Fred Frankel

Evidence-Based Social Skills Training for Adolescents with Autism Spectrum Disorders: The UCLA PEERS Program

The present study examines the efficacy and durability of the PEERS Program, a parent-assisted social skills group intervention for high-functioning adolescents with ASD. Results indicate that teens receiving PEERS significantly improved their social skills knowledge, social responsiveness, and overall social skills in the areas of social communication, social cognition, social awareness, social motivation, assertion, cooperation, and responsibility, while decreasing autistic mannerisms and increasing the frequency of peer interactions. Independent teacher ratings revealed significant improvement in social skills and assertion from pre-test to follow-up assessment. Examination of durability of improvement revealed maintenance of gains in nearly all domains with additional treatment gains at a 14-week follow-up assessment.

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.

Parent-Assisted Transfer of Children's Social Skills Training: Effects on Children With and Without Attention-Deficit Hyperactivity Disorder

OBJECTIVE Previous research has demonstrated that peer rejection is a significant part of the clinical presentation of many children with attention-deficit hyperactivity disorder (ADHD). Outcome studies of treatment interventions have typically failed to show generalization of treatment gains to the home and classroom. This has been especially true for children who have comorbid oppositional defiant disorder (ODD). The present study was intended to demonstrate generalization of an outpatient social skills training program when parents were trained in skills relevant to their childs social adjustment. METHOD Thirty-five children with ADHD and 14 children without ADHD were given 12 sessions of treatment (treatment group). Outcome was compared with 12 children with ADHD and 12 children without ADHD who were on a waitlist for treatment (waitlist group). Nineteen children with ODD were in the treatment group and five in the waitlist. Stimulant medication was prescribed for all children with ADHD. RESULTS Subjects with ADHD showed improvement comparable with that of subjects without ADHD on all teacher- and parent-reported measures of peer adjustment and social skills, except teacher-reported withdrawal. Children with ODD had outcome comparable with that of children without ODD. Effect sized ranged from 0.93 to 1.34 indicating that the average treatment group subject was better off than 83.4% of waitlist subjects on outcome measures. CONCLUSIONS The present results suggest that children with ADHD are best heiped by a combination of social skills training for themselves, collateral training for their parents and stimulant medication.

Executive functioning predicts social skills following prenatal alcohol exposure.

Adverse sequelae of prenatal alcohol exposure include executive function and social skills impairments, although these two domains have not been empirically linked in alcohol-exposed individuals. This study investigated this relationship using the BRIEF and the SSRS in 98 children aged 6 to 11 years. Executive functions explained a significant percentage of variance in parent and teacher rated social skills. No differences were found among children with diagnoses of FAS, partial FAS, or alcohol-related neurodevelopmental disorder. It may be helpful to consider executive functioning in designing social skills interventions for alcohol-exposed children whether or not they have full FAS.

Predictors of Stress in Parents of Children with Fetal Alcohol Spectrum Disorders

ABSTRACT This study examined child characteristics and family factors as predictors of stress in the biological or adoptive parents of 6- to 12-year-old children with fetal alcohol spectrum disorders (FASDs). Impaired executive functioning, poorer adaptive functioning, externalizing and internalizing behavior problems, and adoptive parent status all made significant and independent contributions to the prediction of higher levels of child domain stress, as reported by parents on the Parenting Stress Index. Biological parent status and fewer family resources were associated with higher levels of parent domain stress. Teacher ratings of the childs executive functioning impairments and externalizing and internalizing behavior problems also were associated with parent reports of child domain stress. Findings highlight the need to provide support not only to children with FASDs, but to their caregivers as well.

Social Problems Associated with ADHD vs. ODD in Children Referred for Friendship Problems

Four groups were composed of children referred for friendship problems (age range: 6 to 12 years old). One group was diagnosed with both Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional-Defiant Disorder (ODD), one group with ADHD only, one group with ODD only and one group with neither disorder. Parents and teachers were given questionnaires to rate the social behavior of each child. The groups differed significantly on one parent scale (Self-control) and one teacher scale (Aggression). Inspection of the items composing these scales suggested that some items measured social relationships with adults while other items measured peer relationships. Subsequent factor analysis separated peer and adult components. Analysis of subscales derived from factor analysis revealed the diagnosis of ADHD was associated with increases in classroom disruption and decreased resistance to provocation by peers, while the diagnosis of ODD was associated with increased in hostility towards peers, decreased resistance to provocation by peers and decreased respect for adults. Limitations of the study were: domains of social functioning assessed, sample size and diversity, and the absence of a comparison group with adequate peer relationships. Social skills programs should target social deficits associated with ODD and ADHD. The scales refined in the present study offer a convenient means of assessing peer dysfunction from the points of view of parents and teachers.

