Autism, Autism Spectrum Disorder
Conditions
Keywords
Social skill training, PEERS
Brief summary
Despite the psychosocial difficulties common among young adults with autism spectrum disorders(ASD), little to no evidence-based social skills interventions exist for this population. Using a randomized controlled trial(RCT) design, the current study tested the effectiveness of an evidence-based, caregiver-assisted social skills intervention known as PEERS for Young Adults with high-functioning young adults with ASD using self- and caregiver-report measures.
Detailed description
1. Both the case and the control of this study shall be a high-functioning group consisting of young adults aged 18 to 35 years with ASD and an IQ of 70 or over. A total of 48 young adults will be recruited and divided into two groups. One will be the case group and the other will be the waitlist control group. And the study will be going on 3 institutions. Again, the case will be divided into two sub-groups of ten and carry out this new developed program for both parents and young adult. That is, the program will be carried out two times in each of both groups. The waitlist control group will be allowed to receive personal outpatient treatment and general therapeutic intervention from community while waiting. 2. Effects of the program will be measured both at the case and the control by using a scale which measures social interaction, quality of peer relationship, disposition of autism and social anxiety. Equal assessments for both the case and the control will be conducted right before the beginning of the program and right after the completion of the program and four months after the completion of the program.
Interventions
BEHAVIORALParent-assisted social skills training program for young adult with ASD
The subjects will participate in the treatment program weekly for a total of 16 weeks. The final visit will be made at the point four months after the completion of treatment to see long-term effects.
Sponsors
Seoul National University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to 35 Years
Healthy volunteers
No
Inclusion criteria
* 18\ 35 years of age with ASD and IQ of 70 or over
Exclusion criteria
* Young adults who are hard to understand the content of treatment and carry out the task due to their IQs or limited linguistic abilities * Young adults who are uncooperative in the treatment, lack motives and are hard to participate voluntarily * Young adults who have behavior problems so clinically significant that they affects the therapeutic procedure or problems in controlling their emotion and have psychotic symptoms
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Autism Diagnostic Observation Schedule(ADOS) at 4 Month | baseline, after the completion of the treatment, 4 month | The ADOS is a play-based, semistructured, standardized assessment of communication, social interaction, and play (i.e. imaginative use of materials) for individuals with a suspected diagnosis of autism or ASD. The ADOS consists of four modules, each of which can be selected on the basis of the participant's expressive language skills and hronological age. Module 4 of the ADOS is designed for adolescents and adults with fluent speech, and includes 10 essential and 5 optional activities. The scores from each activity are coded as well as those for five subdomains: language and communication, reciprocal social interaction, imagination, stereotyped behaviors and restricted interests, and other abnormal behaviors. minimum 0, maximum 18, higherscores mean a worse outcome. |
| Change From Baseline in Test of Young Adult Social Skills Knowledge(TYASSK) at 4 Month | baseline, 4 month | The TYASSK is a 22-item criterion-referenced test developed for this study to assess the teen's knowledge about the specific social skills taught during the intervention. Two items were derived from key elements of each of the 11 didactic lessons. Teens were presented with sentence stems and asked to choose the best option from two possible answers. Scores range from 0 to 22, with higher scores reflecting greater knowledge of teen social skills. |
| Change From Baseline in Korean Version of the Social Skills Rating System (K-SSRS) at 4 Month | baseline,4 month | The SSRS consists of 38-items and took approximately 10 min to complete. Questionnaires were completed independently by the teen's parent and teacher. For example, items included ''Starts conversations rather than waiting for someone to talk first.'' The items were rated as either ''Never,'' ''Sometimes,'' or ''Very Often.'' The Social Skills and Problem Behaviors scales were derived from factor analysis. minimum 50 and maximum 163, and higherscores mean a better outcome |
| Change From Baseline in Social Responsiveness Scale-2 (SRS-2) at 4 Month | baseline,4 month | The SRS is a 65-item questionnaire that assesses the various dimensions of interpersonal behavior, communication, and repetitive/stereotypic behavior that are characteristics of ASD. minimum 92, maximum 200, higherscores mean a worse outcome |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Korean Version of the Vineland Adaptive Behavior Scale, Second Edition | baseline,4 month | The K-VABS is an interviewed survey and measures adaptive behaviors of individuals such as personal and social skills, used for everyday living from birth to age 90. These are based on the reports of primary caregivers and teachers. The K-VABS contains 5 domains each with 2-3 subdomains. The main domains are: Communication, Daily Living Skills, Socialization, Motor Skills, and Maladaptive Behavior (optional). Behaviors are rated on a 0 (a skill that is not used by the individual) - 2 (a skill used most of the time) rating scale. The current study used only the communication, daily living skills, and socialization domains. minimum 25, maximum 108, higherscores mean a better outcome. |
| Change From Baseline in Beck Depression Inventory (BDI) at 4month | baseline,4 month | The BDI consists of 21 items measuring the severity of subjective symptoms of depression, with emotional, cognitive, motivational, and physiological symptom profiles for adults. Each question has four possible answer choices, scored from 0 (no symptoms) to 3 (the most severe symptoms). minimum 1, maximum 45, higherscores mean a worse outcome |
Participant flow
Recruitment details
The participants were recruited from the Child and Adolescent Psychiatric Clinic at Seoul National University Bundang Hospital, through advertisements at the Smile Together Foundation (a local advocacy institute of ASD), a community of child and adolescent psychiatrists, an internet group of families of youth with ASD.
