Speaking of Psychology: Teaching social skills to autistic teens

Episode 1

Going back to school and making friends is a challenge, especially for students with autism spectrum disorder. Psychologist Elizabeth Laugeson, PsyD, discusses a training program that she developed to teach skills that allow them to interact with their peers and build lasting friendships. The Program for the Education and Enrichment of Relational Skills (PEERS®) is designed for adolescents through young adults and can be provided by professionals in the schools or mental health providers.

About the expert: Elizabeth Laugeson, PsyD

Elizabeth Laugeson, PsyDElizabeth Laugeson, PsyD, is a licensed clinical psychologist and an assistant clinical professor in the department of psychiatry and biobehavioral sciences at the UCLA Semel Institute for Neuroscience and Human Behavior. She is the founder and director of the UCLA PEERS Clinic and is also the director of The Help Group – UCLA Autism Research Alliance.

Laugeson has been a part of numerous National Institutes of Health (NIH) and Centers for Disease Control and Prevention studies involving social skills training for youths and is two-time recipient of the Ruth L. Kirschstein National Research Service Award from the NIH, the recipient of the Semel Scholar Award for Junior Faculty Career Development and the Distinguished Alumnus Award from Pepperdine University.

Laugeson has presented her research at conferences around the world and has been featured in People Magazine, USA Today, The Los Angeles Times, The New York Times and Washington Post, as well as on CBS and NBC, among others.

Transcript

Audrey Hamilton: Hello, I’m Audrey Hamilton. Welcome to “Speaking of Psychology,” a podcast from the American Psychological Association. The anxiety of a new school year can affect almost any student. They may be worried about which teachers they’ll have or the prospect of meeting new classmates. For students with autism spectrum disorder, meeting new people and making friends is especially challenging. In this episode, we’ll hear from Dr. Elizabeth Laugeson, a psychologist who runs the Program for the Education and Enrichment of Relational Skills, or PEERS, at UCLA, where the latest autism behavioral research is used to help teens make and keep friends.

Elizabeth Laugeson is a licensed clinical psychologist and assistant clinical professor of psychiatry and biobehavioral sciences at UCLA. She is the founder and director of the UCLA PEERS clinic, where she works directly with teens and young adults with Autism Spectrum Disorder. Her research investigating social skills training for youth from preschool to early adulthood has been widely published and recognized. Her studies have been funded by the National Institutes of Health and Centers for Disease Control and Prevention. Welcome, Dr. Laugeson.

Elizabeth Laugeson: Thank you for having me.

Audrey Hamilton: The program you lead at UCLA, the PEERS program, focuses on improving social skills among high functioning adolescents with autism using evidence-based training. Can you give us some real life examples of how this program works?

Elizabeth Laugeson: Sure, absolutely. You know, one of the things we really focus on in PEERS is not just social skills, which is rather broad, but really making and keeping friends. We know that having a few close friends in adolescence and adulthood is really critical to later adjustment in life. And so, the types of skills that we focus on are things like conversational skills, knowing how to go up to a group of people and join their conversation, how to assess whether or not you are accepted into those conversations and if you’re not, how to exit the conversation. We also talk about things like having get- togethers and developing closer, more meaningful friendships with people, as well as handling things like peer-rejection and peer-conflict.

Audrey Hamilton: Why do autistic children need social skills training specifically and when have you seen them gain from it?

Elizabeth Laugeson: Well, you know, social skill deficits are one of the hallmark features in autism across the spectrum. And the way that sort of manifests itself is in difficulty with things like social communication, knowing how to have a conversation with someone. Also social awareness, so really understanding the social landscape in which you live. Kind of picking up on social cues. We know that our kids really struggle with social motivation, wanting to actually engage their peers, as well as social cognition, which is another one of those hallmark features of autism. And that’s basically difficulty kind of putting yourself in someone else’s shoes. Understanding the perspectives of others. So, we know that adolescents and adults with autism really struggle socially and so, of course we want to intervene and help them in this very vital and important area.

Audrey Hamilton: Can you talk about what it is about this disorder that makes it so difficult for them to maintain friendships and engage with others their age?

Elizabeth Laugeson:  Well, I think difficulty with conversational skills, for example, makes it very, very difficult to develop meaningful and close relationships with people, whether they be friendships or romantic relationships. And difficulty picking up on social cues and understanding the perspectives of others, knowing how someone might actually react to something that we say or something that we do. That sort of difficulty makes it really challenging for people with autism to develop these relationships.