An extinction procedure for eliminating self-destructive behavior in a 9-year-old autistic girl

A 24-week program of 2 daily 2-hour sessions of noncontingent social isolation was successful in eliminating multiple self-destructive behaviors in a 9-year-old autistic child. A previous program of response-contingent shock met with failure, resulting in (1) increased self-destructive responding, (2) complete suppression of self-feeding, and (3) the necessity for constant physical restraint. Generalization of the extinction program to the ward was inferred on the basis of the subjects subsequent cessation of restraint-wearing, a decrease in self-destructive behavior in the dayroom and subsequently in other settings following the removal of restraints, and a renewed interest in food. A brief program based upon elements of the noncontingent social isolation program was sufficient to reinstitute self-feeding. The subject was gradually removed from social isolation sessions with no reappearance of self-destruction. However, during week 72, self-destructive behavior again appeared, at which time a reinstatement of the original program dramatically reduced its rate.

The peer relationships of girls with ASD at school: Comparison to boys and girls with and without ASD

BACKGROUND This study examines the social relationships of elementary school children with high-functioning autism, focusing on how gender relates to social preferences and acceptance, social connections, reciprocal friendships, and rejection. METHOD Peer nomination data were analyzed for girls with and without ASD (n = 50) and boys with and without ASD (n = 50). Girls and boys with ASD were matched by age, gender, and IQ. Each child with ASD was matched by age and gender to a typically developing classmate. RESULTS Consistent with typically developing populations, children with ASD preferred, were accepted by, and primarily socialized with same-gender friends. With fewer nominations and social relationships, girls and boys with ASD appear more socially similar to each other than to the same-gender control group. Additionally, girls and boys with ASD showed higher rates of social exclusion than their typically developing peers. However, boys with ASD were more overtly socially excluded compared to girls with ASD, who seemed to be overlooked, rather than rejected. CONCLUSIONS Our data suggest a number of interesting findings in the social relationships of children with ASD in schools. Like typically developing populations, children with ASD identify with their own gender when socializing and choosing friends. But given the social differences between genders, it is likely that girls with ASD are experiencing social challenges that are different from boys with ASD. Therefore, gender is an important environmental factor to consider when planning social skills interventions at school.

The effects of fluorescent and incandescent illumination upon repetitive behaviors in autistic children.

Repetitive behaviors of six autistic children were observed under two conditions of background illumination. During two sessions, the room was illuminated by fluorescent light and during two other sessions, by equal intensity incandescent light. Subjects spent significantly more time engaged in repetitive behavior under fluorescent light. Previous research suggested that these findings were related to the flickering nature of fluorescent illumination. Practical and theoretical implications were discussed. Further experimentation was suggested to assess relationships between flickering illumination and arousal.

Impact of a Social Skills Intervention on the Hostile Attributions of Children With Prenatal Alcohol Exposure

BACKGROUND Prenatal alcohol exposure (PAE) has been linked to a wide array of developmental deficits, including significant impairments in social skills. Given the extensive body of evidence linking social information-processing patterns with social behavior, it is possible that social information-processing may represent one mechanism of behavioral change. The present investigation sought to answer the question of whether a well-established social skills intervention decreased the hostile attributions of children with PAE. Further, was there a differential impact of the intervention on hostile attributions in the context of peer provocation versus group entry scenarios? METHODS Participants consisted of 100 children (51% male) with PAE between the ages of 6 and 12 years. Participants were randomly assigned to either a social skills intervention, Childrens Friendship Training (CFT), or to a Delayed Treatment Control (DTC) condition. RESULTS Analyses indicated that the social skills intervention resulted in a significantly lower proportion of hostile attributions in peer group entry, but not peer provocation, scenarios. This decrease was maintained over a 3-month follow-up period. CONCLUSIONS Deficits in social information-processing among individuals with PAE can be improved through social skills intervention, and these changes may lead to more positive developmental outcomes.