Skip to main content
Log in

Examining Feasibility and Outcomes of the PEERS® for Preschoolers Program

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

Social impairments characteristic of autism spectrum disorder (ASD) are evident in early childhood and often worsen. There is a paucity of evidence-based interventions explicitly targeting social skill development for young children with ASD and few actively integrate caregivers. The PEERS® program, an evidence-based caregiver-assisted social skills program, was extended for young children with ASD (i.e., PEERS® for Preschoolers (P4P)). This pilot study expands upon initial results by examining the feasibility of a briefer intervention period and the effectiveness in improving child social skills among 15 children with ASD. Results suggest P4P recruitment, participant retention, and implementation are feasible across clinicians and sites. Further, P4P appears to improve social skills, maintained post-intervention. Future research might examine mechanisms that lead to results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Data Availability

Patients signed informed consent regarding publishing their data. Data is available upon request.

Notes

  1. Many self-advocates from the autism community (Bury et al., 2020) and current research has indicated both a preference for identify first language (e.g., autistic children) or language describing the individual. Therefore, this language will be utilized throughout the present manuscript.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.

    Book  Google Scholar 

  • Bauminger, N., & Kasari, C. (2000). Loneliness and friendship in high-functioning children with autism. Child Development, 71(2), 447–456. https://doi.org/10.1111/1467-8624.00156

    Article  PubMed  Google Scholar 

  • Bauminger, N., Shulman, C., & Agam, G. (2003). Peer interaction and loneliness in high-functioning children with autism. Journal of Autism and Developmental Disorders, 33(5), 489–507. https://doi.org/10.1023/A:1025827427901

    Article  PubMed  Google Scholar 

  • Bearss, K., Johnson, C., Handen, B., Smith, T., & Scahill, L. (2013). A pilot study of parent training in young children with autism spectrum disorders and disruptive behavior. Journal of Autism and Developmental Disorders, 43(4), 829–840. https://doi.org/10.1007/s10803-012-1624-7

    Article  PubMed  Google Scholar 

  • Bottema-Beutel, K., Mullins, T. S., Harvey, M. N., Gustafson, J. R., & Carter, E. W. (2016). Avoiding the “brick wall of awkward”: Perspectives of youth with autism spectrum disorder on social-focused intervention practices. Autism, 20(2), 196–206. https://doi.org/10.1177/1362361315574888

    Article  PubMed  Google Scholar 

  • Bottema-Beutel, K., Park, H., & Kim, S. Y. (2018). Commentary on social skills training curricula for individuals with ASD: Social interaction, authenticity, and stigma. Journal of Autism and Developmental Disorders, 48(3), 953–964. https://doi.org/10.1007/s10803-017-3400-1

    Article  PubMed  Google Scholar 

  • Boyd, B. A., Hume, K., McBee, M. T., Alessandri, M., Gutierrez, A., Johnson, L., & Odom, S. L. (2014). Comparative efficacy of LEAP, TEACCH and non-model-specific special education programs for preschoolers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(2), 366–380. https://doi.org/10.1007/s10803-013-1877-9

    Article  PubMed  Google Scholar 

  • Bristol, M. M., Gallagher, J. J., & Holt, K. D. (1993). Maternal depressive symptoms in autism: response to psychoeducational intervention. Rehabilitation Psychology, 38(1), 3.

    Article  Google Scholar 

  • Bury, S. M., Jellett, R., Spoor, J. R., & Hedley, D. (2020). “It defines who I am” or “It’s something I have”: What language do [autistic] Australian adults [on the autism spectrum] prefer? Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-020-04425-3

    Article  Google Scholar 

  • Caplan, B., Blacher, J., & Eisenhower, A. (2019). Responsive Parenting and Prospective Social Skills Development in Early School-Aged Children with Autism Spectrum Disorder. Journal of Autism and Developmental DisorderS., 49, 3203–3217. https://doi.org/10.1007/s10803-019-04039-4

    Article  PubMed  Google Scholar 

  • Clearinghouse, W. W. (2017). Reviewer guidance for use with the procedures and standards handbooks (Version 4.0).

  • Constantino, J. N., & Gruber, C. P. (2012). Social Responsiveness Scale (2nd ed.). Western Psychological Services.

