Translation, Cultural Adaptation and Initial Testing of PEERS in the Netherlands

Background:

The PEERS intervention can be considered a well-established, evidence-based intervention in the USA. However, testing the efficacy of cultural adaptations of PEERS is still ongoing. So far, only Yoo et al. (2014) investigated the efficacy of PEERS outside the USA, and their study demonstrated promising findings regarding the Korean version of PEERS. More and more, the involvement of all stakeholders in the development and evaluation of interventions is acknowledged as crucial for the longer term implementation of interventions across settings. Therefore, in the current project, teens with ASD, their neurotypical peers, parents, teachers, clinicians as well as management staff were involved in the development and evaluation of the Dutch version of PEERS.

Objectives:

The current presentation covers the formative phase (1) and the preliminary adaptation test phase (2) of the cultural adaptation of evidence-based interventions, as adapted from Barrera and colleagues (M. Barrera & Castro, 2006; M. Barrera, Jr., Castro, Strycker, & Toobert, 2012), i.e. describing the process of adaptation of the PEERS program to the Dutch culture and care system (1), and presenting results from the preliminary adaptation test among 32 12-18 year old adolescents with ASD (2).

Methods:

In phase 1, a panel inventory on common vocabulary was conducted among 70 teenagers (and their teachers) from special and regular education aged 12-18 years old. This inventory concerned 14 key constructs from PEERS, e.g. areas of interests, locations for making friends, common peer groups and crowds inside and outside of school, activities with friends, commonly used ways for electronic communication, ways for handling disagreements, and common teasing comebacks. Also, 15 clinicians were involved in the translation and cultural adaptation process. The translation and cultural adaptation process was guided by the research team, and who included input and feedback from all stakeholders through an iterative feedback incorporation procedure. In phase 2, The parent-reported Social Responsiveness Scale (SRS) and the the Test of Adolescent Social Skills Knowledge (TASSK) were assessed pre- and post intervention to evaluate potential treatment outcome.

Results:

The most striking cultural adaptation - reflecting the standpoints of all stakeholders - concerned the strategies for handling rumors and gossip, which were suggested to be taught using a similar approach as the teasing comebacks, more in line with ‘down-to-earth’ Dutch standards. The preliminary testing of this adapted version indicated that the adolescents with ASD significantly improved their social knowledge (TASSK; t₃₁ = -10.9, p<.01) and in parent-reported social responsiveness (SRS; t₃₃ = 3.9, p<.01). In addition, subjective evaluations of teens with ASD, their parents and clinicians were positive.

Conclusions: Although these preliminary results are promising, larger scale controlled research is needed. Methodological and practical considerations in the design and implementation of a recently started randomized controlled trial will therefore be discussed.