Espelage & Swearer, 2003;
Hawker & Boulton, 2000; Schwartz, 2010; Perry et al., 2001; Doren et al., 1996; Little, 2001, 2002; Montes & Halterman,
2007; van Roekel et al., 2010; Whitney et al., 1992, Martlew & Hodson, 1991; O’Moore & Hillery, 1989)
Identifying Peer Rejected and Socially Neglected Individuals with
ASD ! Peer rejection
! Teasing and bullying ! Bad reputations ! Actively seeking out peers ! ADHD, Mood disorders,
Impulse control disorders
! Social neglect ! Isolated and withdrawn ! Ignored and unnoticed ! Actively avoiding peers ! Anxiety, Depression (Volkmar & Klin, 1998; Bauminger & Kasari, 2000; Orsmond, Krauss, &
Seltzer, 2004; Koning & Magill-Evans, 2001; LeCouteur et al., 1989; Marks, Schrader, Longaker, & Levine, 2000; Ghaziuddin & Gerstein,
PEERS® Program for the Education & Enrichment of Relational Skills
(Laugeson & Frankel, 2010)
• Parent-assisted program • Concurrent parent and teen sessions • Addresses core deficits for ASD • Focuses on friendship skills • Teaches ecologically valid social skills • 14 week curriculum
– 90 minute weekly sessions • Evidence-based:
– Teens in middle and high school with ASD – Young adults (18-24) with ASD – Teens with ADHD – Teens with FASD – Teens with ID
PEERS® Program for the Education & Enrichment of Relational Skills
(Laugeson, 2014)
• School curriculum • Teacher-facilitated in the
classroom • 16-week program • Daily lesson plans • Focuses on friendship skills • Strategies for handling peer
rejection/conflict • Includes weekly comprehensive
parent handouts • Evidence-based treatment for ASD
– Middle school – High school
The Science of Making Friends: Helping Socially Challenged Teens and Young Adults
(Laugeson, 2013)
• Parent book • Friendship skills • Handling peer
rejection and conflict • Parent section
– Narrative lessons – Social coaching tips
• Teen and young adult chapter summaries
• Chapter exercises • Companion DVD • Mobile App: FriendMaker
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Evidence-Based Methods for Teaching Social Skills
! Small class format ! Didactic lessons
! Concrete rules and steps of social etiquette ! Ecologically valid social skills
! Role-play demonstrations ! Model social behavior ! Appropriate and inappropriate
demonstrations ! Behavioral rehearsal exercises
! Practice with coaching ! Homework assignments
! Practice in natural social settings ! Helps generalize skills
! Starting conversations and trading information * ! Maintaining conversations and trading information * ! Finding a source of friends * ! Electronic communication ! Appropriate use of humor ! Peer entry ! Peer exiting (three types) * ! Get-togethers ! Dating etiquette (four sessions) * ! Handling arguments and disagreements ! Handling direct bullying * ! Handling indirect bullying * * Different from teen groups
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Daily Lesson Format
Mondays • Homework Review
Tuesdays • Didactic Lesson • Role Play
Wednesdays • Lesson Review • Role Play • Behavioral Rehearsal • Homework Assignment • Distribute parent handout
Thursdays & Fridays
• Didactic Summary • Teen Activity • Homework Assignment
Higher scores indicate more autism-related symptoms
p<.05
Moderate Range
Mild Range
Preliminary Results: Social Responsiveness Scale - 2
Higher scores indicate more social impairment
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Average Range
Preliminary Results: Social Skills Improvement Scale
Higher scores indicate better social skills
Preliminary Results: Social Skills Improvement Scale
Average range
Higher scores indicate more problem behaviors
Preliminary Results: Quality of Play Questionnaire
Number of play dates in the past month
p<.05
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Summary of Findings
• Difference scores (DS) were calculated to examine changes in social functioning following treatment
• Preliminary findings from paired sample t-tests of the open trial reveal a significant:
– Decrease in autism symptoms on the ADOS-2 from a moderate range to a low range (p<.05)
– Improvement in social responsiveness on SRS T-scores in the areas of: • Social communication (DS=5.1; p<.05) • Social awareness (DS=6.2; p<.05) • Social motivation (DS=6.5; p<.05) • Decreased repetitive behaviors / restricted interests (DS=7.3; p<.05)
– Improvement in overall social skills on the SSIS (DS=4.9; p<.05) – Decreased problem behaviors on the SSIS (DS=4.7; p<.05) – Increased frequency of play dates on the QPQ (p<.05).
