Overview of the UCLA Peers Program

Aarti Nair, Ph.D. Author

02/18/2019 Added

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After this webinar participants will be familiar with social deficits and consequences of peer rejection in autism spectrum disorder. Additionally, the webinar will discuss the limitations of existing social skills programs and effective methods of social skills instruction. An overview of PEERS® curriculum and research findings will be shared.

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[00:00:03.530]Hello everyone.
[00:00:05.360]I'm Dr. Aarti Nair,
[00:00:06.670]from the UCLA PEERS clinic,
[00:00:08.850]and today I will be providing an overview
[00:00:11.990]of the UCLA PEERS Program through this webinar.
[00:00:14.920]And so we're going to discuss the background
[00:00:17.530]that went into the development of this program,
[00:00:20.550]the format,
[00:00:21.410]the curriculum,
[00:00:22.790]as well as some of the research
[00:00:24.290]on the effectiveness of this program.
[00:00:28.750]So to begin with, let's talk a little bit about
[00:00:32.210]the Social Deficits Among Youth with
[00:00:34.330]Autism Spectrum Disorders, or ASD,
[00:00:37.410]that we hope to target through this program.
[00:00:41.140]So, one of the hallmark features of this program,
[00:00:45.916]or is to target the poor social communication
[00:00:48.410]that we see with our youth with ASD.
[00:00:51.600]So this could include programs with topic initiation.
[00:00:54.870]So not even knowing what sort of topics
[00:00:57.100]to talk about with their peers.
[00:00:59.080]Often they may use repetitive themes,
[00:01:01.370]that usually center around their own restricted interests.
[00:01:05.960]And they could end up disregarding the other person's
[00:01:09.520]interests in the conversation.
[00:01:11.260]So this leads to a lot of one-sided conversation.
[00:01:13.810]So either focused on their interests and giving few
[00:01:17.240]less appropriate responses,
[00:01:18.770]or giving few extended responses when asked
[00:01:21.300]about other topics.
[00:01:23.090]What happens then is they may fear to identify
[00:01:25.490]common interests with their peers,
[00:01:27.210]which is really one of the key things that they need to do,
[00:01:31.120]to have, to share, within a friendship.
[00:01:35.825]A lot of times they may have difficulty providing
[00:01:37.760]relative information about what is being asked,
[00:01:41.030]or what is being talked about.
[00:01:42.610]They could make unexpected leaps in the topic,
[00:01:45.810]or kind of, again, just revolve back to the topic
[00:01:48.827]that they are interested in talking about.
[00:01:51.630]We often see them use a very pedantic style of speaking.
[00:01:54.980]So we look at this as, the scientist sort of
[00:01:59.600]way of speaking, is focused on facts, and details,
[00:02:02.700]rather than it being this kind of two-way
[00:02:04.857]give and take less reciprocol conversation.
[00:02:07.870]We also often see them use very poor speech prosody,
[00:02:11.990]and they could get highly verbose on their topic,
[00:02:15.120]which then ends up, the other person,
[00:02:18.740]leaving the other person feeling disengaged in that topic.
[00:02:22.990]And go along with the verbal communication,
[00:02:26.060]we also notice that our youth with Autism Spectrum Disorders
[00:02:29.850]have difficulty interpreting
[00:02:31.570]verbal and non-verbal social cues.
[00:02:33.850]Such as the other person's tone of voice,
[00:02:36.317]and the use of sarcasm,
[00:02:38.190]use of gestures,
[00:02:39.320]or use of social touch to communicate.
[00:02:44.770]Other areas of deficits amongst our youth with ASD,
[00:02:48.540]could include poor social awareness.
[00:02:50.830]So that could involve poor eye contact,
[00:02:53.170]this is pretty, this is something we see pretty often.
[00:02:56.727]And if you're not making good eye contact,
[00:02:58.640]it's really hard to understand social cues,
[00:03:01.170]and the social contacts,
[00:03:02.570]or landscape that you're operating within.
[00:03:05.766]We also see them struggle with poor social motivation.
[00:03:08.880]And this makes sense,
[00:03:09.780]if it's something that's really difficult for them.
[00:03:12.190]You know, you're not gonna be very motivated
[00:03:14.566]to be engaged in these activities.
[00:03:17.530]So, we find that they are less involved in social activity,
[00:03:21.560]such as extra-curriculars at school,
[00:03:24.060]or being parts of clubs or sports, or other teams at school.
[00:03:28.920]So, they have fewer opportunities to engage their peers.
[00:03:32.930]They also make fewer peer entry attempts.
