PREFACE
This manual is based upon the original work, Social Skills for Teenagers with Developmental and Autism Spectrum Disorders: The PEERS Treatment Manual, which is a parent-assisted social skills program for adolescents with Autism Spectrum Disorder (ASD) and other social challenges. The research upon which the original work was conducted was funded through a Ruth L. Kirschstein National Research Service Award, through the National Institutes of Health Training Grant NIH T32-MH17140 (Andrew Leuchter, Principal Investigator). The research upon which this derivative work was conducted was funded through grants from the Nathan and Lily Shapell Foundation, the Shapell and Guerin Family Foundation, and The Friends of the Semel Institute at UCLA.
This manual includes several adaptations of the original PEERS Treatment Manual, replacing the original parent-assisted outpatient model with a teacher-facilitated school-based model. Using the new curriculum, social skills groups that were once facilitated by mental health professionals in clinical settings are now taught in the classroom by school personnel, much like we would teach math or science. One benefit of the current approach is that we teach social skills in one of the most natural adolescent social settings of all: the school. Parents are provided with Parent Handouts outlining the lessons and corresponding homework assignments each week, but concurrent parent groups are not offered in this manual. School personnel wishing to include parent groups as part of their program are encouraged to do so by using the Parent Therapist Guides found in the original PEERS Treatment Manual
Another departure from the original manual is that this curriculum utilizes a daily lesson format rather than a once weekly format. School personnel present the curriculum daily in the classroom for 30–60 minutes at a time, 4–5 days per week, as opposed to once a week for 90 minutes. School personnel wishing to conduct weekly 90-minute groups should use the suggestions for modifying this curriculum described in Chapter 1 or refer to the original PEERS Treatment Manual
This manual is also different from the original manual in that it includes 16 weeks of lessons, as opposed to the 14 weeks offered in the parent-assisted program. The supplement of two additional weeks of material includes an added lesson on strategies for handling cyber bullying, as well as the separation of didactic lessons on handling physical bullying and changing a reputation, which were combined into one lesson in the original manual. The additional didactic lesson on cyber bullying was developed as an outgrowth of greater research in this area since the publication of the original manual in 2010. The separation of lessons on handling physical bullying and changing a reputation was the result of feedback from teachers involved with the implementation of the PEERS® curriculum in the school setting during two large research trials.
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Post–test measures, graduation diplomas, food, beverages, plates, napkins, cups, silverware, decorations, TV, DVD player, PG–rated DVDs
Age Distribution of the Class
Classes may have a wide range in age providing there is more than one teen around the same grade level. Ideally, middle school and high school groups should be separate, but this is not absolutely necessary.
Gender Distribution of the Class
Girls and boys are easily mixed in PEERS® without problems. Historically, boys are more likely to present for social skills treatment, so it is likely that classes will be composed of fewer girls. It is recommended that classes with only one female member be avoided, unless the girl agrees.
Including Students Without ASD
It has been repeatedly observed that teens with ASD are often most comfortable and appear to thrive more successfully in social skills groups with other teens with ASD. Therefore, homogenous PEERS® classes for teens with ASD are encouraged. However, teens with ADHD, depression, anxiety, and other social behavioral problems, who are accepting of the unique challenges of teens with ASD, might also be included. Although the curriculum was developed for teens with ASD, we have seen lasting benefits for other teens as well. Since PEERS® targets skill development through instruction of ecologically valid social skills (those behaviors exhibited by socially accepted teens), PEERS® may have widespread applicability, regardless of the diagnosis of the teen. We suspect that any teen who does not know the rules for developing and maintaining friendship could benefit from this curriculum.
Required Personnel
School-based PEERS® instructors typically include teachers, school counselors, school psychologists, speech and language therapists, occupational therapists, recreational therapists, school nurses, teacher aides, and teaching assistants. Whatever the professional background, instructors should have previous experience working with high-functioning teens with ASD and be fully trained on all aspects of the PEERS® curriculum, either by reading this manual beforehand or attending a PEERS® Training Seminar.
In addition to having one primary instructor, it will be essential to have 1–2 behavioral coaches to assist with the class. Behavioral coaches often include teacher aides, teaching assistants, or other school personnel. Some schools have even included neurotypical peer mentors as coaches in PEERS® classes, although the effectiveness of this approach has yet to be tested. Coaches should be trained on all aspects of the PEERS® curriculum and have a good understanding of behavior management strategies. Behavioral coaches are often responsible for conducting role-play demonstrations, providing performance feedback through coaching during behavioral rehearsal exercises and teen activities, and assisting the primary instructor with reinforcement and behavior management.