    Google Scholar 

  • Corona, L. L., Janicki, C., Milgramm, A., & Christodulu, K. V. (2019). Brief report: Reductions in parenting stress in the context of PEERS—A social skills intervention for adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 49(12), 5073–5077. https://doi.org/10.1007/s10803-019-04201-y

    Article  PubMed  Google Scholar 

  • DeRosier, M. E., Swick, D. C., Davis, N. O., McMillen, J. S., & Matthews, R. (2011). The efficacy of a social skills group intervention for improving social behaviors in children with high functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 41(8), 1033–1043. https://doi.org/10.1007/s10803-010-1128-2

    Article  PubMed  Google Scholar 

  • Factor, R. S., Ryan, S. M., Farley, J. P., Ollendick, T. H., & Scarpa, A. (2017). Does the presence of anxiety and ADHD symptoms add to social impairment in children with autism spectrum disorder? Journal of Autism and Developmental Disorders, 47(4), 1122–1134. https://doi.org/10.1007/s10803-016-3025-9

    Article  PubMed  Google Scholar 

  • Farroni, T., Csibra, G., Simion, F., & Johnson, M. H. (2002). Eye contact detection in humans from birth. Proceedings of the National Academy of Sciences, 99(14), 9602–9605. https://doi.org/10.1073/pnas.152159999

    Article  Google Scholar 

  • Frankel, F., & Mintz, J. (2008). Measuring the quality of play dates. Available from UCLA Parenting and Children’s Friendship Program.

    Google Scholar 

  • Fritz, C. O., Morris, P. E., & Richler, J. J. (2012). Effect size estimates: Current use, calculations, and interpretation. Journal of Experimental Psychology: General, 141(1), 2–18. https://doi.org/10.1037/a0024338

    Article  PubMed  Google Scholar 

  • Gantman, A., Kapp, S. K., Orenski, K., & Laugeson, E. A. (2012). Social skills training for young adults with high-functioning autism spectrum disorders: A randomized controlled pilot study. Journal of Autism and Developmental Disorders, 42(6), 1094–1103. https://doi.org/10.1007/s10803-011-1350-6

    Article  PubMed  Google Scholar 

  • Garbarino, J., Dow-Burger, K., & Ratner, N. B. (2020). Implementation of the program for the education and enrichment of relational skills (PEERS®) social skills intervention in a university-based communication sciences and disorders clinic. Perspectives of the ASHA Special Interest Groups, 5(3), 637–645. https://doi.org/10.1044/2020_PERSP-20-00001

    Article  Google Scholar 

  • Gardner, D. M., Gerdes, A. C., & Weinberger, K. (2019). Examination of a parent-assisted, friendship-building program for adolescents with ADHD. Journal of Attention Disorders, 23(4), 363–373. https://doi.org/10.1177/1087054715588188

    Article  PubMed  Google Scholar 

  • Gengoux, G. W., Schapp, S., Burton, S., Ardel, C. M., Libove, R. A., Baldi, G., Berquist, K. L., Phillips, J. M., & Hardan, A. Y. (2019). Effects of a parent-implemented developmental reciprocity treatment program for children with autism spectrum disorder. Autism, 23(3), 713–725. https://doi.org/10.1177/1362361318775538

    Article  PubMed  Google Scholar 

  • Gresham, F. M., & Elliott, S. N. (2008). Social skills improvement system rating scales manual. NCS Pearson.

    Google Scholar 

  • Grzadzinski, R., Di Martino, A., Brady, E., Mairena, M. A., O’Neale, M., Petkova, E., et al. (2011). Examining autistic traits in children with ADHD: does the autism spectrum extend to ADHD? Journal of autism and developmental disorders, 41(9), 1178-1191

    Article  PubMed  PubMed Central  Google Scholar 

  • Happé, F., & Frith, U. (2020). Annual research review: Looking back to look forward–changes in the concept of autism and implications for future research. Journal of Child Psychology and Psychiatry, 61(3), 218–232. https://doi.org/10.1111/jcpp.13176

    Article  PubMed  Google Scholar 

  • Horner, R. H., Carr, E. G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of single-subject research to identify evidence-based practice in special education. Exceptional Children, 71, 165–179. https://doi.org/10.1177/001440290507100203

    Article  Google Scholar 

  • Iadarola, S., Shih, W., Dean, M., Blanch, E., Harwood, R., Hetherington, S., Mandell, D., Kasari, C., & Smith, T. (2018). Implementing a manualized, classroom transition intervention for students with ASD in under resourced schools. Behavior modification, 42(1), 126–147.