• No other statistically significant changes were observed across the outcome measures
PEERS® Evidence-Base: Parent-Assistance with Teens and Adults
PEERS® Evidence-Base: Replication Studies with Teens
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UCLA PEERS® Research Partners • Seoul National University (South Korea)
– Randomized controlled trial (Yoo et al. 2014) – Teens with ASD – Korean manual published in 2013
• University of Calgary (Canada) – Adolescents and adults with ASD
• Cal Tech – Pre-post comparison of biomarkers – Predictors of treatment outcome
• Erasmus University (Holland) – Randomized controlled (Yulius Academy) – Teens with ASD – Dutch manual in preparation
• Bar Ilan University (Israel) – Manual translated into Hebrew – Randomized controlled trial – Teens with ASD
• Marquette University – Replication study – social anxiety and parenting
stress (Schohl et al. 2013; Karst et al. 2014) – EEG – first biomarker of treatment outcome
(Van Hecke et al. 2013)
Current Research: PEERS® Virtual Coach
Organization for Autism Research (Laugeson, PI)
• High-functioning adolescents with ASD
• N = 36 • Test the effectiveness of a “virtual coach” using a mobile application (FriendMaker)
• Compare three groups: – PEERS parent-assisted
treatment as usual – PEERS parent-assisted with
virtual coach – Delayed treatment control
Future Research
ACCEPTED
• PEERS dissemination project in the schools for teens with ASD
PROPOSED
• PEERS for Teens with Intellectual Disabilities
• Club PEERS – Maintenance program with booster
sessions • Camp PEERS • PEERS for Dating • PEERS for Careers
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UCLA PEERS Groups
Clinical Example: Preschool
QUESTION:
What do most parents tell preschoolers to do to join a game?
Clinical Examples
QUESTION:
What are common social errors committed by teens with ASD when talking to others?
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Bad Role-Play: Conversational Skills
The Science of Making Friends DVD and Mobile App (Laugeson, 2013)
! Trade information ! Ask the person about himself or
herself ! Answer your own question ! Find a common interest ! Share the conversation ! Ask open-ended questions ! Ask follow-up questions ! Don’t be repetitive ! Listen to your friend ! Be a little more serious when first
getting to know someone (Laugeson & Frankel, 2010; Laugeson, 2013;
Laugeson, 2014)
Clinical Example: Entering Group Conversations
QUESTIONS:
What are most children and teens told to do to meet new people?
What do children and teens with ASD often do to meet new people? The Science of Making Friends DVD and Mobile App
(Laugeson, 2013)
Bad Role-Play: Entering Group Conversations
Perspective Taking Questions:
• What was that like for the group?
• What did the group think of Yasamine?
• Will the group want to talk to Yasamine again? The Science of Making Friends DVD and Mobile App
(Laugeson, 2013)
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PEERS® Steps for Entering Group Conversations
1. Watch / Listen ! Watch from a distance
! Using a prop is helpful ! Listen for the topic ! Identify common interests ! Make periodic eye contact ! Watch to see if you know
someone ! Make sure they’re talking nicely
2. Wait ! Wait for a pause in the
conversation 3. Move closer
! Arm’s length away 4. Join the Topic
! Make a comment or ask a question that is ON TOPIC
The Science of Making Friends DVD and Mobile App (Laugeson, 2013)
Good Role-Play: Entering Group Conversations
Perspective Taking Questions:
• What was that like for the group?
• What did the group think of Yasamine?
• Will the group want to talk to Yasamine again?
The Science of Making Friends DVD and Mobile App (Laugeson, 2013)
Clinical Example: Assessing Interest
QUESTION:
Do most children and teens with ASD know when they are accepted or not accepted into a conversation?