Pre-assignment details
Ten participants were excluded during the randomization procedure; six were not adequately motivated, one did not meet the diagnosis of ASD, one had difficulty understanding self-report scales, one had a problem with school, and one had to fulfill a military commitment.
Participants by arm
| Arm | Count |
|---|---|
| Case Group Behavioral: parent-assisted social skills training program for young adults with autism spectrum disorder The subjects will participate in the treatment program weekly for a total of 14 weeks. The final visit will be made at the point three months after the completion of treatment to see mid- and long-term effects.
Parent-assisted social skills training program for young adult with ASD: The subjects will participate in the treatment program weekly for a total of 16 weeks. The final visit will be made at the point four months after the completion of treatment to see long-term effects. | 19 |
| Waitlist Control Group For this group, same intervention with the Experimental group will be provided after waiting for 16 weeks.
Behavioral: Delayed intervention Intervention is provided to Waitlist Control Group after waiting for 16 weeks
Parent-assisted social skills training program for young adult with ASD: The subjects will participate in the treatment program weekly for a total of 16 weeks. The final visit will be made at the point four months after the completion of treatment to see long-term effects. | 18 |
| Total | 37 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | aggravation of depression | 0 | 1 |
| Overall Study | Lost to Follow-up | 2 | 3 |
Baseline characteristics
| Characteristic | Case Group | Waitlist Control Group | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 19 Participants | 18 Participants | 37 Participants |
| Age, Continuous | 23.3 years STANDARD_DEVIATION 3.7 | 23.5 years STANDARD_DEVIATION 4.1 | 23.4 years STANDARD_DEVIATION 4.2 |
| Race/Ethnicity, Customized Korean | 19 Participants | 18 Participants | 37 Participants |
| Region of Enrollment South Korea | 19 Participants | 18 Participants | 37 Participants |
| Sex: Female, Male Female | 0 Participants | 1 Participants | 1 Participants |
| Sex: Female, Male Male | 19 Participants | 17 Participants | 36 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 19 | 0 / 18 |
| other Total, other adverse events | 0 / 19 | 0 / 18 |
| serious Total, serious adverse events | 0 / 19 | 0 / 18 |
Outcome results
Primary
Change From Baseline in Autism Diagnostic Observation Schedule(ADOS) at 4 Month
The ADOS is a play-based, semistructured, standardized assessment of communication, social interaction, and play (i.e. imaginative use of materials) for individuals with a suspected diagnosis of autism or ASD. The ADOS consists of four modules, each of which can be selected on the basis of the participant's expressive language skills and hronological age. Module 4 of the ADOS is designed for adolescents and adults with fluent speech, and includes 10 essential and 5 optional activities. The scores from each activity are coded as well as those for five subdomains: language and communication, reciprocal social interaction, imagination, stereotyped behaviors and restricted interests, and other abnormal behaviors. minimum 0, maximum 18, higherscores mean a worse outcome.
Time frame: baseline, after the completion of the treatment, 4 month
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Case Group | Change From Baseline in Autism Diagnostic Observation Schedule(ADOS) at 4 Month | communication | 3.3 score on a scale | Standard Deviation 1 |
| Case Group | Change From Baseline in Autism Diagnostic Observation Schedule(ADOS) at 4 Month | social interaction | 7.5 score on a scale | Standard Deviation 2.1 |
| Case Group | Change From Baseline in Autism Diagnostic Observation Schedule(ADOS) at 4 Month | Stereotyped behaviors and restricted interests | 1.0 score on a scale | Standard Deviation 0.2 |
| Case Group | Change From Baseline in Autism Diagnostic Observation Schedule(ADOS) at 4 Month | Imagination | 0.4 score on a scale | Standard Deviation 0.6 |
| Waitlist Control Group | Change From Baseline in Autism Diagnostic Observation Schedule(ADOS) at 4 Month | Imagination | 0.6 score on a scale | Standard Deviation 0.1 |
| Waitlist Control Group | Change From Baseline in Autism Diagnostic Observation Schedule(ADOS) at 4 Month | communication | 3.6 score on a scale | Standard Deviation 1.3 |
| Waitlist Control Group | Change From Baseline in Autism Diagnostic Observation Schedule(ADOS) at 4 Month | Stereotyped behaviors and restricted interests | 1.1 score on a scale | Standard Deviation 0.2 |
| Waitlist Control Group | Change From Baseline in Autism Diagnostic Observation Schedule(ADOS) at 4 Month | social interaction | 8.8 score on a scale | Standard Deviation 2.3 |
Primary
Change From Baseline in Korean Version of the Social Skills Rating System (K-SSRS) at 4 Month
