Treatment As Usual and Peer Engagement in Teens with High Functioning Autism

Background: Impairment in the ability to interact socially is the hallmark feature of teens with High Functioning Autism (HFA). Few interventions and supports are available to these adolescents, despite their significant need. As a result, these adolescents are at risk for depression and anxiety, often experiencing marginalization within their peer group and community. Several clinical interventions have been designed to improve social relationships for teens with HFA and typically include a clinic based social skills group composed of teens from different locales who share a diagnosis of ASD. Despite widespread use of this intervention, it has not been found to be effective in changing peer relationships or increasing engagement in the teen’s natural environment. Thus, there continues to be a pressing need for effective treatments that improve skills and foster generalization of skills. This muti-site study aims to address this need by examining two school based treatment approaches for teens with ASD: a peer mediated program (ENGAGE) and a more typical social skills group intervention comprised of teens with HFA (TSS).

 

Objectives: This multi-site study (Orlich, Treatment as usual and peer engagement in teens with High Functioning Autism R01HD65291) examines the effectiveness of two group interventions: a typical social skills intervention (TSS) and a novel peer mediated intervention (ENGAGE) aimed at increasing peer interactions, social competence, affiliation and quality of life in teens with HFA within their natural school environment.

Methods: Adolescents with HFA were randomized at the school level to either the skills only (TSS) or peer mediated (ENGAGE) groups for 8 weeks. All adolescents received pre-, post-, and follow-up assessment. Pre-treatment evaluation included confirmation of diagnosis, measurement of IQ, and assessment of social skills, behavioral adjustment and self esteem. To address social relationships, adolescent self perceptions of friendships and loneliness at school, a social network measure, and observation of teen initiations, responses, and engagement took place at school pre-treatment, end of treatment and at follow up. A total of 72 teens will complete the study by February, 2012.

Results: Preliminary data analysis including a repeated measures ANOVA examining intervention type across pre and post assessment points indicated no differences between intervention types but yielded main effects for assessment point on interpersonal relationships by self report (p<.05), internalizing behaviors by parent report (p<.05), and empathy by teacher report (p<.01), indicating that after intervention, participants reported improved interpersonal relationships, parents reported fewer internalizing behaviors, and their teachers reported greater empathy regardless of the type of treatment The finding of improved empathy remained at follow up assessment 3 months later (p<.01).

Conclusions: Findings from the study suggest that adolescents receiving social skills intervention within the teens’ natural environment of school improved perception of their quality of social relationships, teacher report of empathy, and decreased anxiety and depression as observed by their parents. In contrast to previous studies demonstrating gains in social skills, but limited generalizability, our preliminary findings underscore the positive and generalizable impact of naturalistic, school based, group interventions on social engagement and emotional adjustment in adolescents with HFA.