Examining the Social Validity and Outcomes of Clinically Replicated PEERS (R) for Young Adults, Adolescents, and Preschoolers Groups

Background: PEERS® is an empirically supported, parent-assisted social skills group that delivers comprehensive, skills-based curricula to adolescents and young adults. PEERS® research suggests positive and durable effects on the social skills of teens and young adults with ASD and related disabilities (Laugeson et al., 2012; 2015). PEERS® Preschool curriculum is undergoing initial evaluation.

Few studies are devoted to evaluating the social validity (SV) of research-demonstrated interventions such as PEERS®, while fewer studies consider relationships between SV and outcomes. Despite this, stakeholder approval is paramount when considering intervention diffusion and refinement. Indeed, stakeholders are more likely to select interventions they deem acceptable, while discontinuing those viewed as too demanding or inappropriate (Kazdin, 2000). Capitalizing on the burgeoning PEERS® evidence-base, replications considering outcomes must pivot to empirical questions that integrate stakeholder experiences.

Objectives: We are surveying parent and patient participants across four SV domains: acceptability, feasibility, perceived effectiveness, and satisfaction, and then analyzing SV in relation to parent- and patient-informed outcome measures.

Methods: We are clinically replicating PEERS® under the supervision of a certified PEERS® clinician and licensed psychologist at a university-based clinic. We included data from 57 stakeholders (92% of potential participants consented/included) across two Adolescent, two Young Adult, and one Preschool group (n = 30 parents; n = 27 patients) and aim to enroll 78 more by May 2018. Our inclusion criteria were identical to those described in PEERS® research. Every group had at least one female patient and 78% had ASD. Attrition was minimal (two drops after the 1^st session, one after the 6^th). We obtained pre-outcome measures prior to the first session, and post-outcome and SV questionnaires on the final session. The SV questionnaire used a 5-point scale: strongly agree = 5 to strongly disagree = 1. Outcome measures mirrored those used in prior PEERS® research.

Results: Overall satisfaction across the groups was 4.1, with relatively high ratings by parents in the preschool group (4.6) and low ratings by patients in the teen group (3.6). Descriptively, patient teens and young adults consistently rated SV less favorably than parents. Young adult patients perceived a more neutral effect (3.6), whereas parents of preschoolers perceived larger effects (4.5). In terms of acceptability of weekly lesson topics, ratings across respondents and groups were high. For outcomes, clear gains were indicated by several measures (see Table 2), whereas many measure showed minimal improvement. Some outcome data showed discrepancies between patient and parent responses. Attendance was high (M = 87%; range: 62.5-100%) and not associated with SV/outcomes. Exploratory correlations suggest, at p < .05, that (a) teens and young adults with ASD rated PEERS® significantly less feasible than those without ASD, and (b) some outcomes, such as Empathy Quotient, are strongly and positively associated with SV (r = 0.74).

Conclusions: Preliminary results suggest mostly positive SV of PEERS®, inconsistent outcome data, and associations emerging between SV and outcome, as well as SV and diagnosis. Understanding the SV of PEERS® could help stakeholders improve successful contact with intervention and better understand the variation in outcomes.