Physical Facilities
The PEERS® curriculum should be presented much like any class, particularly during the homework review and didactic portions of the lessons. The classroom should have a whiteboard and markers, with tables/desks and chairs for students to sit facing the board. Smartboards may be used, but rules and steps from the lesson should not be created prior to the class, as the lesson should appear to be generated by the students using a Socratic method. Sufficient space should be available in the classroom to break the class into smaller dyads or groups during behavioral rehearsal exercises. Teen activities during Weeks 12–15 are conducted on an outside play area or in an indoor gymnasium in order to practice good sportsmanship during sports activities. Access to sports equipment such as a basketball hoop, soccer net, and/or volleyball net is preferable if possible. In the event that such outdoor accommodations are not possible, teen activities for Weeks 12–15 will need to be modified for indoor games as described in Weeks 8–11.
Materials Needed
The following materials will need to be available for the class:
• Phone Roster. A roster including each student’s name and number, where they can be easily reached for in-class phone assignments, is needed for Weeks 1–6 to practice conversational skills. This roster should be distributed to teens during the first week of the class (see Appendix C). Depending on the policies of the school, consent from parents to release this information to other students may be needed.
• In-Class Call Assignment Log. This sheet is needed to track in-class call assignments during Weeks 1–6, while teens are practicing conversational skills with one another. Keeping careful track of which teens are assigned to call one another will enable instructors to switch the order of “caller” and “receiver” for these phone calls and video chats, while ensuring that teens call different classmates throughout this process (see Appendix D).
• Daily Point Log. The Daily Point Log is used to track the individual points earned during each day of the class. This log should include the name of each teen, along with individual points used toward the distribution of graduation prizes (see Appendix E).
• Good Sportsmanship Point Log. A few copies of the Good Sportsmanship Point Log will be needed in Weeks 8–15 to track teens’ attempts at good sportsmanship during both indoor games and outdoor sports activities. The number of point logs needed will be determined by the number of instructors and behavioral coaches in the class (see Appendix F).
• Homework Compliance Sheets. These sheets are highly recommended to track weekly progress and completion of homework assignments. The Homework Compliance Sheets may be completed by a behavioral coach during the Homework Review on Day One of each week. These sheets might be filed for future reference and used to track program compliance (see Appendix G).
• Certificates of Completion. These certificates are given at the graduation ceremony on the last day of the class. It is strongly encouraged that certificates be awarded as a way of honoring the accomplishments of the students and celebrating their achievements (see Appendix H).
Behavioral Management Techniques
Some teens may be disruptive during the class and will require behavioral management techniques to modify these disruptions. Three particular types of behaviors that will require attention include: (1) inattention (e.g., trouble focusing or maintaining attention); (2) disruption (e.g., engaging in behaviors that distract or disturb the lesson); and (3) disrespect (e.g., teasing, bullying, making rude or inappropriate comments). Suggestions for how to handle these behaviors are listed below.
Verbal Praise
One of the most powerful behavioral management techniques you have with socially motivated teens is the use of verbal praise. Periodically praising the class or individual students for behaviors you want to see will probably increase their frequency. For example, saying, “You guys are doing a great job listening,” or “I like how you’re raising your hand before you speak,” are nice ways to encourage teens to act in a socially appropriate manner.
Reinforcement Using Points
In each class, teens should be earning points for completing homework assignments, through class participation, and the following of rules. During the first class, teens are told that they will be earning points toward a graduation party with graduation prizes. However, these incentives do not hold the power of the points. The true power in using points comes from social comparison. Teens’ names should be listed on the whiteboard in the front of the room tracking points during every class. You will observe teens watching their points very closely. They may even begin to count them, or remind you if you have forgotten to give them a point for something. In fact, we have observed that teens that are known to speak very little in class will begin to participate more just to get points. Again, this is probably just a simple case of social comparison or competition. Regardless of the reason, this behavioral management strategy works, so be sure to use the point system. If points are not visible on the board and are tallied separately by behavioral coaches, they will not be effective.
Using Names to Redirect Attention
It is fairly common for teens to appear to drift off during lessons. They will sometimes appear distracted when in fact they are attending perfectly, although it is difficult to know for sure. If you suspect a teen is having trouble paying attention, rather than interrupting the lesson to bring them back to task, simply use their name as you’re presenting the lesson. For example, you might say, “So Jimmy, one of the rules for trading information is . . .” or “So the goal of trading information is to find common interests, right Jimmy?” (nodding your head to prompt him). Using names to redirect attention is a nice way to bring your students back to task without embarrassing them or seeming punitive.
Using Peer Pressure
Teens will invariably make inappropriate comments or behave improperly from time to time. Rather than scold teens in front of their peers®, causing defensiveness or hurt feelings, apply a little
Another option for including parents in this program would be to offer weekly 90-minute parent groups during the duration of the class. Although this option may not be feasible for some schools, inclusion of parent groups is anticipated to enhance outcome. For school personnel interested in providing weekly parent groups, please refer to the original work, Social Skills for Teenagers with Developmental and Autism Spectrum Disorders: The PEERS Treatment Manual (Laugeson & Frankel, 2010), which includes lesson guides for parent groups.
