2018 Gatlinburg Conference Symposium Submission SS-7

Transcription

1 Symposium Title: The Impact of Age and Comorbidities on Social Skills Outcomes across the Lifespan in Autism Spectrum Disorder Chair: Elizabeth Laugeson, Psy Discussant: Jan Blacher, Ph.D. Overview: Autism spectrum disorder (ASD) is a neurodevelopmental disorder that impacts individuals ability to communicate and interact with others (National Institute of Mental Health 2017). Extensive research proves that evidence-based social skills interventions like UCLA s Program for the Education and Enrichment of Relational Skills (PEERS ) can significantly improve symptoms; however, more research is needed to examine the impact of development and comorbidities on treatment outcomes across the lifespan. The four presentations in this symposium will address a few different factors that impact treatment outcomes. The first presentation examines depression in young adults with ASD and its relationship to social isolation and romantic loneliness. The second presentation compares changes in social anxiety following social skills treatment between adolescents and young adults. The third presentation compares social skills treatment gains for individuals with ASD at three different ages over the lifespan (preschool, adolescence, adulthood). The fourth presentation examines social skills treatment gains for adolescents with ASD when comorbid diagnoses including ADHD, anxiety, and depression are present. Collectively, these presentations investigate how age and comorbid conditions impact treatment gains in individuals with autism spectrum disorder following evidence-based social skills interventions. Paper 1 of 4 Paper Title: Connecting Depression and Levels of Loneliness among Young Adults with Autism Spectrum Disorder Authors: Ana Mendoza, M.A., Morgan Jolliffe, Nicole Rosen, & Elizabeth Laugeson, Psy.D. Introduction: Depressive symptoms have been found to be related to many social processes including satisfaction with one s social experience (Kornienko & Santos 2014). Research has shown that adolescents who feel secure in their relationships have a decreased risk of depression in adulthood (Cook, Heinze, Miller, & Zimmerman 2016), while typically developing adults reporting lower levels of social support report higher levels of depression and loneliness (Calmes 2009). Previous research has shown that children with Autism Spectrum Disorder (ASD) experience greater loneliness than their typically developing counterparts, possibly due to poor friendship quality (Bauminger & Kasari 2000). Although the relationship between depression and loneliness has been studied extensively with typically developing youth, this relationship has yet to be explored in young adults with ASD. This study seeks to examine the relationship between self-reported depression and levels of loneliness in young adults with clinically elevated autism symptoms. It is hypothesized that young adults who report higher levels of depression will also report experiencing higher levels of loneliness. Methods: Participants in this study included 78 young adults ranging from age 18 to 35 (Male=64%; mean age=22.32, SD=3.88) presenting for social skills treatment as part of the UCLA Program for the Education and Enrichment of Relational Skills (PEERS; Laugeson 2017), an evidence-based, caregiver-assisted social skills program for young adults with ASD and other social challenges. Young adults completed the Social and Emotional Loneliness Scale for Adults (SELSA; Tomasso & Spinner 1993) and the Major Depression Inventory (MDI; Bech, Rasmussen, Olsen, Noerholm, & Abildgaard 2001) prior to treatment. In order to examine the relationship between social and emotional loneliness and depression, Pearson correlations were calculated using baseline scores on the MDI in comparison to ratings of loneliness on SELSA. Results: Pearson correlations revealed a significant positive relationship between Total Scale scores on the SELSA and the MDI (p<.001). Post hoc analyses revealed that the Social Isolation and the Romantic Isolation subscale of the SELSA were positively Page 1 of 5

