Introduction to Psychology
Behavioral Interventions in Autism
Mayur Mahendrakumar Jain
Autism spectrum disorders (ASD) are developmental disorders affecting social functioning, language and behavior. Symptoms of ASD are not static. Symptoms have been observed to change across development phases, with the transition to adolescence being the most unpredictable one. Experts agree that neurological disturbances contribute to lack of social functioning in ASD. This paper focuses on two studies. The purpose of the first study by Van Hecke et al. (2013) was to examine whether electrophysiological asymmetry in adolescents with ASD changes due to a intervention called Program for the Education and Enrichment of Relational Skills (PEERS). The study by Loredana Marchica & Miranda D’ Amico (2016) focused on finding out whether the results of the intervention technique used in the first study can be improved by providing intensive sessions while the small scale study by Hill et al. (2017) tries to observe the effects of social engagement and community setting on PEERS program.
Due to social skill deficit patients with ASD show withdrawal and high rates of depression usually characterized by greater right-frontal hemisphere activity and less left-frontal hemisphere activity (Van Hecke et al., 2013). Interventions have proved helpful in improving the behavior. However, if left untreated, subjects with ASD lack social connections and friendships resulting in poor quality of life. Interventions such as PEERS have a goal of increasing social communication such as response to social behaviors of others, maintaining eye contact and initiating interaction with others.
Dominance of hemisphere activity in a person’s social life has been confirmed by multiple studies. Studies have found that individuals with more left-hemisphere activity show motivation and positive emotions while more right-hemisphere activity results in withdrawal and negative emotions. It has also been found that children with ASD who had dominant right-hemisphere activity were first reported by parents concerned about autism as compared to children with left-hemisphere activity (Van Hecke et al., 2013).
Parents’ involvement in adolescents with ASD
Parents play an important role in interventions as well. Child’s functioning depends on multiple factors such as relationships with parents, school, peers and society. Parents have positive impact on success of intervention techniques as they help maintain children with ASD learned skills and provide support as in development (Van Hecke et al., 2013).
(A) PEERS Program
PEERS is parent-assisted intervention program over a duration of 14 weeks. For this study total of 110 families were selected and divided into two groups. First group was Experimental group (EXP, n = 41) and second group was Waitlist control (WL, n = 38) (Van Hecke et al., 2013). Assignment was done randomly. EXP families were admitted to PEERS program immediately after first appointment while WL families did not enter PEERS program after first appointment but were asked to wait until the next PEERS session 14 weeks later(Van Hecke et al., 2013). The candidates between the ages of 11 and 16 years with an IQ of 70 or more were selected for this study. Subjects and their families were fluent in English and subjects showed no physical or neural impairments. They also had frequent social contacts and were keen to learn how to make friends. The families participated in minimum of 12 weeks of sessions out of total of 14(Van Hecke et al., 2013; Hill et al., 2017).
The sessions were provided over 14 weeks with each session counting for 1.5 hours. The intervention focused on : developing conversation skills and expanding social networks, learning about etiquettes and reputation and handling bullying and peer pressure (Van Hecke et al., 2013; Hill et al., 2017). Each week a new topic was discussed and a homework assignment was given to participants. Throughout the study it was made sure that parents were able to support practice and helped maintain the skills. The final 14th session consisted of brief review. Questionnaires and Electroencephalogram Session were conducted throughout the study.
The first aim of this study was to find out whether neural asymmetry would change in subjects who received PEERS intervention. Findings indicated that the adolescents with ASD who participated in PEERS showed dominant left-hemisphere activity while adolescents who were placed in Waitlist Control did not show any such change in hemisphere activity (Van Hecke et al., 2013). Secondly, participants with dominant left-hemisphere activity showed more knowledge about intervention concept along with increase in social contacts (Van Hecke et al., 2013).
The purpose of this study was to find out whether PEERS can be implemented to individuals with ASD over shorter period of time and compare the results with the results obtained by Van Hecke et al. (2013)
The participation for this experiment was voluntary and participants were allowed to discontinue at any point during the study without any penalties if they felt discomfort. The subjects between the ages of 12 and 17 years with an IQ of 70 or more were selected for this study. Subjects and their families were fluent in English and participants were previously diagnosed with ASD. They also had frequent social contacts and were keen to learn how to make friends. Subjects were also required to have no previous records of aggressive behaviors (Loredana Marchica & Miranda D’ Amico, 2016). A total of 11 participants were selected for this study. The participants were allowed to continue any medication that they were taking before the study. Participants also continued attending schools and had social contact. At each session during the study attendance of parents was made mandatory (Loredana Marchica ; Miranda D’ Amico, 2016).
This study followed the same procedure followed by PEERS program. Questionnaires were given to parent and adolescent groups pre-rest, post-test and during follow ups. Both groups completed any tests with the help of experienced personnel in separate rooms. The study was conducted over 7 weeks instead of an original 14 week timeline that is usually followed. The purpose of this study was to find if PEERS can be administered in intensive sessions and how would that affect final results (Loredana Marchica & Miranda D’ Amico, 2016).
This study used social skills improvement system-rating scale (SSIS-RS) (Gresham ; Elliot, 2008) and quality of play questionnaires (QPQ) (Frankel ; Mintz, 2011). The results from SSIS-RS and QPQ showed improvements from pre- to post- intervention. There were also improvements participants’ social cognition, communication and motivation and significant decrease in problem behaviors (Loredana Marchica & Miranda D’ Amico, 2016; Hill. et al., 2017). Additionally, QPQ showed less conflict during get-togethers. Even though parents observed improvements in adolescents with ASD in responsibility, empathy and engagement with peers, the improvements were not significant (Loredana Marchica ; Miranda D’ Amico, 2016).
The intervention technique PEERS has shown a lot promise over the years through multiple studies. The results from study performed by Loredana Marchica & Miranda D’ Amico (2016) also suggest that time was an important factor for subjects to learn social skills and integrate them as part of their daily lives. A future direction might be using diverse sample size and gathering data over a long period of time and assessing how teenagers with autism face transitions in their lives and would yield useful data towards further determining the durability of findings. The study by Hill. et al. (2017) also offers a new way to test PEERS and work towards the betterment of the intervention technique. PEERS should be tested in a community environment to evaluate and compare its results with previous results obtained which will certainly help implement the intervention program in a better way and help more individuals with ASD.
Frankel, F. ; Mintz, J. (2011). Maternal reports of play dates of clinic referred and community children. Journal of Child and Family Studies, 20, 623-630
Gresham, F. M. ; Elliot, S. N. (2008). Social Skills Improvement System (SSIS) Rating Scales Manual. Minneapolis, MN: Pearson Education
Hill, T. L. et al. (2017). A Pilot Study Examining the Effectiveness of the PEERS Program on Social Skills and Anxiety in Adolescents with Autism Spectrum Disorder. Journal of Developmental and Physical Disabilities, 29, 797-808
Loredana Marchica ; Miranda D’ Amico (2016). Examining the Efficacy of an Adapted Version of the UCLA PEERS Program with Canadian Adolescents. Journal of Education & Social Policy, 3, 54-65
Van Hecke, A. V. et al. (2013). 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, 316–335.
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