Improvement in Social Communication Skills Following the PEERS® for Preschoolers Intervention

Background: Social impairment is a hallmark feature of neurodevelopmental disorders, and significantly affects individuals with ASD regardless of cognitive and language functioning (Carter et al. 2005). While social challenges emerge early, and are highly impairing across the lifespan (Howlin et al, 2000; Rao et al. 2008), few evidence-based social skills interventions (SSIs) exist, particularly for young children with ASD. Children with generally average cognitive abilities have unique SSI needs; however, even fewer programs exist for this group (Reichow et al. 2013). These children are likely to be socially motivated, and to be aware of their differences, leading to distress if social skills impairments are unaddressed.

Objectives: To develop and test a time-limited SSI for young children with ASD with average cognitive abilities. Multiple components which were previously found to bolster treatment gains were included, including active parent education and training, play-based group format, multimodal teaching strategies, and teaching of concrete skills for friendship building. In addition to studying treatment efficacy, predictors of treatment gains were investigated.

Methods: An open-trial (Study 1) and a randomized-controlled trial (Study 2) were completed. Study 1 included 5 children with ASD (mean age = 5.28 years); Study 2 included 11 children with ASD (mean age = 4.89 years). Methods across studies were similar. The PEERS® for Preschoolers intervention is a parent-assisted social skills treatment program that met once weekly over the course of 16 weeks. Each session was 90 minutes; parents and children attended separate and joint concurrent sessions that focused on key strategies for friendship development and maintenance. At baseline, the KBIT-2 and VABS-2 were collected. At baseline and post-treatment, the QPQ, SSiS, SRS-2 and ADOS-2 were collected. Select measures will be discussed here.

Results: Study1: Parent-reported SRS-2 Total Scores decreased by 9.00 T-score points (p=.158, d=.776), indicating a strong trend with a medium/large effect overall. Parent-reported SSiS Social Skills scores increased by 5.40 Standard Score (SS) points (p=.633, d =.132) and SSiS Problem Behavior scores decreased by 2.20 SS points (p=.782, d=.231); effect sizes were small. Study2: Parent-reported SRS-2 Total Scores decreased by 9.45 T-score points (p=.001, d=1.40), indicating a clinically and statistically significant improvement with a large effect size. From pre-to post-treatment, there was a significant decrease in parent-reported SSiS Problem Behavior scores (-5.90 SS points, p=.032, d=.803, large effect). There was a strong trend toward a significant improvement in parent-reported SSiS Social Skills. Predictors of treatment gains: Across studies, treatment gains were independent of baseline KBIT-2, VABS-2, and ADOS-2 comparison scores. Treatment gains on the SSiS Social Skills domain were predicted by baseline SSiS Social Skills scores (r=.531; p=.042, r²=.282). No predictors were identified for improvements in SSiS Problem Behaviors or SRS-2 Total Scores.

Conclusions: Though results should be interpreted with some caution and are limited due to small sample sizes, they suggest social growth and a decrease in problematic behaviors following the PEERS® for Preschoolers intervention. Treatment gains are largely independent of baseline functioning, indicating that the program is likely to be beneficial for many young children with ASD.