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Because autism research tends to focus on therapies for younger children, the study's attention to this older age group is unusual, said lead author and program founder Elizabeth Laugeson, an assistant clinical professor at the University of California, Los Angeles.
"But the reality is these kids grow up and social demands change, and we are not keeping up with these demands," she noted.
Anna Vagin, a speech language pathologist and director-elect of the California Speech and Hearing Association, agreed. "Those of us who work with students with ASD need to remember how quickly [they] become young adults," she said. "Each year is precious, and every therapy decision is important."
The 16-week program, called PEERS, focuses on breaking down social behaviors step-by-step and includes caregivers in all of the sessions. The caregiver participation is a unique aspect of the PEERS program, Laugeson said.
"We include parents, other family members, adult siblings, life coaches or peer mentors, because we want to teach people to be social coaches to these young adults outside of the treatment setting," she explained.
Students in the program meet for 90 minutes a week. Caregivers meet at the same time, and the two groups come together at the end of a session to review the day's material and homework assignments, which focus on peer practice between sessions.
In the study, Laugeson and her co-authors had 12 young adults in the program and another 10 in a control group for whom treatment was delayed 16 weeks. After the PEERS sessions ended, follow-up evaluations 16 weeks later showed that those who had completed the program had maintained their improvements. The study was published recently in the Journal of Autism and Developmental Disorders.
A key to PEERS, Vagin said, is the chance to "practice relationship skills in the therapy room as well as the real world."
Jordan Sadler, a speech language pathologist and clinical faculty member at Northwestern University in Chicago, said that being able to generalize skills outside the therapy setting is important. "I strongly believe in taking the time to teach the hows and whys of social communication," she said, to allow for responses in different real-world situations.
Laugeson agreed that is critical. To that end, PEERS participants learn steps of social interactions that people who aren't on the autism spectrum might not even think about, she said.
She gave an example of approaching a group of people and joining their conversation. "We might first teach them to watch and listen, maybe using a prop like a cell phone or gaming device to look distracted while you're sort of eavesdropping," she said. The next step, she added, would be "wait for a pause and then join in by saying something on topic, and then maybe later introducing yourself."
During practice and role play in the sessions, participants get feedback from each other, and that's crucial, Vagin said. "The feedback and support received during treatment sessions allow the young adults, as well as their caregivers, to leave with clear weekly homework [and] the sense that the assignment is attainable," she said.
Autism blogger M. Kelter, who has written about social difficulties, said that a program like PEERS might have helped him as a teen and young adult with his challenges in "basic interactions."
"I think making the program about genuine comprehension is a step in the right direction," he said. He added that the question he would ask is: "Are these trainings empowering individuals on the spectrum or teaching them to conceal their differences?" If it's the former, he said, then "these measures can be a positive thing."
Laugeson said that in developing the program, her team consulted with adolescents and young adults with autism, along with parents. One area where the two groups diverged was dating. "The teens' number one treatment priority was dating etiquette," she said, "and their least prioritized was conversational skills." The parents felt exactly the opposite.
Laugeson and her colleagues ultimately incorporated dating etiquette into their young adult version of PEERS. "Even though many of the young adults are not actively dating, most are pretty curious about it, and we want to make sure that they know what they're doing," she said.
This disconnect between what social skills patients and parents want emphasized might reflect a broader misconception about autism. Because so many people still see it as a condition of childhood, said Laugeson, "we're just not doing enough, unfortunately, for adults."
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SOURCES: Elizabeth Laugeson, assistant clinical professor, University of California, Los Angeles; Anna Vagin, speech language pathologist and director-elect, California Speech and Hearing Association; Jordan Sadler, speech language pathologist and clinical faculty member, Northwestern University, Chicago; M. Kelter, autism blogger; June 25, 2015, Journal of Autism and Developmental Disorders