Parent and Family Outcomes of PEERS Intervention

Background: The difficulties of children with Autism Spectrum Disorders (ASD) affect caregivers across a variety of domains.  The impact of having a child with ASD appears to reverberate throughout the entire family system, and ultimately has transactional effects on the diagnosed child.  Interventions for ASD do not necessarily ameliorate, and may even exacerbate, parent and family distress.  Thus, comprehensive evaluation of interventions should include assessment of parent and family domains.  The Program for the Education and Enrichment of Relationship Skills (PEERS; Laugeson & Frankel, 2009) is a manualized, evidence-based, social skills training intervention for adolescents with ASD. Parents participate in a concurrent, separate group designed to teach PEERS concepts to parents, generalize teen practice of skills outside of group, and troubleshoot issues with assignment completion and development of new teen friendships.  Though numerous studies have suggested positive outcomes for teens following PEERS, no research has evaluated parent and family outcomes.

Objectives: The purpose of this study is to understand how participation in PEERS intervention affects parents and families of teenagers with ASD in terms of parenting efficacy, parenting stress, the parent-child relationship, and family functioning.

Methods: Sixteen parent-child dyads were randomly assigned to an “Experimental” (n = 8) or “Waitlist Control” (n=8) group for PEERS intervention.  Parents in both groups completed the following measures at pre and post intervention: The parenting efficacy subscale of the Parenting Sense of Competency (PSOC); the Stress Index for Parents of Adolescents (SIPA), the Parenting Relationship Questionnaire (PRQ), and the Parent-Child Relationship Inventory (PCRI).  Teenagers with ASD and their parents in the Experimental group then participated in 14 weeks of 1.5 hour sessions focusing on initiating and maintaining friendships.   Mixed between-within subjects Analysis of Variance (ANOVA) was conducted to assess differences between groups over time.

Results: Results indicated a significant interaction effect between treatment condition and time, suggesting a reduction in total parenting stress in the Experimental group in comparison to the Waitlist Control group from pre- to post-PEERS intervention, F (1,13) = 9.74, p = .008, η² = .428.  Additionally, there was a trend toward significant interaction effects between treatment condition and time for child autonomy, suggesting an increase in parent ratings of child autonomy within the Experimental group compared to the Waitlist Control group, F(1,14) = 3.47, p = .083,  η² = .199.  Finally, main effects analysis indicated that parents across groups experienced a significant decrease in relational frustration, F(1,13) = 24.13, p < .001, η² = .650, and family chaos, F(1,14) = 5.34, p = .037, η² = .276; along with a significant increase in parenting efficacy, F (1,14) = 17.05, p = .001, η² = .549.

Conclusions: These results suggest that significant, positive changes occur in parents and families of adolescents with ASD following involvement in PEERS.  Specifically, parents participating in PEERS experienced decreased parenting stress following the intervention.  Further, the parent-adolescent interaction following PEERS appears to facilitate increased teen autonomy, a developmentally important trajectory.  In conjunction with previous literature on PEERS, these findings highlight the comprehensive benefits of this intervention.