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PEERS® Assessing Interest During Conversational Entry
! Verbal signs: ! Are they talking to you? ! Good: Talking nicely, asking you
questions ! Bad: Giving short answers, not
asking you questions ! Eye contact:
! Are the looking at you? ! Good: Smiling, nodding, making eye
contact ! Bad: Look confused, making faces,
rolling eyes, no eye contact ! Body language:
! Are they facing you? ! Good: OPEN the circle, turn toward
(Olweus,1973,1993; Rose et al., 2009; Dinkes et al., 2006; Poteat & Espelage, 2007; Nansel et al., 2001; Espelage & Swearer, 2003;
Hawker & Boulton, 2000; Schwartz, 2010; Perry et al., 2001; Doren et al., 1996; Little, 2001, 2002; Montes & Halterman,
2007; van Roekel et al., 2010; Whitney et al., 1992, Martlew & Hodson, 1991; O’Moore & Hillery, 1989)
Clinical Example: Teasing
QUESTIONS:
What are most children and teens told to do in response to teasing?
What do most children and teens with ASD do in response to teasing?
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Rules for Handling Teasing
! Do not walk away, ignore the person, or tell an adult
! Don’t show you’re upset or tease back ! Act like what the person said did not
bother you ! Provide a SHORT COMEBACK that
shows what the person said was lame: ! Whatever! ! Anyway… ! So what? ! Big deal! ! Who cares? ! Yeah and? ! And your point is? ! Am I supposed to care? ! Is that supposed to be funny? ! (Shrug shoulders) ! (Roll eyes)
What are most teens told to do in response to cyber bullying?
What do cyber bullies want their victims to do?
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Addressing Cyber Bullying
! Don’t feed the trolls ! Don’t react ! Have friends stick up for you ! Lay low online ! Block the bully ! Save the evidence ! Get help from supportive adults ! Report cyber bullying to the
proper authorities ! Webmasters ! Service providers ! School ! Law enforcement (extreme cases)
What do most adults tell children and teens to do when they are the target of rumors and gossip?
What is the natural response to someone spreading a rumor about you?
PEERS® Handling Rumors & Gossip
How to avoid being the target of gossip:
• Avoid being friends with gossips • Don’t being enemies with the gossips • Be as neutral as possible with the gossips • Don’t spread rumors or gossip about people
PEERS® Handling Rumors & Gossip What to do if you’re the target of gossip: • Every instinct we have is WRONG • Don’t try to disprove the gossip • Don’t show that you’re upset • Don’t confront the source of the gossip • Avoid the source of the gossip • Act amazed anyone would BELIEVE or CARE about the gossip
Spread the rumor about yourself: 1. Find a supportive friend 2. Find an audience 3. Acknowledge the rumor
– “Did you hear this rumor….” 4. Act amazed anyone would BELIEVE or CARE about the rumor
– “I can’t believe anyone believes that.” – “People are so gullible.” – “People need to find something interesting to talk about.” – “People need to get a life.”
5. Repeat with other friends (Laugeson & Frankel, 2010; Laugeson, 2013;
Laugeson, 2014)
Bad Role-Play: Handling Rumors and Gossip
Perspective Taking Questions:
• What was that like for Lara?
• What did Lara think of Yasamine?
• Will Lara want to spread the rumor?
The Science of Making Friends DVD and Mobile App (Laugeson, 2013)
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Good Role-Play: Handling Rumors and Gossip
Perspective Taking Questions:
• What was that like for Lara?
• What did Lara think of Yasamine?
• Will Lara want to spread the rumor?
The Science of Making Friends DVD and Mobile App (Laugeson, 2013)
Clinical Example: Letting Someone Know You Like Them
QUESTIONS:
What are most people with autism told to do to let someone know they like them romantically?
What do people with autism often do to let someone know they like them?