    Article  PubMed  Google Scholar 

  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19. https://doi.org/10.1037/0022-006X.59.1.12

    Article  PubMed  Google Scholar 

  • Kaat, A. J., & Lecavalier, L. (2014). Group-based social skills treatment: A methodological review. Research in Autism Spectrum Disorders, 8(1), 15–24. https://doi.org/10.1016/j.rasd.2013.10.007

    Article  Google Scholar 

  • Kapp, S. K., Steward, R., Crane, L., Elliott, D., Elphick, C., Pellicano, E., & Russell, G. (2019). “People should be allowed to do what they like”: Autistic adults’ views and experiences of stimming. Autism, 23(7), 1782–1792. https://doi.org/10.1177/1362361319829628

    Article  PubMed  PubMed Central  Google Scholar 

  • Kasari, C., Locke, J., Gulsrud, A., & Rotheram-Fuller, E. (2011). Social networks and friendships at school: Comparing children with and without ASD. Journal of Autism and Developmental Disorders, 41(5), 533–544. https://doi.org/10.1007/s10803-010-1076-x

    Article  PubMed  Google Scholar 

  • Kaufman, A. S., & Kaufman, N. L. (2004). Kaufman brief intelligence test. John Wiley.

    Google Scholar 

  • Kazdin, A. E. (1997). Parent management training: Evidence, outcomes, and issues. Journal of the American Academy of Child & Adolescent Psychiatry, 36(10), 1349–1356.

    Article  Google Scholar 

  • Kratochwill, T. R., & Levin, J. R. (2014). Enhancing the scientific credibility of single-case intervention research: Randomization to the rescue. In T. R. Kratochwill & J. R. Levin (Eds.), Single-case intervention research: Methodological and statistical advances (pp. 53–89). American Psychological Association.

    Chapter  Google Scholar 

  • Laugeson, Park, Bolton, Bolourian, & Sanderson. (2016) A Randomized controlled trial of a parent-assisted social skills treatment: The UCLA PEERS® for preschoolers program. poster abstract presented at the International Meeting for Autism Research, Baltimore.

  • Laugeson, E. A., & Frankel, F. (2010). Social skills for teenagers with developmental and autism spectrum disorder: The PEERS treatment manual. Routledge.

    Google Scholar 

  • Laugeson, E. A., Frankel, F., Gantman, A., Dillon, A. R., & Mogil, C. (2012). Evidence-based social skills training for adolescents with autism spectrum disorders: The UCLA PEERS program. Journal of Autism and Developmental Disorders, 42(6), 1025–1036. https://doi.org/10.1007/s10803-011-1339-1

    Article  PubMed  Google Scholar 

  • Laugeson, E. A., Frankel, F., Mogil, C., & Dillon, A. R. (2009). Parent-assisted social skills training to improve friendships in teens with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(4), 596–606. https://doi.org/10.1007/s10803-008-0664-5

    Article  PubMed  Google Scholar 

  • Laugeson, E. A., Gantman, A., Kapp, S. K., Orenski, K., & Ellingsen, R. (2015). A randomized controlled trial to improve social skills in young adults with autism spectrum disorder: The UCLA PEERS® program. Journal of Autism and Developmental Disorders, 45(12), 3978–3989. https://doi.org/10.1007/s10803-015-2504-8

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule (2nd ed.). Western Psychological Services.

    Google Scholar 

  • Lordo, D. N., Bertolin, M., Sudikoff, E. L., Keith, C., Braddock, B., & Kaufman, D. A. (2017). Parents perceive improvements in socio-emotional functioning in adolescents with ASD following social skills treatment. Journal of Autism and Developmental Disorders, 47(1), 203–214. https://doi.org/10.1007/s10803-016-2969-0

    Article  Google Scholar 

  • Maag, J. W. (2006). Social skills training for students with emotional and behavioral disorders: A review of reviews. Behavioral Disorders. https://doi.org/10.1177/019874290603200104

    Article  Google Scholar 

  • Mandelberg, J., Laugeson, E. A., Cunningham, T. D., Ellingsen, R., Bates, S., & Frankel, F. (2014). Long-term treatment outcomes for parent-assisted social skills training for adolescents with autism spectrum disorders: The UCLA PEERS program. Journal of Mental Health Research in Intellectual Disabilities, 7(1), 45–73. https://doi.org/10.1080/19315864.2012.730600

    Article  Google Scholar 

  • McConachie, H., Wilson, C., Mason, D., Garland, D., Parr, J. R., Rattazzi, A., Rodgers, J., Skevington, S., Uljarevic, M., & Magiati, I. (2020). What is important in measuring quality of life? Reflections by autistic adults in four countries. Autism in Adulthood, 2(1), 4–12. https://doi.org/10.1089/aut.2019.0008

    Article  PubMed  PubMed Central  Google Scholar 

  • McCrimmon, A., & Rostad, K. (2014). Test review: Autism diagnostic observation schedule, (ADOS-2) manual (Part II): Toddler module.

