Schiltz, H. K., McVey, A. J., Dolan, B. K., Willar, K. S., Pleiss, S., Karst, J. S., Carson, A. M., Caiozzo, C., Vogt, E. M., Yund, B. D., & 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

Reviewed by: Anna Linnehan, MEd, BCBA, LABA and Mary Jane Weiss, PhD, BCBA-D, Endicott College

Why research this topic?

Procedures to teach specific skills for individuals with autismAutism Spectrum Disorder (ASD) is characterized by deficits in social communication, including difficulties in social reciprocity and insistence on sameness (American Psychiatric Association, 2013). Individuals with autism often have limited social interest and motivation, and therefore do not easily learn from casual exposure to the social community. These social challenges also exist for those who are high functioning. Adolescents with high-functioning ASD may be at risk for misreading social cues and failing to understand social nuances. They are also at high risk of being bullied, leading to feelings of isolation and loneliness.

Symptoms of depression may be difficult to assess in these individuals, due to restricted ranges of interests and a decreased motivation to interact with the social environment, both of which are common in individuals with ASD. Ghaziuddin et al. (2002) cite several studies (Ghaziuddin et al. 1992, 1998, Tantum, 1998, Wing, 1981) that suggest depression is the most common psychiatric disorder found in individuals with Asperger’s syndrome. To combat the depression that can co-occur with social isolation in ASD, it is imperative that interventions are developed to increase the motivation for youth with autism to engage with the social environment and learn the skills to form positive relationships with others. 

What did the researchers do?

The aim of this study was to expand on current literature and determine if a social skills intervention (PEERS®) improved outcomes for adolescents with ASD in the United States. The PEERS® curriculum provides training in a variety of social skills domains, including conversational skills, good sportsmanship, managing rejection, and handling disagreements to name a few. The researchers utilized a randomized control trial of PEERS® for adolescents to determine the impact of this social skills intervention on depressive symptoms, on the relation between direct peer interaction and depression at the intervention post-test phase, and on changes in self-reported suicidal ideation ratings.

Forty-nine adolescents, ages 11-16, with a diagnosis of ASD participated in the study. The participants were randomly assigned into two groups, experimental (EXP; n=24) and waitlist (WL; n=25). The researchers utilized the Children’s Depression Inventory (CDI) to assess depressive symptoms pre and post intervention for the experimental group and following 14 weeks for the wait-list group. The CDI is a 27-item self-report questionnaire used to rate depressive symptoms of youth ages 7-17. The CDI assesses five factors: negative mood (example item: “I am sad once in a while, many times, or all the time); ineffectiveness (example item: “I can never be as good as other kids, I can be as good as other kids if I want to, or I am just as good as other kids.”); negative self-esteem (example item: “Nothing will ever work out for me, I am not sure if things will work out for me, or things will work out for me O.K.”); interpersonal problems (example item: “I get along with people, I get into fights many times, or I get into fights all the time.”); and anhedonia (example item: “I have fun in many things, some things, or nothing is fun at all.”). Statistical significance was utilized as a measure to determine the effects of the study. The researchers also obtained information via parent report on the number of social get-togethers in which the participants engaged.

What did the researchers find?

Statistically significant changes from pre-test to post-test for the experimental group were measured in an overall drop in scores on the CDI, with negative mood and anhedonia showing the most significant changes. Marginally significant changes were noted in the areas of ineffectiveness and negative self-esteem, and no major significant change was noted in interpersonal problems. There was no significant change measured in the waitlist group on any of these items. Suicidal ideation in the experimental group was endorsed in the mid-level range pre-intervention and dropped to 0% ideation following treatment. This is a very significant finding. The waitlist group also endorsed a mid-level suicidal ideation at pre-test (18%, n=3), and actually reported higher levels at post-test (30%, n=5).

What are the strengths and limitations of this study?

The study extends research in employing the CDI subscales as a measure for identifying the impact of interventions designed to remediate symptoms of depression and reduce suicidal ideology for individuals with ASD. Although not directly measured, the results of the study indicate that the development of social skills may decrease symptoms of depression. Specifically, teaching individuals to build friendships and develop skills in approaching social situations may reduce vulnerability to depression in adolescents with ASD. A limitation of the CDI interpersonal ratings subscale is it does not address social skills; rather, it addresses the individual’s interest in being with and following directions from others. This is an important consideration for future studies. Enhancing motivation to be with others may need to be specifically addressed for adolescents with ASD. The researchers also indicated they did not control for any effects from concurrent interventions. Future studies should examine the role of concurrent interventions, to increase the confidence that the PEERS® intervention is the agent of change. Finally, this study utilized self-report as a measure to determine the effects of the intervention. Individuals with ASD may not accurately report their feelings and emotions; therefore, multiple raters would strengthen the results. For example, the perceptions of family members or educators might be an interesting addition to the assessment of behavioral changes.

What do the results mean?

This research is encouraging in its attempt to link the importance of teaching social behaviors to increase socially mediated reinforcement from the community, addressing one of the core deficits in ASD. Social isolation is a serious issue and increases vulnerability to depression in adolescents with ASD. Adolescence represents a developmentally appropriate and clinically crucial time to acquire skills in forming friendships and making social connections. More research is needed in understanding the unique features of depression in adolescents with ASD and in identifying effective strategies to reduce social isolation and increase social skills in these individuals.

References:

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

Ghaziuddin, M., Tsai, L., & Ghaziuddin, N. (1992). Comorbidity of autistic disorder in children in children and adolescents. European Child and Adolescent Psychiatry, 1, 209-213.

Ghaziuddin, M., & Greden, J. (1998). Depression in children with autism/pervasive developmental disorders: a case-control family history study. Journal of Autism and Developmental Disorders, 28, 111-115.

Schlitz, H. K., McVey, A. J., McVey, A. J., Dolan, B. K., Willar, K. S., Pleiss, S., Karst, S., Carson, A. M., Caiozzo, C., Vogt, E. M., Yund, B. D., & Van Hecke, A. (2017). Changing depressive symptoms among adolescents with ASD completing the PEERS® social skills intervention. Journal of Autism and Developmental Disorders, 48(3), 834-843.

Tantam, D. (1998). Asperger’s syndrome. Journal of Child Psychology and Psychiatry, 29, 245-253.

Wing, L. (1981). Asperger’s syndrome: A clinical account, Psychological Medicine, 11, 115-119.

Citation for this article:

Linnehan, A., & Weiss, M.J. (2020). Research synopsis: Changes in depressive symptoms among adolescents with ASD completing the PEERS® social skills intervention. Science in Autism Treatment, 17(9).

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