PEERS® Social Skill: Letting Someone Know You Like Them
• Speak to a mutual friend – Ask if the person is dating
anyone – Ask if the person might be
interested in you – Ask if they think the person
might go out with you – Causally mention that you like
them
• Show interest in the person – Trade information – Find common interests
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PEERS® Social Skill: Letting Someone Know You Like Them
• Flirt with them
1. Make eye contact 2. Give a slight smile
• Not a big smile • No teeth
3. Look away 4. Repeat
PEERS® Social Skill: Letting Someone Know You Like Them
• Give compliments
– GENERAL compliments ONLY if you know them well
• Example: “You’re so smart!” – SPECIFIC compliments for
people you don’t know well • Example: “That was really
interesting!” – Avoid too many physical
compliments – Physical compliments should
be from the neck-up
PEERS® Social Skill: Asking Someone on a Date
BEFORE ASKING THEM OUT:
• Figure out their dating status • Let them know you like them • Flirt with them • Trade information multiple times • Find common interests
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PEERS® Social Skill: Asking Someone on a Date
1. Trade information 2. Mention your common interests 3. Ask what they’re doing at some
general time (e.g., this weekend) 4. Assess their interest 5. Use common interests as a cover
story for going out 6. If interested:
– Choose a day and general time – Exchange contact information
7. Contact them to finalize plans 8. If NOT interested:
1. Keep your cool 2. Casually say, “Okay” 3. Change the subject Video courtesy of www.wrongplanet.net
Acknowledgements Funding Support
NIMH U54-MH-068172 (Sigman, PI) NIH T32 MH17140 (Leuchter, PI) Nathan & Lilly Shapell Foundation (Laugeson, PI) Semel Scholar Award (Laugeson, PI) Friends of the Semel Institute (Laugeson, PI) Organization for Autism Research (Gantman, PI) Shapell & Guerin Family Foundation (Laugeson, PI) Organization for Autism Research (Laugeson, PI) Lang Family Foundation (Laugeson, PI)
Research Collaborators
Fred Frankel, Ph.D., ABPP (co-developer) Andrew Leuchter, M.D. (post-doc mentor) Alex Gantman, Psy.D. Catherine Mogil, Psy.D. Helena Johnson, Ph.D. Josh Mandelberg, M.D. Mina Park, Ph.D. Enjey Lin, Ph.D. Jilly Chang, Ph.D. Jennifer Sanderson, Psy.D.
Administrative Support
Yasamine Bolourian, M.A. Jessica Hopkins Shannon Bates, M.A. Lara Tucci, M.A. Ashley R. Dillon, Ph.D. Ruth Ellingsen, M.A. Clare Gorospe Jessie Sanchez Elina Veytsman James Yang
THG Research Assistants Maria Kriv Stephen Kapp, Ph.D. Kaely Orenski, Psy.D. Georgia Yu, M.A. Dali Tung Jan Stolpe Dawn Mitchell, M.A. Rosanna Rivero, M.A. Mary Goodarzi, M.A. Alex Friedman Sarah Bohlman, M.A. Lindsay Henry, M.A. Summer Vilkins Maile Adolphson Horn, M.A. Michelle Jackson, M.A. Sarah Taylor, M.A. Melissa Wasserman, M.A. Lindsey Hughes, M.A. Ellie Mellon Daniel Janulaitis, M.A. Rohini Bagrodia Kathryn Fitzpatrick Tiana Bayrami, M.A. Jason Tinero Elizabeth Shipley, M.A. Khadija Noorbhai Catherine Wallace Marlene Cabrera Renee Doe Alexandra Walsh Marina Avetisian Maria Pizzano Eugene Kutasevich Maricella Campuzano Leijing Zhang
UCLA Research Assistants Jin Lee, Psy.D. Amanda Lenvin Cordelia Ross Kristine McGlennen Jeff Rudie Natalie Colich Dana Lieberman, M.A. Siena Whitham, M.A. Allison Vreeland Lucy Vo Chloe Koeffler Alea Baron, M.A. Laura Knoll, M.A. Ahoo Karimian, M.A. Kathleen Jorgenson, M.A. Rebecca Fountain, M.A. Erin Cornack, M.A. Emily Chen, M.A. Kandyse Christopher Devi Beck-Pancer Ben Schwartman, Ph.D. Elan Javanfard, M.A. Meredith Kalies, M.A. Meagan Cronin, M.A. Lyndsay Brooks, M.A. David Diaz, M.A. Cecilia Costa, M.A. Crystal Ferrendelli, M.A. Erin Santos, M.A. Danielle Missler, M.A. Cara Lam Fernanda Samaia Tony Abuyo Angela Dahiya Jennifer Majdick