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Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, Ï㽶ÊÓƵ of Utah Health Sciences Radio. Dr. Elizabeth Laugeson is the founder and director of the UCLA PEERS clinic and PEERS curriculum developer and today we're going to learn more about what the PEERS program is and what it has to offer individuals with autism. So let's talk about the PEERS program. What is the PEERS program?

Dr. Laugeson: So PEERS actually stands for the program for the education and enrichment of relational skills. Which is really just a fancy term for it's a social skills training program for adolescents and also for adults on the autism spectrum. And so we're trying to focus on things like friendship skills, how to make and keep friends as well as things like how to handle peer conflict and peer rejection.

Scot: And what's the philosophy behind the PEERS program? What makes it different from other programs that might teach the same things?

Dr. Laugeson: Well one thing that makes it different is that it's actually an evidence based program, meaning that we have a lot of research to support the effectiveness of the program. We know that social skills training is really common for people on the autism spectrum but unfortunately the research suggests that most of these programs aren't very effective. That's one thing that makes it sort of unique from other programs.

The other thing is that we include either parents or social coaches, even teachers as additional interventionists essentially, to provide social coaching outside of our groups. So we'll often have co-occurring parent groups, caregiver groups, or we'll even train teachers on how to provide social coaching to teens and adults outside of our group setting, so that's sort of unique.

The third thing that really makes PEERS unique though is that we're teaching what are called ecologically valid social skills. So that's not just we think that kids should do in social situations but what actually works in reality and that's somehow very unusual in social skills training. A lot of times we give kind of bad advice in social skills training unfortunately and not really teaching what kids actually do in reality.

Scot: So you said a little bit earlier that some of these methods that people teach social skills aren't effective. Is that because of different needs between individuals with autism, or is it just we're not good at teaching social skills to anybody really?

Dr. Laugeson: I don't think we're very good at teaching social skills, even when we have good social skills. I think it's one of those things that it comes very naturally to a lot of people and we don't think about why we do the things we do, or even what we do. So for example, common mistakes that people can relate to, meeting new people. Imagine you have a teenager at a party. They don't know anyone. What do you think that most adults would tell that kid to do to go up and meet new people?

Scot: Just go up and say hi.

Dr. Laugeson: That's right. They're told to go up and say hi or they're told to go up and introduce themselves.

Scot: Yeah, sure.

Dr. Laugeson: And then just to think about that would actually look like, to just walk up randomly to a group of people that you don't know and say hi. Or "Hi, I'm Scot," you know, what would they think of you if you did that?

Scot: I struggle with that all the time. And I want you to actually hold that answer for a second. Let's have this be a little cliffhanger. Do you have the right answer on how to do this?

Dr. Laugeson: I actually do have the right answer.

Scot: Okay, hold on to that, we'll find out what that right answer is in just a couple seconds. I love this. This is great. So the philosophy of the PEERS program is social skills based on evidence based, what we've learned actually does work. What are some of the outcomes that you're noticing as a result of teaching these social skills?

Dr. Laugeson: Well we have a lot of different types of programs. Our most common program is a parent assisted program, where we actually teach parents to be social coaches outside of the group. And in those studies what we found is that teens and adults significantly improve in their overall social skills, particularly in the areas of things like assertion, responsibility, cooperation. They improve in their social responsiveness, that's their ability to communicate with people. What we call social cognition, putting themselves in someone else's shoes, kind of taking on the perspective of others.

Also things like social awareness and social motivation, those also improve, as well as just the frequency of social interactions that they're having with their peers and improvements in friendship qualities. So we see lots of changes, lots on improvements across the board in our parent assisted programs. But we also do a lot of research in the schools as well and use teachers actually as social coaches and we get very similar findings there.

But the most exciting research I think we're doing now and the research that we're going to be presenting when we're in Salt Lake next week is actually related to a combination of a parent assisted program with teacher facilitation. So where we're actually teaching social skills in the classroom, much like we would teach math or science or any other subject, but then providing additional assistance by including parents in weekly social coaching groups. And this is kind of a revolutionary idea for teaching social skills in the school setting.

Scot: I love it. I am a communication major myself. I was a late college student and after I had got my degree I thought how come we don't have an interpersonal communications skill at the junior high or high school level? Because there are all these things that go on in communication that were a mystery to me for the longest time and then I learn about them and like "oh, now I get what it means to be a good listener. Oh, now I get when I said that to that person the underlying message below my words was you don't matter." I'm like why don't we teach this And social skills I feel is the same thing regardless of who you are.

Dr. Laugeson: You know, I think that is so true, and it's not just kids with autism that can really benefit from this type of instruction. A lot of people struggle socially. In fact, there's a lot of research that suggests that in any typical middle school or high school in the US there's about 15% of kids that are what we call peer rejected. These are kids who are teased. They're bullied. They might have bad reputations. These are kids that are actively seeking out their PEERS but they're getting pushed away.

And then there's another 15% of these kids that are what we call socially neglected. These are the kids who are very isolated, they're often seen as shy or withdrawn, and they're not even trying to engage their peers. And what that tells us is about 1/3 of any typical middle or high school has kids who are really struggling social, and unfortunately we don't do enough for these kids.

