Background. Social difficulties are a lifespan characteristic of the autism spectrum disorder (ASD), targeted in interventions for preschoolers and children, while evidence of their effectiveness in adolescents is lacking. The Program for the Education and Enrichment of Relational Skills (PEERS®) is an internationally recognized parent-assisted program on social skills, but in Italy there is no validated adaptation of this specific intervention. Objectives. A two-arm Randomized Controlled Trial to evaluate the effectiveness of the PEERS® intervention in the Italian context was conducted. Methods. The study was conducted according to CONSORT guidelines (Schulz et al., 2010) and registered in Clinical Trial (NCT05473104) (Figure 1). Adolescents with ASD (Level 1) were recruited through national stakeholders and public clinical services. Participants were randomly assigned to two groups stratified by gender and age: the experimental group (TG), attending training immediately, and the delay treatment group (WL), which participated after 14 weeks. Evaluation of primary (social abilities) and secondary outcomes (co-occurring conditions, executive functions) (Figure 2) was performed at 4 time-points: T0 (baseline), T1 (TG post-intervention and WL second baseline), T2 (TG follow-up and WL post-intervention), T3 (WL follow-up). A total of 99 teleconference interviews were conducted by an expert clinician, and 55 participants were excluded. Due to COVID-19, PEERS® training was delivered via telehealth (January-July 2021) and only questionnaires to multi-informant assessors (adolescents, parents, and teachers) were administered, with teachers blinded about the group allocation. Results. Of the 44 participants, 3 in the TG and 4 in the WL dropped out and were not replaced. Therefore, the sample was composed by 37 participants (Mage=15.3; SDage=2.0; range age:12.2-18.2), with 11 girls (29.7%) (TG=18; WL=19). There was no attrition in the outcome measures, except for 1 participant assigned to WL (T0 unavailable). No differences were found at T0 between TG and WL groups in baseline characteristics and primary outcomes. Significant groups differences emerged instead between T0 vs. T1 on primary (TASSK-R, F(1,22) = 40.79, p < .001, η2p = .65; QSQ-Social Initiative Scale parent version z = -3.412, p < .001; adolescent version z = -3.086, p = .002) and secondary outcomes (BRIEF-2 Emotion Regulation Index, F(1,22) = 15.20, p < .001, η2p = .41). To test additional treatment-related effects, we evaluated the changes in overall group (TG+WL) among pre- and post-intervention, and follow-up. Further changes from pre- to post-intervention emerged in secondary outcomes -(BRIEF- Global Executive Composite Score; CBCL-Youth version internalizing, externalizing, total problems; CDI-2 Functional Problems). All the improvements detected in post-treatment were also maintained at a 3-months follow-up. Conclusions. The efficacy of the Italian version of PEERS®– with minor changes to the original content's program – was ascertained on primary and secondary outcomes. Innovative findings on emotion regulation and depression symptoms have also emerged. Study limitations are due to blinding outcome assessors' bias and the absence of qualitative measures. Future studies should confirm the PEERS’ efficacy in community settings with traditional administration methods. Keywords: Autism spectrum disorder; Social skills training; Adolescents; validation; PEERS.
The Italian Validation of the Social Skills Program PEERS® in Adolescents with Autism Spectrum Disorders (ASD): A Randomized Controlled Trial during COVID-19 / Fatta, L. M.; Laugeson, E. A.; Bianchi, D.; Carnovale, C.; Antei, A.; Iannucci, I.; Giammello, F.; Melis, A.; Giartosio, C.; Testino, A.; Laghi, F.; Scattoni, M. L.. - (2023). (Intervento presentato al convegno Accepted as a poster presentation at the International Society for Autism Research Annual Meeting (INSAR 2023) tenutosi a Stockholm, Sweden.).
The Italian Validation of the Social Skills Program PEERS® in Adolescents with Autism Spectrum Disorders (ASD): A Randomized Controlled Trial during COVID-19
Fatta L. M.;Bianchi D.;Melis A.;Laghi F.;
2023
Abstract
Background. Social difficulties are a lifespan characteristic of the autism spectrum disorder (ASD), targeted in interventions for preschoolers and children, while evidence of their effectiveness in adolescents is lacking. The Program for the Education and Enrichment of Relational Skills (PEERS®) is an internationally recognized parent-assisted program on social skills, but in Italy there is no validated adaptation of this specific intervention. Objectives. A two-arm Randomized Controlled Trial to evaluate the effectiveness of the PEERS® intervention in the Italian context was conducted. Methods. The study was conducted according to CONSORT guidelines (Schulz et al., 2010) and registered in Clinical Trial (NCT05473104) (Figure 1). Adolescents with ASD (Level 1) were recruited through national stakeholders and public clinical services. Participants were randomly assigned to two groups stratified by gender and age: the experimental group (TG), attending training immediately, and the delay treatment group (WL), which participated after 14 weeks. Evaluation of primary (social abilities) and secondary outcomes (co-occurring conditions, executive functions) (Figure 2) was performed at 4 time-points: T0 (baseline), T1 (TG post-intervention and WL second baseline), T2 (TG follow-up and WL post-intervention), T3 (WL follow-up). A total of 99 teleconference interviews were conducted by an expert clinician, and 55 participants were excluded. Due to COVID-19, PEERS® training was delivered via telehealth (January-July 2021) and only questionnaires to multi-informant assessors (adolescents, parents, and teachers) were administered, with teachers blinded about the group allocation. Results. Of the 44 participants, 3 in the TG and 4 in the WL dropped out and were not replaced. Therefore, the sample was composed by 37 participants (Mage=15.3; SDage=2.0; range age:12.2-18.2), with 11 girls (29.7%) (TG=18; WL=19). There was no attrition in the outcome measures, except for 1 participant assigned to WL (T0 unavailable). No differences were found at T0 between TG and WL groups in baseline characteristics and primary outcomes. Significant groups differences emerged instead between T0 vs. T1 on primary (TASSK-R, F(1,22) = 40.79, p < .001, η2p = .65; QSQ-Social Initiative Scale parent version z = -3.412, p < .001; adolescent version z = -3.086, p = .002) and secondary outcomes (BRIEF-2 Emotion Regulation Index, F(1,22) = 15.20, p < .001, η2p = .41). To test additional treatment-related effects, we evaluated the changes in overall group (TG+WL) among pre- and post-intervention, and follow-up. Further changes from pre- to post-intervention emerged in secondary outcomes -(BRIEF- Global Executive Composite Score; CBCL-Youth version internalizing, externalizing, total problems; CDI-2 Functional Problems). All the improvements detected in post-treatment were also maintained at a 3-months follow-up. Conclusions. The efficacy of the Italian version of PEERS®– with minor changes to the original content's program – was ascertained on primary and secondary outcomes. Innovative findings on emotion regulation and depression symptoms have also emerged. Study limitations are due to blinding outcome assessors' bias and the absence of qualitative measures. Future studies should confirm the PEERS’ efficacy in community settings with traditional administration methods. Keywords: Autism spectrum disorder; Social skills training; Adolescents; validation; PEERS.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
