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A Randomized Controlled Trial of the Korean Version of the Program for the Education and Enrichment of Relational Skills for Young Adults (PEERS®-YA-K) for Adults with Autism Spectrum Disorder
Objectives: The objectives of this study are, 1) examining feasibility of the PEERS-YA® through cross-cultural modification for Korean language and culture, and 2) validation of the Korean version (PEERS-YA®-K) using a randomized controlled trial (RCT) design, for efficacy in improving social skills of young adults with ASD.
Methods: 1) Cultural adaptation: The original version of the PEERS-YA® treatment manual was translated. Focus group interview was performed for 29 typical adults recruited from advertisement in the community. We asked 33 questions regarding dating etiquettes of young adults and 14 questions about social groups/activities and bullying. The interview questions consist of “whether the contents of the manual are different in Korea”, and “how to modify the differences if we implement it.” We modified the didactic lessons and role play scripts into more culturally sensitive and linguistically appropriate way. 2) Young adults diagnosed with ASD (18~35 years of age, IQ>70) and their social coaches were recruited for RCT. The subjects were randomly assigned to a treatment group (TG, n=19) or waitlist control group (CG, n=19). Primary outcome measures included questionnaires and direct observations quantifying social ability and problems directly related to ASD. Secondary outcome measures included scales for depressive symptoms, anxiety, and other behavioral problems. The effects of the intervention were analyzed by paired samples t-test and repeated measures ANOVA.
Results: 1) Based on focused group interview, several etiquettes for dating have been modified, including rules for follow up call and “blind dating”, examples of appropriate/inappropriate places for dating, conventions for compliments and controversies about online dating. Culturally unique characteristics of romantic relationship are added, and examples of social groups/activities were also modified. 2) Thirty eight young adults (age 23.50±3.89, IQ 99.34±15.01, all male) were participated in RCT. Attrition rate was 10.5% (4 subjects) due to diminishing motivation of the adults, social anxiety and major depressive episode). After the 16 weeks of treatment, participants showed significant improvement in social skills knowledge measured by Test of Adolescent Social Skills Knowledge Recised (TYASSK-R, t=-6.14, p < 0.01), decreased anxiety symptoms on Beck Anxiety Inventory (t=2.19, p < 0.05), and maladaptive behavior on Asperger Syndrome Diagnostic Scale (t=2.41, p < 0.05), ‘Offers Information’ item in language and communication domain score on the Autism Diagnostic Observation Schedule (ADOS, t=3.46, p < 0.05). When we compared TG and CG, TG showed significant difference in TYASSK-R (F=24.69, p < 0.01) and state and trait anxiety (F=5.78, p < 0.05).
Conclusions: After modest cultural adaptation focusing on dating sessions and social activities, implementation of PEERS®-YA-K was feasible to Korean community. We observed improvement in social knowledge and skills, as well as decrease in anxiety in the participants of PEERS®-YA-K.