Audrey Hamilton:  You talk about engaging and even having a real conversation, but, you know, these days when there’s cyberbullying, there’s social media. I mean, how is that challenging for autistic teens when it comes to making friends and interacting?

Elizabeth Laugeson: You know, what’s interesting about kids with autism is that they very often gravitate toward technology and computers and being on the Internet. But interestingly enough, they’re not that engaged in traditional forms of social media, like a lot of kids are on Facebook, for example. But, our kids in the spectrum don’t tend to be involved in things like Facebook, those types of social media. They do tend to gravitate toward things like online gaming, things like World of Warcraft and Minecraft and things like that. But, there’s not as much social interaction in those types of forums. When our kids are, though, involved with types of social media like Facebook, they are more prone to actually being cyberbullied, very sadly, by their peers. So, there’s many different, you know, hypotheses about why that might be. But again, knowing that our kids aren’t quite as socially savvy and aren’t necessarily picking up on the same cues that the rest of us might be picking up on. They do become easier targets for bullying. So, one of the things that we do in PEERS is we actually target that type of peer rejection and give them strategies for how to handle cyberbullying.

Audrey Hamilton: Well, going back to the program itself, I know that it relies a lot on role playing to help students understand how to behave. What are some examples of these social situations they face during training?

Elizabeth Laugeson: Well, I’m glad you asked. I love talking about the program and the skills that we teach. You know, we basically teach two types of skills. We teach, sort of, how to develop meaningful relationships with other people. And we also teach our kids how to handle things like peer-rejection and peer-conflict because we know that that’s very, very common, unfortunately for a lot of our teens and adults.

So, to give you an example of how we might handle, sort of, making new friends, meeting new people. So we mentioned that one of the things that people often have to do in order to meet new friends is to go up and join conversations with people. But, what do you think that most adults might tell a teen to do in that situation? Like imagine they’re at a party. They don’t really know anyone and they want to get to know the other people. What would an adult tell that teen to do?

Audrey Hamilton: Just go up, introduce yourself. Find something in common.

Elizabeth Laugeson: Okay, well, they definitely tell them to go up and introduce themselves. I mean, we hear that time and time again from kids. They’re also told to go up and say “hi.” But, if you step back and you really think about what that would look like, I mean, imagine if a teen were to walk up to another group of teens and say “hi.” You know, and kind of wave their hand or even worse say, “Hi, I’m Liz” and kind of put their hand out to shake hands. That’s not really what kids who are socially accepted are naturally doing. It’s not what we call an ecologically valid social skill. What people who are socially accepted would naturally do. So, in PEERS, what we try to do is actually teach what people who are socially accepted do in these real world situations. So, instead of going up and saying “hi” or going up and introducing ourselves, instead what we would teach our kids to do is first start by just kind of listening and watching the conversation. And, you mentioned something a moment ago. What do you think we’re kind of watching and listening for?

Audrey Hamilton: We’re listening for an in. Some way to join the conversation that would be interesting.

Elizabeth Laugeson: Yeah, and you kind of mentioned about this sort of this common interest, right? So, we’re listening for the topic, first of all. And we’re trying to make sure that we actually have something in common with the people that are talking. That we know something about the topic. That we have something to contribute. Now, while we’re doing that, do you think that we should be, sort of staring at the group as we’re listening?

Audrey Hamilton: Seems awkward.

Elizabeth Laugeson: It would be a little bit awkward. Yeah, we probably don’t want to stare at them. So what a lot of people do is they’ll actually use a prop. They’ll have a phone or like a gaming device or something like that. But, they’ll be kind of looking at their phone, maybe appearing to be looking at text messages or something. But really, they’re eavesdropping. We just don’t want to look like we’re eavesdropping.

So, once we’ve sort of listened, figured out what the topic is and decided that we want to join this conversation, we’re going to wait for something. So, what do you think we’re waiting for?

Audrey Hamilton: A pause.

Elizabeth Laugeson: Yeah, exactly. We’re waiting for a pause in the conversation. Now, why do we need a pause in the conversation before we join?

Audrey Hamilton: We don’t want to interrupt them.

Elizabeth Laugeson: Basically, right. So, we want to wait for a little pause. We’ll move a little bit closer and then, and then as we join we make some kind of a comment or ask a question that’s on topic. Now, those are very, very concrete steps for what we call “peer entry.” But, do you think that, you know, a kid with autism could actually pick up on these steps and learn how to actually do that?