2 correlated with overall depression on the MDI (p s<.001). There was no significant association between the Family Isolation subscale of the SELSA and overall self-reported depression. Discussion: Findings support the original hypothesis that young adults reporting higher levels of depression also report higher levels of overall loneliness, particularly in the areas of social and romantic isolation. These findings are important because they reveal a relationship between depression and social and romantic relationships in young adults with ASD. Furthermore, these results suggest that when the treatment priority is to decrease depressive symptoms in youth with ASD, targeted interventions to improve social and romantic relationships may be useful. Bach, P. (2000). Quality of life instruments in depression. European Psychiatry, 12(4), Bauminger, N. & Kasari, C. (2000). Loneliness and friendship in high-functioning children with autism. Child Development, 71(2), Calmes, C.A. (2009). The relationship between co-rumination, relationship satisfaction, and emotional distress. Dissertation Abstracts International: Section B: The Sciences and Engineering, 69(8-B), Cook, S.H., Heinze, J., Miller, A.L., & Zimmerman, M.A. (2016). Transitions in friendship attachment in adolescence is associated with developmental trajectories of depression through adulthood. Journal of Adolescent Health, 58(3), DiTommaso, E. & Spinner, B. (1993). The development and initial validation of the Social and Emotional Loneliness Scale for Adults (SELSA). Personality and Individual Differences, 14(1), Kornienko, O. & Santos, C.E. (2014) The effects of friendship network popularity on depressive symptoms during early adolescence: Moderation by fear of negative evaluation and gender. Journal of Youth and Adolescence, 43(4), Laugeson, E. A. (2017). PEERS for Young Adults: Social Skills Training for Adults with Autism Spectrum Disorder and Other Social Challenges. New York, NY: Taylor & Francis. Paper 2 of 4 Paper Title: Comparing Changes in Level of Social Anxiety in Teens and Young Adults with ASD following the PEERS Social Skills Intervention Authors: Niki Bahri, Yong Seuk S. Lograsso, Nicole Rosen, Morgan Jolliffe, & Elizabeth Laugeson Introduction: Previous research shows that deficits in social skills may increase anxiety in individuals with autism spectrum disorder (ASD) (Kuusikko 2008). Research also suggests that social skills interventions often decrease anxiety symptoms as social skills improve (White, Ollendick & Bray 2011). However, children with ASD report an increase in social anxiety as they grow older (Kuusikko 2008). Given this trend, it would be beneficial to determine whether social skills interventions are as effective in decreasing social anxiety for young adults as they are for adolescents. While there is empirical support demonstrating the effectiveness of social skills interventions in decreasing anxiety for adolescents with ASD, the effectiveness for young adults requires further examination. The purpose of this study was to compare changes in anxiety levels pre- to post-treatment between adolescents and young adults following the UCLA Program for the Education and Enrichment of Relational Skills (PEERS ), an evidence-based, caregiver-assisted social skills program. Methods: Fifty-four young adults (72.2% male; mean age=23.07, SD=4.36) and 158 teens (76.6% male; mean age= 13.64, SD=1.84) with ASD and their caregivers participated in the 16-week UCLA PEERS social skills intervention, which targets skills related to making and keeping friends and handling peer conflict and rejection. At baseline, all participants had clinically-elevated ASD symptoms, as determined by a total score 60 on the Social Responsiveness Scale-Second Edition (SRS-2; Constanino 2012). Treatment gains were assessed using caregiver-reports on the Social Anxiety Scale (La Greca 1999). Treatment benefit was Page 2 of 5

3 confirmed in the teen and young adult groups using Paired sample T-tests of pre- and post-treatment total scores on the SAS. Differences in rate of treatment gains across the two groups were determined using an ANOVA. Results: Paired samples T-tests show significant decreases in social anxiety on the SAS pre- to post-treatment in both groups: adolescent (t=.576, p<.000), and young adult (t=.672, p<.000). Results from the ANOVA reveal no statistically significant difference in rate of decreased parent-reported social anxiety across the adolescent and young adult groups, F(.967, 1) =.995, p<.327. Discussion: These results suggest that PEERS is equally effective in decreasing social anxiety in adolescents and young adults with ASD. These findings are encouraging given our understanding of how social anxiety may increase as youth with ASD get older (Kuusikko 2008). Future research is needed to continue to compare differential treatment gains across other stages of development following social skills interventions to determine if these differences are consistent across other domains. Kuusikko, S., Pollock-Wurman, R., Jussila, K., Carter, A. S., Mattila, M. L., Ebeling, H.,... & Moilanen, I. (2008). Social anxiety in high-functioning children and adolescents with autism and Asperger syndrome. Journal of autism and developmental disorders, 38(9), La Greca, A. M. (1999). Social anxiety scales for children and adolescents manual. Miami, FL: University of Miami. Orsmond, G. I., Shattuck, P. T., Cooper, B. P., Sterzing, P. R., & Anderson, K. A. (2013). Social participation among young adults with an autism spectrum disorder. Journal of