The SSRS consists of 38-items and took approximately 10 min to complete. Questionnaires were completed independently by the teen's parent and teacher. For example, items included ''Starts conversations rather than waiting for someone to talk first.'' The items were rated as either ''Never,'' ''Sometimes,'' or ''Very Often.'' The Social Skills and Problem Behaviors scales were derived from factor analysis. minimum 50 and maximum 163, and higherscores mean a better outcome
Time frame: baseline,4 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Case Group | Change From Baseline in Korean Version of the Social Skills Rating System (K-SSRS) at 4 Month | 115.7 score on a scale | Standard Deviation 32.5 |
| Waitlist Control Group | Change From Baseline in Korean Version of the Social Skills Rating System (K-SSRS) at 4 Month | 108.4 score on a scale | Standard Deviation 26.3 |
Primary
Change From Baseline in Social Responsiveness Scale-2 (SRS-2) at 4 Month
The SRS is a 65-item questionnaire that assesses the various dimensions of interpersonal behavior, communication, and repetitive/stereotypic behavior that are characteristics of ASD. minimum 92, maximum 200, higherscores mean a worse outcome
Time frame: baseline,4 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Case Group | Change From Baseline in Social Responsiveness Scale-2 (SRS-2) at 4 Month | 146.5 score on a scale | Standard Deviation 22.9 |
| Waitlist Control Group | Change From Baseline in Social Responsiveness Scale-2 (SRS-2) at 4 Month | 147.9 score on a scale | Standard Deviation 24.3 |
Primary
Change From Baseline in Test of Young Adult Social Skills Knowledge(TYASSK) at 4 Month
The TYASSK is a 22-item criterion-referenced test developed for this study to assess the teen's knowledge about the specific social skills taught during the intervention. Two items were derived from key elements of each of the 11 didactic lessons. Teens were presented with sentence stems and asked to choose the best option from two possible answers. Scores range from 0 to 22, with higher scores reflecting greater knowledge of teen social skills.
Time frame: baseline, 4 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Case Group | Change From Baseline in Test of Young Adult Social Skills Knowledge(TYASSK) at 4 Month | 17.5 score on a scale | Standard Deviation 4.3 |
| Waitlist Control Group | Change From Baseline in Test of Young Adult Social Skills Knowledge(TYASSK) at 4 Month | 21.7 score on a scale | Standard Deviation 3.4 |
Secondary
Change From Baseline in Beck Depression Inventory (BDI) at 4month
The BDI consists of 21 items measuring the severity of subjective symptoms of depression, with emotional, cognitive, motivational, and physiological symptom profiles for adults. Each question has four possible answer choices, scored from 0 (no symptoms) to 3 (the most severe symptoms). minimum 1, maximum 45, higherscores mean a worse outcome
Time frame: baseline,4 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Case Group | Change From Baseline in Beck Depression Inventory (BDI) at 4month | 12.8 score on a scale | Standard Deviation 10.2 |
| Waitlist Control Group | Change From Baseline in Beck Depression Inventory (BDI) at 4month | 14.5 score on a scale | Standard Deviation 11.4 |
Secondary
Korean Version of the Vineland Adaptive Behavior Scale, Second Edition
The K-VABS is an interviewed survey and measures adaptive behaviors of individuals such as personal and social skills, used for everyday living from birth to age 90. These are based on the reports of primary caregivers and teachers. The K-VABS contains 5 domains each with 2-3 subdomains. The main domains are: Communication, Daily Living Skills, Socialization, Motor Skills, and Maladaptive Behavior (optional). Behaviors are rated on a 0 (a skill that is not used by the individual) - 2 (a skill used most of the time) rating scale. The current study used only the communication, daily living skills, and socialization domains. minimum 25, maximum 108, higherscores mean a better outcome.
Time frame: baseline,4 month
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Case Group | Korean Version of the Vineland Adaptive Behavior Scale, Second Edition | communication | 75.0 score on a scale | Standard Deviation 13.4 |
| Case Group | Korean Version of the Vineland Adaptive Behavior Scale, Second Edition | daily living skills | 78.3 score on a scale | Standard Deviation 16.5 |
| Case Group | Korean Version of the Vineland Adaptive Behavior Scale, Second Edition | socialization | 71.9 score on a scale | Standard Deviation 18.3 |
| Waitlist Control Group | Korean Version of the Vineland Adaptive Behavior Scale, Second Edition | communication | 70.5 score on a scale | Standard Deviation 16.4 |
| Waitlist Control Group | Korean Version of the Vineland Adaptive Behavior Scale, Second Edition | daily living skills | 74.4 score on a scale | Standard Deviation 20.9 |
| Waitlist Control Group | Korean Version of the Vineland Adaptive Behavior Scale, Second Edition | socialization | 65.9 score on a scale | Standard Deviation 12.7 |