Whatever the method of inclusion, involvement of parents and other family members will likely improve the effectiveness and generalizability of your school-based program through the use of social coaching outside of the school setting.
Using this Curriculum with Young Adults
PEERS® also uses a caregiver-assisted model to teach young adults with ASD how to develop and maintain meaningful relationships. This 16-week program utilizes a separate manual known as the PEERS® for Young Adults Treatment Manual, which includes modified lessons adapted from the original manual, as well as four new lessons related to dating etiquette. New didactic material on dating etiquette includes ecologically valid strategies for letting someone know you like them, assessing interest, asking someone on a date, accepting rejection, organizing and having successful dates, and general dating do’s and don’ts. Social coaching is provided by caregivers close to young adults with ASD, including parents, adult siblings, peer mentors, job coaches, life coaches, or other family members. Although the PEERS® for Young Adults Treatment Manual is anticipated to follow the publication of this manual by 1–2 years, educators and practitioners interested in using the program sooner might use the existing manuals as an alternative tool in the interim, as approximately 65 percent of the young adult manual is derived from the original PEERS® manual.
Tracking Progress
Tracking progress is an essential part of determining whether your program is working. It is how a program maintains quality control. Below are the tests we have used in our published studies with PEERS®. Several standardized assessments of social functioning are included. These measures are widely available and have shown substantial change following the program. They also impose few demands upon teachers, teens, and parents to complete. Teachers and teens should complete the pre- and post-test assessments before and after the program. The forms can easily be administered as a packet sent to parents to complete before the class begins and again after the class ends.
Social Responsiveness Scale, Second Edition (SRS-2; Constantino & Gruber, 2012)
The SRS-2 consists of 65 items assessing the presence and severity of social deficits (i.e., social awareness, social cognition, social communication, social motivation, and restricted interests and repetitive behaviors) associated with ASD as they occur in natural social settings. The SRS-2 can be completed by teachers and parents. It was normed on a representative national sample and has good internal consistency (a = .95), interrater agreement reliability (r = .61), and convergent validity (Constantino & Gruber, 2012).
Social Skills Improvement System (SSIS; Gresham & Elliot, 2008)
The SSIS is a standardized, 75-item measure that assesses social skills (communication, cooperation, assertion, responsibility, empathy, engagement, self-control) and problem behaviors (externalizing and internalizing behaviors, bullying, hyperactivity and inattention, ASD-related behaviors) for adolescents between the ages of 13 and 18 years. Using a four-point rating system, teachers, parents, and students rate the frequency and relative importance of various social skills and problem behaviors.
Social Anxiety Scale (SAS; La Greca & Lopez, 1998)
The SAS was developed to assess perceptions of children’s and adolescent’s feelings of social anxiety in the context of their peer relations. The SAS can be administered to parents and teens and has been found to have good convergent validity with the Social Phobia and Anxiety Inventory for Children (SPAI-C) in a sample of 1,147 adolescents aged 13–17 years. The fit indices of confirmatory factor analyses were comparable to those obtained in prior studies and supported the hypothesized models of the SAS-P and SPAI-C. The internal consistency was good, and 12-month test–retest reliability was modest for both measures. A significant, positive correlation was found between the SAS-P and SPAI-C, showing that these measures assess related, but relatively independent, constructs of social anxiety and phobia.
Friendship Qualities Scale (FQS; Bukowski, Hoza & Boivin, 1994)
The FQS is a teen self-report measure that assesses the quality of best friendships. It consists of 23 Likert scale items, ranging from 1–5, from five different subscales (Companionship, Closeness, Helpfulness, Security, and Conflict) and takes approximately five minutes to complete. Teens are instructed to identify their best friend and keep this friendship in mind while completing this measure. For example, items include, “My friend and I spend all of our free time together.” The total score ranges from 23–115, with higher scores reflecting better-quality friendships. According to the authors, coefficient alphas for subscales range from .71 to .86. Confirmatory factor analysis supported the factor structure of the subscales and comparisons between ratings by reciprocated versus non-reciprocated friends supported the discriminant validity of the scales (Bukowski et al., 1994).
Test of Adolescent Social Skills Knowledge (TASSK; Appendix A)
The TASSK is a 26-item criterion-referenced test developed for PEERS® to assess teens’ knowledge about the specific social skills taught during the intervention. Items are derived from key elements from the didactic lessons. Teens are presented with sentence stems and asked to choose the best option from two possible answers. Scores range from 0–26, with higher scores reflecting greater knowledge of teen social skills. The coefficient alpha for the TASSK was .56. This moderate level of internal consistency was acceptable, given the large domain of questions on the scale. The TASSK takes approximately five minutes to complete and can be found in Appendix A.