Audrey Hamilton: It seems like it would be challenging for them to learn them.

Elizabeth Laugeson: It can be challenging. But, the great thing is that not only do we rely on these concrete, kind of rules and steps of social behavior, which is actually, by the way, a really helpful way of teaching kids with autism, because they think so concretely and so literally. We’re taking something that seems abstract and we’re making it very black and white for them.

But, it’s not just enough to actually teach them those rules and steps. Next, we actually have to demonstrate what that looks like and that’s where the role playing comes in. We do a lot of role playing demonstrations in our groups of sort of the social skills you want to use, but also, the behaviors that you don’t want to engage in. So, we show good and bad examples of social behavior.

And then, we kind of have them take on the perspectives of the other people and ask them things like, you know “what do you think that was like for that group of people?” “What do you think they thought of them?” “Are they going to want to talk to them again?” Those types and sorts of things.

And from there, the next step is that there should be some kind of a behavior rehearsal, where they’re practicing the newly learned skills. We’re giving them coaching in the moment, because, as you say, they don’t get it right away. They’re not going to master it perfectly. And then, to generalize these skills to other settings, we need to actually provide some kind of homework assignment where they’re practicing the skill in the real world, essentially.

Audrey Hamilton: What about younger children with autism? I’m sure this is something that concerns parents and teachers. Trying to get them to engage more socially. Is there anything that you do differently with younger children?

Elizabeth Laugeson: You know, one of the things that’s sort of unique about PEERS is that it’s actually a parent-assisted program. You know, the vast majority of social skills programs do not include parents or caregivers in the treatment. And, I think that’s a really big mistake because parents act as social coaches to their kids all the time. But, as we just discovered in that last example, the advice that they give isn’t always the best advice. They might tell their kid to go up and say hello or go up and say hi. So, instead, we want to include them on the treatment. And so, that’s what sort of makes our program unique and in addition to working with adolescents and teens and their parents, we also work with younger kids through our program.

We have a program that just was recently developed called PEERS for Preschoolers, for example, and this program actually works with preschool kids with Autism Spectrum Disorder and we’re teaching social skills using that same method of very concrete rules and steps of social behavior. They’re much more simplified, of course.

Audrey Hamilton: Hmm, hmm, right, I can imagine.

Elizabeth Laugeson: But, then also including parents on that and providing role play demonstrations and behavioral rehearsal opportunities. Lots of homework assignments. And helping parents to learn how to organize things like play dates for their kids. You know, really the crux of all of this really comes down to social interaction and engagement with peers. And, for younger kids, that really is the responsibility of a parent. For older, you know, adolescents and for adults, that’s their responsibility and they can use support from their parents. But, for our younger kids, they need a lot more support in providing the social opportunities. So, the parent involvement, I think, is really the key piece to the success of this program.

Audrey Hamilton: Is there anything else that you wanted to talk about? Anything exciting that you’re working on with PEERS?

Elizabeth Laugeson: Sure, yeah, we’re working on a lot of really exciting things right now. So, I’ve talked a lot about the parent assistant portion of this program, that we include parents as social coaches to their kids through PEERS. We’ve also done some work in the schools, where we actually include teachers as the social coaches. And in this case, these programs are teacher facilitated. We teach social skills in the classroom much like we would teach math or science, something like that, using these very concrete rules and steps. And we have a school-based manual that’s actually coming out now that’s based on the research that we’ve done with our PEERS school-based program. So, we’re very excited about that and that’s due out in October 2013. So, that’s something to look for.

And we also have another resource that will be available to families and that’s a parent book that’s coming out in September of 2013. And that’s called “The Science of Making Friends.” And the idea behind this book is that we’re actually trying to provide the skills, the rules and steps of social behavior that we teach in PEERS to families that might not be able to access a PEERS program in their community or their school. You know, we work really hard on trying to disseminate our program throughout the world, really. We do trainings all over the globe, but the reality is that you can’t access a PEERS program in every community and because we know parents are very desperate, very often to help their kids with their social skills, we’ve provided this parent book, “The Science of Making Friends.” So, we’re real excited about that.

Audrey Hamilton: Well, it sounds like you have a lot going on. It’s very exciting. Thank you so much for joining us today.

Elizabeth Laugeson: Well thank you so much for having me.

Audrey Hamilton: For more information on the PEERS program, please visit our website. Thank you for joining us. I’m Audrey Hamilton with the American Psychological Association’s “Speaking of Psychology.”