A Randomized Controlled Study of Parent-assisted Children’s Friendship Training with Children having Autism Spectrum Disorders

This study evaluated Children’s Friendship Training (CFT), a manualized parent-assisted intervention to improve social skills among second to fifth grade children with autism spectrum disorders. Comparison was made with a delayed treatment control group (DTC). Targeted skills included conversational skills, peer entry skills, developing friendship networks, good sportsmanship, good host behavior during play dates, and handling teasing. At post-testing, the CFT group was superior to the DTC group on parent measures of social skill and play date behavior, and child measures of popularity and loneliness, At 3-month follow-up, parent measures showed significant improvement from baseline. Post-hoc analysis indicated more than 87% of children receiving CFT showed reliable change on at least one measure at post-test and 66.7% after 3 months follow-up

The Italian validation of the Social Skills Program PEERS® in autistic adolescents: a randomized controlled trial during COVID-19

Background. Social difficulties are a lifespan characteristic of autism (ASD), targeted by preschoolers and children’s interventions while lacking evidence in adolescence. The Program for the Education and Enrichment of Relational Skills (PEERS®) is a recognized parent-assisted program on social skills, but there is no validated adaptation in Italy. Objectives. A two-arm RCT to evaluate the effectiveness of the PEERS® was conducted. Methods. Thirty-seven ASD adolescents (Level 1) were randomly assigned to two groups: experimental (TG), attending training immediately, and the delayed treatment (WL), which participated after 14 weeks. Evaluation on primary (social abilities) and secondary outcomes (co-occurring conditions, executive functions) was performed at four-time points. Due to COVID-19, PEERS® it was delivered via telehealth and questionnaires to multi-informant assessors (adolescents, parents, and blinded teachers) were administered. Results. No differences were found at T0 between TG and WL in baseline characteristics and primary outcomes. Significant group differences emerged between T0 vs. T1 on primary (TASSK-R; QSQ-Social Initiative Scale parent and adolescent’s versions) and secondary outcomes (BRIEF-2 Emotion Regulation Index). To test additional treatment-related effects, we evaluated the changes in the overall group (TG+WL) among pre- and post-intervention and follow-up. Further changes emerged in secondary outcomes (BRIEF-2 Global Executive Composite Score; CBCL-Youth; internalizing, externalizing, total problems; CDI-2 Functional Problems), maintained at a 3-months follow-up. Conclusions. The efficacy of the Italian validation of PEERS® was ascertained on primary and secondary outcomes. Innovative findings on emotion regulation and depression symptoms have also emerged. Future studies should confirm the PEERS’ efficacy in community settings

A controlled social skills training for children with fetal alcohol spectrum disorders

Children with fetal alcohol spectrum disorders (FASD) have significant social skills deficits. The efficacy of a child friendship training (CFT) versus a delayed treatment control (DTC) was assessed for 100 children ages 6 to 12 years with FASD. Children in the CFT showed clear evidence of improvement in their knowledge of appropriate social behavior, and according to parent report, CFT resulted in improved social skills and fewer problem behaviors compared with DTC. Gains were maintained at 3-month follow-up. After receiving treatment, the DTC group exhibited similar improvement. Teachers did not report improvement as a function of social skills treatment. The findings suggest that children with FASD benefit from CFT but that these social skills gains may not be observed in the classroom

Distinct Patterns of Neural Habituation and Generalization in Children and Adolescents With Autism With Low and High Sensory Overresponsivity

ObjectiveSensory overresponsivity (SOR), an atypical negative reaction to sensory stimuli, is highly prevalent in autism spectrum disorder (ASD). Previous work has related SOR to increased brain response in sensory-limbic regions. This study investigated where these atypical responses fall in three fundamental stages of sensory processing: arousal (i.e., initial response), habituation (i.e., change in response over time), and generalization of response to novel stimuli. Different areas of atypical response would require distinct intervention approaches.MethodsFunctional MRI was used to examine these patterns of neural habituation to two sets of similar mildly aversive auditory and tactile stimuli in 42 high-functioning children and adolescents with ASD (21 with high levels of SOR and 21 with low levels of SOR) and 27 age-matched typically developing youths (ages 8-17). The relationship between SOR and change in amygdala-prefrontal functional connectivity across the sensory stimulation was also examined.ResultsAcross repeated sensory stimulation, high-SOR participants with ASD showed reduced ability to maintain habituation in the amygdala and relevant sensory cortices and to maintain inhibition of irrelevant sensory cortices. These results indicate that sensory habituation is a dynamic, time-varying process dependent on sustained regulation across time, which is a particular deficit in high-SOR participants with ASD. However, low-SOR participants with ASD also showed distinct, nontypical neural response patterns, including reduced responsiveness to novel but similar stimuli and increases in prefrontal-amygdala regulation across the sensory exposure.ConclusionsThe results suggest that all children with autism have atypical brain responses to sensory stimuli, but whether they express atypical behavioral responses depends on top-down regulatory mechanisms. Results are discussed in terms of targeted intervention approaches

The Italian Validation of the Social Skills Program PEERS® in Adolescents with Autism Spectrum Disorders (ASD): A Randomized Controlled Trial during COVID-19

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