  • McVey, A. J., Dolan, B. K., Willar, K. S., Pleiss, S., Karst, J. S., Casnar, C. L., Caiozzo, C., Vogt, E. M., Gordon, N. S., & Van Hecke, A. V. (2016). A replication and extension of the PEERS® for young adults social skills intervention: Examining effects on social skills and social anxiety in young adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(12), 3739–3754.

    Article  PubMed  PubMed Central  Google Scholar 

  • Messinger, D. S., Fogel, A., & Dickson, K. L. (2001). All smiles are positive, but some smiles are more positive than others. Developmental Psychology, 37(5), 642. https://doi.org/10.1037/0012-1649.37.5.642

    Article  PubMed  Google Scholar 

  • Milton, D. E. (2012). On the ontological status of autism: the “double empathy problem.” Disability & Society, 27(6), 883–887.

    Article  Google Scholar 

  • Morgan, D. L., & Morgan, R. K. (2008). Single-case research methods for the behavioral and health sciences. Sage publications.

    Google Scholar 

  • Park, M.N., Moulton, E., & Laugeson, E. A. (under review). Parent-assisted social skills training for children with autism spectrum disorder: PEERS for Preschoolers. Manuscript in press.

  • Paul, R. (2003). Promoting social communication in high functioning individuals with autistic spectrum disorders. Child and Adolescent Psychiatric Clinics of North America, 12(1), 87–106. https://doi.org/10.1016/S1056-4993(02)00047-0

    Article  PubMed  Google Scholar 

  • Rao, P. A., Beidel, D. C., & Murray, M. J. (2008). Social skills interventions for children with Asperger’s syndrome or high-functioning autism: A review and recommendations. Journal of Autism and Developmental Disorders, 38(2), 353–361. https://doi.org/10.1007/s10803-007-0402-4

    Article  PubMed  Google Scholar 

  • Reichow, B., Steiner, A. M., & Volkmar, F. (2012). Social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD). The Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858

    Article  PubMed  Google Scholar 

  • Reichow, B., & Volkmar, F. R. (2010). Social skills interventions for individuals with autism: Evaluation for evidence-based practices within a best evidence synthesis framework. Journal of Autism and Developmental Disorders, 40(2), 149–166. https://doi.org/10.1007/s10803-009-0842-0

    Article  PubMed  Google Scholar 

  • Rogers, S. J., & Dawson, G. (2020). Early start denver model for young children with autism: Promoting language, learning, and engagement. Guilford Publications.

    Google Scholar 

  • Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., Megye, G., & Dawson, G. (2012). Effects of a brief Early Start Denver Model (ESDM)–based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 51(10), 1052–1065. https://doi.org/10.1016/j.jaac.2012.08.003

    Article  Google Scholar 

  • Russell, G., Kapp, S. K., Elliott, D., Elphick, C., Gwernan-Jones, R., & Owens, C. (2019). Mapping the autistic advantage from the accounts of adults diagnosed with autism: A qualitative study. Autism in Adulthood, 1(2), 124–133. https://doi.org/10.1089/aut.2018.0035

    Article  PubMed  Google Scholar 

  • Schiltz, H. K., McVey, A. J., Dolan, B. K., Willar, K. S., Pleiss, S., Karst, J. S., & Van Hecke, A. V. (2018). Changes in depressive symptoms among adolescents with ASD completing the PEERS® social skills intervention. Journal of Autism and Developmental Disorders, 48(3), 834–843. https://doi.org/10.1007/s10803-017-3396-6

    Article  PubMed  Google Scholar 

  • Schohl, K. A., Van Hecke, A. V., Carson, A. M., Dolan, B., Karst, J., & Stevens, S. (2014). A replication and extension of the PEERS intervention: Examining effects on social skills and social anxiety in adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(3), 532–545. https://doi.org/10.1007/s10803-013-1900-1

    Article  PubMed  Google Scholar 

  • Shire, S. Y., Shih, W., Chang, Y. C., Bracaglia, S., Kodjoe, M., & Kasari, C. (2019). Sustained community implementation of JASPER intervention with toddlers with autism. Journal of Autism and Developmental Disorders, 49(5), 1863–1875. https://doi.org/10.1007/s10803-018-03875-0

    Article  PubMed  Google Scholar 

  • South, M., Carr, A. W., Stephenson, K. G., Maisel, M. E., & Cox, J. C. (2017). Symptom overlap on the SRS-2 adult self-report between adults with ASD and adults with high anxiety. Autism Research, 10(7), 1215–1220. https://doi.org/10.1002/aur.1764

