Examining the Relationship between Social Anxiety and Quality of Social Skills Among Adolescents with ASD Following the UCLA PEERS® Intervention

Background: Deficits in social skills, such as poor reciprocal social communication, restricted interests, and repetitive behavior are hallmarks of those with Autism Spectrum Disorder (ASD; Murphy et al. 2016). As a result of these deficits, adolescents with ASD often experience less successful implementation of social skills and integration into social settings (Little et al. 2014). These difficulties in social integration often contribute to the development of anxiety, which tends to worsen during the adolescent years (White et al. 2009). Previous research on the UCLA Program for the Education and Enrichment of Relational Skills (PEERS^®), an evidence-based social skills intervention for adolescents with ASD, demonstrates improved social skills following treatment (Laugeson et al. 2012). However, the extent to which social anxiety at baseline predicts social skills outcomes has yet to be examined.

Objectives: The present study examines the relationship between social anxiety and improved social skills among adolescents with ASD following a 16-week social skills intervention.

Methods: Participants from two cohorts included 98 adolescents (males=84, females=14) with ASD ranging from 11-17 years of age (M=13.86; SD=1.68) and their parents, who participated in a parent-assisted intervention, and a separate group of 73 adolescents (males=59; females=14) with ASD ranging from 12-18 years of age (M=15.05; SD=1.71), who participated in a school-based intervention. Adolescent participants had clinically-elevated ASD symptoms as determined by the Social Responsiveness Scale-2 (SRS-2; Constantino, 2012) and clinically-elevated social anxiety as determined by the Social Anxiety Scale (SAS; La Greca, 1999). Baseline social anxiety was measured using adolescent- and parent-reported SAS scores prior to intervention. Participants then completed a 16-week parent-assisted or school-based PEERS^® social skills intervention. Treatment outcome was assessed by examining parent-reported change in social skills using the Social Skills Improvement System (SSIS; Gresham and Elliot, 2008) and change in social responsiveness on the SRS-2 pre- and post-intervention.

Results: Simple linear regressions revealed that baseline adolescent- and parent-reported social anxiety scores were not significantly related to change in social responsiveness on the SRS-2 in the parent-assisted sample (F=.213, p>.10, R²=.002; F=.116, p>.10, R²=.001). Likewise, social anxiety was not predictive of change in social skills (F=.352, p>.10, R²=.004; F=.169, p>.10, R²=.002) or problem behaviors (F=.084 p>.10, R²=.001; F=1.743, p=.190, R²=.019) on the SSIS in the same sample. In the school-based sample, simple linear regressions also revealed that baseline adolescent- and parent-reported social anxiety scores were not significantly related to change in social responsiveness (F=2.201, p=.143, R²=.031; F=.009, p>.10, R²=.000), social skills (F=.490, p>.10, R²=.007; F=.828, p=.366, R²=.012), or problem behaviors (F=.087, p>.10, R²=.001; F(1.72)=.005, p=.945, R²=.000).

Conclusions: Findings reveal that adolescent baseline social anxiety, though a common comorbid symptom of ASD, is not predictive of improvement in social responsiveness or social skills behavior among adolescents with ASD following the PEERS^® intervention in parent-assisted and school-based settings. These findings are encouraging in that they suggest that adolescent anxiety does not appear to impact treatment outcome following PEERS^®.