autism and developmental disorders, 43(11), White, S. W., Ollendick, T. H., & Bray, B. C. (2011). College students on the autism spectrum: Prevalence and associated problems. Autism, 15(6), Paper 3 of 4 Paper Title: Examining Treatment Gains over the Lifespan in Individuals with ASD Following the UCLA PEERS Intervention Authors: Morgan Jolliffe, Ruth Ellingsen Ph.D., Nicole Rosen, Elizabeth Laugeson Psy.D. Introduction: Prior research shows that psychiatric disorders may be triggered by stress in adolescence, and that social stress in particular is thought to have a disproportionate impact during this time (Anderson & Teicher 2008). It has also been suggested that while early childhood is a sensitive time for sensory, motor, and language development, adolescence may be a second window of opportunity in brain development, particularly for improving social skills (Fuhrmann, Knoll, Blakemore 2015), a factor that is known to be associated with better psychiatric outcomes (Hawker & Boulton 2000). However, there is a dearth of research comparing social skills treatment outcomes across different developmental stages to examine age as a predictor of success in social skills training. The purpose of this study was to compare differences in treatment gains from a parent-assisted social skills intervention across three age groups (preschool, adolescent, young adult). We hypothesized that the adolescent group would demonstrate the greatest treatment gains across these three conditions. Methods: Participants included 28 preschoolers (85.71% male; mean age=4.50, SD=0.75), 181 adolescents (79.9% male; mean age= 13.73, SD= 1.80), and 76 young adults (77.6% male; mean age= 20.92, SD= 2.34) with Autism Spectrum Disorder (ASD), presenting for treatment through the UCLA Program for the Education and Enrichment of Relational Skills (PEERS ; Laugeson & Frankel, 2010), an evidence-based, parent-assisted social skills program. All participants had clinically elevated ASD symptoms at baseline, as determined by a Total Score 60 on the Social Responsiveness Scale-Second Edition (SRS-2; Constanino 2012). Treatment gains were assessed using parent-reports on the SRS-2 pre- and post-treatment. Results were examined using repeated measures ANOVA to compare changes in SRS-2 Total Scores across groups. Page 3 of 5

4 Results: Paired samples t-tests revealed significant decreases in SRS-2 Total Scores pre- to post-treatment in all three age groups: preschool (t=2.48, p<.001), adolescent (t=10.17, p<.001), and young adult (t=6.87, p<.001). A repeated measures ANOVA compared change in SRS-2 Total Scores between groups and revealed a significant difference in amount of change between the adolescent and young adult groups (F=5.02, p<.01), such that SRS-2 Total Scores improved more in the adolescent group than the young adult group, supporting the original hypothesis. However, there were not significant differences in amount of change between the preschool group and the adolescent group or the preschool group and the young adult group. Discussion: These results suggest that the adolescent group did benefit more from treatment than the young adult group. This is consistent with the research advocating adolescence is a critical age for social skills development. This study demonstrates the importance of social skills treatment during adolescence. Future research might examine other social skills gains following the PEERS intervention to determine if these differences are consistent across other domains. Andersen, S.L. and Teicher, M.H. (2008) Stress, sensitive periods and maturational events in adolescent depression. Trends Neuro- sci. 31, Constantino, J. N., & Gruber, C. P. (2005). Social Responsiveness Scale - 2. Los Angeles: Western Psychological Services. Fuhrmann, D., Knoll, L. J., & Blakemore, S. (2015). Adolescence as a sensitive period of brain development. Trends In Cognitive Sciences, 19(10), doi: /j.tics Hawker, D. S., & Boulton, M. J. (2000). Twenty years' research on peer victimization and psychosocial maladjustment: A meta-analytic review of cross-sectional studies. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 41(4), Paper 4 of 4 Paper Title: The Influence of ADHD, Depression & Anxiety in Predicting Social Skills Outcomes among Adolescents with ASD following PEERS Authors: Nicole Rosen, Angela Dahiya, Ruth Ellingsen, Ph.D., Leilani Forby, Elina Veytsman, Elizabeth Laugeson, Psy.D. Introduction: Deficits in social skills, including impaired social-emotional reciprocity and poor nonverbal communicative behaviors, are common hallmarks for those with autism spectrum disorder (ASD) (Otero et al. 2015). These social deficits are often accompanied by deficits associated with other comorbidities that frequently occur in children with ASD (Leyfer et al. 2006). Among these comorbidities, anxiety, depression and