Scot: And not only those that are struggling, but back to the communication thing, which I think social skills and communication are almost hand in hand, it's just assumed that everybody knows these things, right? That you just know how to talk so you know how to communicate but there's so much more and there's so many underlying rules and things going on that some of us just aren't aware of so.

Dr. Laugeson: That's absolutely the case and I think that research speaks to what you're saying there is that you know there are a lot of people who really, really struggle with this.

Scot: Including me. I'm going into that party now. I can still hear my mom saying well just go introduce yourself.

Dr. Laugeson: All right, well do you want to know what you're supposed to do?

Scot: Yes, what should I do?

Dr. Laugeson: Okay, we don't want you to go up and just introduce yourself or go up and say hi randomly. Instead this is what a lot of people sort of naturally do. This is that example of an ecologically valid social skill. These are the things that people do naturally. They don't even think about what they're doing. So imagine you're at the party. You don't know anyone. Before you ever go up to them, you're probably going to try to listen to their conversation, right. What do you think you're listening for?

Scot: The first thing that comes to my mind is how do I approach them? Do I just kind of sidle up to the group and just quietly insert myself? I mean that even seems weird to me.

Dr. Laugeson: That might be a little bit weird. Sidling is probably not a good idea. No, instead you probably want to listen for the topic, figure out what they're talking about. You might even want to sort of show a little bit of interest, maybe look over at the group every so often. But do you think that you should be staring at them, Scot?

Scot: No, I should not be.

Dr. Laugeson: No, instead what you do is you use like a prop. Maybe a cell phone or something like that, maybe you're at a conference you've got your program but you're using some kind of prop to look distracted because really what you're doing is you're eavesdropping but you're trying not to look like you're eavesdropping.

Scot: Okay.

Dr. Laugeson: Okay, so that's the first step, just kind of watching and listening. Let's say you find a common interest, something that you know about and you decide you want to join. Well, before you join you need to wait for something. What do you think you're going to wait for?

Scot: Oh boy, I have no idea. That's how terrible I am at this.

Dr. Laugeson: Okay, well I'll help you out.

Scot: A pause. A pause in the conversation.

Dr. Laugeson: Absolutely, see you're not so bad at this. You're waiting for a pause because you don't want to interrupt the conversation. You don't want to be rude. So you wait for a little bit of a pause. There's never a perfect pause but you move a little bit closer. When there's a little bit of a pause you say something that's on topic essentially. And that's how you basically join a conversation. The introductions come later, and this is something that people naturally do all the time but they don't think about what they're doing. So we take these very natural social skills and we break them down into very concrete rules and steps of social behavior.

Scot: And it's not weird that I'm kind of all of a sudden here I am and I've just inserted something in your conversation where I wasn't here a while ago?

Dr. Laugeson: Well, you know that's where paying attention to the feedback that you get becomes very important. It doesn't have to be weird. This is what people do all the time. However, the research would suggest that about 50% of these what we call peer entry attempts are unsuccessful where you're not accepted. And so you have to pick up on the signs. Now let's talk about that for a second. How do you think you can tell if a group of people want to talk to you?

Scot: If they engage back with me.

Dr. Laugeson: Very good, they're talking to you and they're not giving really short answers or saying rude things. What are they doing with their eyes if they want to talk to you?

Scot: Hopefully, looking at me every once in a while, not staring but.

Dr. Laugeson: Exactly, looking at you but not like rolling their eyes or making a face. And what do they do with their body language that tells you? Where are they facing?

Scot: Open body language, towards me hopefully, not with their backs towards me of their sides.

Dr. Laugeson: Exactly, they're facing you. So they're looking at you, their facing you, their talking to you.

Scot: I got this. This is so awesome.

Dr. Laugeson: You got it

Scot: I can't wait to go, what was it? The social introduction, conversation introduction, what did you call it?

Dr. Laugeson: I call it peer entry. That's the technical term.

Scot: Peer entry.

Dr. Laugeson: But it's basically entering group conversations.

Scot: I like that, peer entry. I absolutely love this. Are there any books or other resources that I mean even I could use to learn more about effective social skills? Anything you recommend?

Dr. Laugeson: Definitely, we actually have three published books as well as an app. So just to let you know what we have out there, we have two manuals. They're treatment manuals for both educators as well as mental health professionals. They're called the PEERS School Based Curriculum and we also have a PEERS Treatment Manual.

But probably more interesting to your listeners would be that we actually have a book for parents, teens, young adults, anyone that's looking to learn about how to make and keep friends and this is not just for kids with autism. This is anyone who is interested in that, and it's called the "Science of Making Friends." And it's meant to be helping teens and young adults who are kind of socially challenged. And it teaches all of the skills that we teach in PEERS but in lay terms.

What's kind of cool about that book is that it actually comes with a companion DVD with role play video demonstrations of these skills. It's one thing to read about social skills but seeing them in action is a whole different thing. And then additionally we have a nice resource called the Friend Maker app, and that teaches all the skills we teach in PEERS in a mobile app for iPhones, iPads, different Apple products. And it has the curriculum laid out in an outline form and there's also 25 embedded role play videos in this app. And so this is also another very affordable way to access the PEERS curriculum.

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