The Cultural Adaptation and Clinical Efficacy of the PEERS® Program in Israel

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition, characterized by social communication deficits and restricted, repetitive behavior patterns. Adolescence is a particularly troubling period for persons with ASD, with increased awareness of teens to the difficulties they encounter when interacting with peers, and their susceptibility to isolation, rejection and bullying. Learning to make and keep friends is especially difficult for teen with ASD. Thus, teaching the necessary skills may have significant life long impact for this group. In Israel, research supported social skills training has been available only for elementary school aged children within the educational settings (Bauminger, 2007). The Program for the Education and Enrichment of Relational Skills (PEERS®; Laugeson & Frankel, 2010) is a parent-mediated social-skills program for adolescents with ASD that has been well validated with and out of North-America.

Objectives: The current study had two objectives: (1) to culturally adapt PEERS® in Israel. (2) to clinically evaluate the efficacy of the adapted PEERS® protocol with Israeli adolescents with ASD and their parents in a clinical setting.

Methods: The PEERS® protocol has been translated to Hebrew and culturally adapted by a team of clinicians specialized in ASD. The adapted protocol was administered to sixty-one adolescents (7 girls), aged 10-16, and their parents, who attended social skills groups at the 'Bait Echad' clinical center for individuals with ASD. Questionnaires were filled out pre- and post-intervention. Parents reported on autism symtomatology (SRS-2) social skills (SSIS), and quality of socialization (QSQ). Teachers reported on autism symtomatology (SRS-2) and social skills (SSIS). Adolescents reported on social skills knowledge (TASSK), quality of socialization (QSQ), autism symtomatology (AQ), empathy (EQ), loneliness (UCLA), and social anxiety (SAS). Qualitative interviews were conducted with teens, parents, and clinicians who took part in the first two groups.

Results: Participants' and clinicians' feedback supported the applicability of PEERS® to adolescents with ASD in Israel. Cultural adaptations have been conducted around several themes, including choosing appropriate friends, appropriate use of humor, good sportsmanship, use of electronic communication, and the management of get-togethers. Questionnaire results show a significant improvement on adolescents’ social skills knowledge (p<.001), and a greater frequency of social get togethers (p<.001). In addition, teens reported reduced feelings of loneliness (p<.05), enhanced empathy (p<.05), and reduced autism symptomatology (p<.05). Parents reported a significant reduction in autism symptomatology (p<.01), and both parents (p<.01) and teachers (p<.05) reported on improved social skills.

Conclusions: Results of this clinical trial support PEERS® as a promising evidence-based intervention for adolescents with ASD in Israel. A randomized controlled trial of the Israeli adaptation is currently undergoing. The significant effects of the intervention, conducted with a broader age range of participants, suggest PEERS® may also be applicable to a younger age group.