Attention-Deficit/Hyperactivity Disorder (ADHD) are most common (Siminoff et al. 2008). Previous research on the UCLA Program for the Education and Enrichment of Relational Skills (PEERS ), an evidence-based social skills intervention for adolescents with ASD, demonstrates increases in social skills outcomes (Laugeson et al. 2012). While research suggests that ADHD, depression, and social anxiety are common symptoms yielding social deficits among adolescents with ASD, the extent to which these symptoms predict social skills outcomes following PEERS requires examination. The present study examines symptoms of ADHD, depression, and social anxiety as predictors of social skills outcomes among adolescents with ASD following a 14-week parent-assisted social skills intervention. Methods: Participants included 99 adolescents (males=81; females=18) with ASD ranging from years of age (M=13.74; SD=1.65) and their parents. Participants attended PEERS, an empirically-supported parent-assisted social skills intervention. They attended 90-minute group treatment sessions over 14 weeks to learn guidelines related to the development and maintenance of social relationships. To assess baseline adolescent comorbidities, parents completed the Swanson, Nolan, and Pelham Questionnaire-4th edition (SNAP-IV: Bussing 2008), which measures ADHD symptoms, and the Social Anxiety Scale (SAS; La Greca 1999). Adolescents also completed the SAS at baseline, as well as the Children s Depression Inventory (CDI; Kovacs 1992). Treatment outcome was assessed by examining parent- and adolescent-reported change in frequency of social Page 4 of 5

5 engagement using the Quality of Socialization Questionnaire (QSQ; Frankel & Mintz 2008), and parent-reported change in social responsiveness on the Social Responsiveness Scale (SRS; Constantino 2005) pre- and post-intervention. Results: Paired samples t-tests reveal significant improvement in number of adolescent-reported hosted (t=-5.22, p<.001) and invited (t=-2.50, p<.05) get-togethers from pre- to post-treatment. Results also reveal significant improvement in parentreported social responsiveness (t=7.84, p<.001) over the course of treatment. Multiple linear regression was used to assess baseline ADHD, social anxiety, and depression symptoms as potential predictors of treatment outcome. Change in social responsiveness was not related to baseline ADHD-inattentive, ADHD-hyperactive/impulsive, depression, or social anxiety scores (p>.10; R 2 =.009). These baseline scores were also not predictive of change in hosted get-togethers (p>.10; R 2 =.005). ADHDinattentive, social anxiety, and depression baseline scores were not predictive of change in invited get-togethers (p>.10), but ADHD-hyperactive/impulsive baseline scores predicted less improvement at a trend-level significance (p<.10; R 2 =.075). Discussion: Findings reveal that baseline ADHD, depression, and social anxiety symptoms are not predictive of improvement in social responsiveness or frequency of social engagement following the PEERS intervention. However, a trend level significance was found for ADHD-hyperactive/impulsive youth, who presented with slightly less social reciprocity through invited gettogethers from peers. Bussing, R., Fernandez, M., Harwood, M., Hou, W., Garvan, C. W., Eyberg, S. M., & Swanson, J. M. (2008). Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms psychometric properties and normative ratings from a school district sample. Assessment, 15(3), Constantino, J. N., & Gruber, C. P. (2012). Social Responsiveness Scale (2 nd ed.). Los Angeles: Western Psychological Services. Frankel, F., & Mintz, J. (2008). Measuring the quality of play dates. Available from UCLA Parenting and Children s Friendship Program, 300 Medical Plaza, Los Angeles, CA. Kovacs, M. (1992). Children's Depression Inventory (CDI) New York: Multi-health Systems, Inc. La Greca, A. M. (1999). Social anxiety scales for children and adolescents manual. Miami, FL: University of Miami. Laugeson, E. A., Frankel, F., Gantman, A., Dillon, A. R., & Mogil, C. (2012). Evidence-based social skills training for adolescents with autism spectrum disorders: The UCLA PEERS program. Journal of Autism and Developmental Disorders, 42(6), Leyfer OT, Folstein SE, Bacalman S, Davis NO, Dinh E, Morgan J, Lainhart J. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36: Otero, T. L., Schatz, R. B., Merrill, A. C., & Bellini, S. (2015). Social Skills Training for Youth with Autism Spectrum Disorders: A Follow-Up. Child and adolescent psychiatric clinics of North America, 24(1), doi: /j.chc Simonoff E, Pickles A, Charman T, Chandler S, Loucas T, Baird G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47: Van Hecke, A. V., Stevens, S., Carson, A. M., Karst, J. S., Dolan, B., Schohl, K., et al. (2015). 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, Page 5 of 5