    Article  PubMed  Google Scholar 

  • Stahmer, A. C., Rieth, S. R., Dickson, K. S., Feder, J., Burgeson, M., Searcy, K., & Brookman-Frazee, L. (2020). Project ImPACT for toddlers: Pilot outcomes of a community adaptation of an intervention for autism risk. Autism, 24(3), 617–632. https://doi.org/10.1177/1362361319878080

    Article  PubMed  Google Scholar 

  • Steiner, A. M., Gengoux, G. W., Klin, A., & Chawarska, K. (2013). Pivotal response treatment for infants at-risk for autism spectrum disorders: A pilot study. Journal of Autism and Developmental Disorders, 43(1), 91–102. https://doi.org/10.1007/s10803-012-1542-8

    Article  PubMed  PubMed Central  Google Scholar 

  • Tripathi, I., Estabillo, J. A., Moody, C. T., & Laugeson, E. A. (2021). Long-term treatment outcomes of PEERS® for preschoolers: A parent-mediated social skills training program for children with autism spectrum disorder. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-021-05147-w

    Article  PubMed  PubMed Central  Google Scholar 

  • Van Hecke, A. V., Stevens, S., Carson, A. M., Karst, J. S., Dolan, B., Schohl, K., McKindles, R. J., Remmel, R., & Brockman, S. (2015). Measuring the plasticity of social approach: A randomized controlled trial of the effects of the PEERS intervention on EEG asymmetry in adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 45(2), 316–335. https://doi.org/10.1007/s10803-013-1883-y

    Article  PubMed  Google Scholar 

  • Wang, S. Y., Parrila, R., & Cui, Y. (2013). Meta-analysis of social skills interventions of single-case research for individuals with autism spectrum disorders: Results from three-level HLM. Journal of Autism and Developmental Disorders, 43(7), 1701–1716. https://doi.org/10.1007/s10803-012-1726-2

    Article  PubMed  Google Scholar 

  • Watkins, L., Kuhn, M., Ledbetter-Cho, K., Gevarter, C., & O’Reilly, M. (2017). Evidence-based social communication interventions for children with autism spectrum disorder. The Indian Journal of Pediatrics, 84(1), 68–75. https://doi.org/10.1007/s12098-015-1938-5

    Article  PubMed  Google Scholar 

  • White, S. W., Keonig, K., & Scahill, L. (2007). Social skills development in children with autism spectrum disorders: A review of the intervention research. Journal of Autism and Developmental Disorders, 37(10), 1858–1868. https://doi.org/10.1007/s10803-006-0320-x

    Article  Google Scholar 

  • Whittingham, K., Sofronoff, K., Sheffield, J., & Sanders, M. R. (2009). Stepping stones triple p: An RCT of a parenting program with parents of a child diagnosed with an autism spectrum disorder. Journal of Abnormal Child Psychology, 37(4), 469–480. https://doi.org/10.1007/s10802-008-9285-x

    Article  PubMed  Google Scholar 

  • Wolstencroft, J., Robinson, L., Srinivasan, R., Kerry, E., Mandy, W., & Skuse, D. (2018). A systematic review of group social skills interventions, and meta-analysis of outcomes, for children with high functioning ASD. Journal of Autism and Developmental Disorders, 48(7), 2293–2307. https://doi.org/10.1007/s10803-018-3485-1

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the Virginia Tech Autism Clinic & Center for Autism Research, the Georgia Autism Center, and the Emory Autism Clinic for assistance with recruitment for this study and in running the groups, as well as all group leaders and research assistants. Finally, we are especially grateful to the families and children who participated.

Funding

The work was supported by the Virginia Tech Center for Autism Research under the SEED Student Grant (RF) as well as the Psi Chi Honor Society under the Mamie Phipps Clark Diversity Research Grant (RF; neither funding sources had Grant Numbers).

Author information

Authors and Affiliations

Authors

Contributions

RF: conceived of the study, trained clinicians, finalized its design, completed all analyses, and coordination and drafted the manuscript; HR: helped draft the manuscript; EL: consulted on and created intervention and study coordination; AS: participated in the design and coordination of the study and statistical manuscript.

Corresponding author

Correspondence to Reina S. Factor.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Virginia Tech Institutional Review Board and all other organizations involved.

Informed Consent

Informed consent was obtained from legal guardians.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Factor, R.S., Rea, H.M., Laugeson, E.A. et al. Examining Feasibility and Outcomes of the PEERS® for Preschoolers Program. J Autism Dev Disord 53, 1821–1833 (2023). https://doi.org/10.1007/s10803-022-05502-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-022-05502-5

Keywords

Navigation