[00:03:35.960]Maybe because of feeling anxious about their skills,
[00:03:39.680]or past bad experiences could also lead to this.
[00:03:45.110]So, overall, this ends up being
[00:03:48.760]fewer social initiations for them.
[00:03:52.750]And another area that they struggle with,
[00:03:54.640]is poor social cognition.
[00:03:55.940]So even on difficulty understanding the other person's
[00:03:59.300]perspective that comes from poor theory of mind,
[00:04:03.030]or the ability to put yourself in someone's else's shoe.
[00:04:06.500]And, we see them struggle more with the cognitive entity,
[00:04:10.960]which is not, they can feel what the other person is
[00:04:14.300]feeling, they do have empathy towards other individuals,
[00:04:17.230]but, knowing how to express that entity
[00:04:21.060]is something that they might struggle more with,
[00:04:22.920]and that's what we refer to
[00:04:24.150]as in terms as cognitive entity.
[00:04:29.290]So what are some of the consequences of these social
[00:04:32.110]deficits with our youth?
[00:04:34.620]One of the ones that we see pretty frequently,
[00:04:37.120]is social neglect and isolation.
[00:04:39.430]And so, our teens, or young adults,
[00:04:42.130]maybe more withdrawn from their social surroundings.
[00:04:45.840]They may be viewed as being shy by others.
[00:04:49.380]A lot of times they just go unnoticed,
[00:04:51.120]they kind of on the periphery of social circles,
[00:04:54.620]and they don't make a lot
[00:04:56.190]of attempts to engage others socially.
[00:04:59.960]Another consequence that we see often is peer rejection.
[00:05:03.030]So this can take on the form of being teased,
[00:05:05.820]or bullied by their peers.
[00:05:07.780]A lot of times it comes from unsuccessful attempts
[00:05:10.630]on their end to socially engage others.
[00:05:13.270]So they may strike people as being odd or strange,
[00:05:18.030]and end up with a bad reputation because of which
[00:05:21.030]they can unfortunately get targeted often for teasing,
[00:05:25.010]or bullying sorts of behaviors.
[00:05:29.250]We also see them, when there is a peer conflict situation,
[00:05:34.880]with the friends that they may have.
[00:05:36.820]These arguments may often result
[00:05:39.290]in the termination of a friendship.
[00:05:41.050]So, it's very black or white.
[00:05:42.380]You know, you either like your friend,
[00:05:43.860]or you don't like your friend,
[00:05:47.610]so there's frequent terminations of friendships.
[00:05:51.800]And, due to all of this, they end up with not having
[00:05:55.590]very many close reciprocal friendships.
[00:05:58.750]These are not very quality, high quality friendships.
[00:06:02.120]And bad results in having few close friends.
[00:06:06.880]So the poor quality, overall quality of friendships
[00:06:09.420]that we see results in less companionship
[00:06:12.840]for our teens, especially after school, or on weekends.
[00:06:18.420]Also, they don't get a lot of help from their friends.
[00:06:21.190]It's not a very supportive friendship usually.
[00:06:25.080]Which is, can be pretty devastating at this age.
[00:06:29.200]And there's less security within friendships.
[00:06:31.250]You know, these can, their friends can outgrow them,
[00:06:34.410]and move on to other friends.
[00:06:36.410]So it feels like very insecure for our youth.
[00:06:41.810]And results in greater loneliness for them,
[00:06:45.100]compared to their typically developing peers.
[00:06:50.300]So why are we targeting friendships in this program?
[00:06:56.141]You know looking at some of the research in the field,
[00:06:57.930]the literature has suggested, that even having
[00:07:01.390]one or two close friends,
[00:07:03.290]can predict later adjustment in life.
[00:07:07.516]So, having one or two close friends is good
[00:07:10.070]for your overall adjustment in life later on.
[00:07:13.490]Again, buffer the impact of stressful life events,
[00:07:16.550]cause you'll have someone to turn to for support, and help.
[00:07:21.520]And it correlates positively with our teens self-esteem
[00:07:26.510]and sense of independence.
[00:07:28.500]And it does also correlate negatively
[00:07:31.150]with rates of depression and anxiety.
[00:07:33.760]So this is very important for us to ensure that our
[00:07:37.140]teens have at least one or two close friends
[00:07:40.550]by the end of this program.
[00:07:44.720]So moving on to what are the limitations
[00:07:46.000]of some of the social, existing social skills training.
[00:07:49.560]So there has been some reviews in the field
[00:07:52.410]that have looked at this.
[00:07:55.091]And these are some of the main highlights
[00:07:57.540]that they found in their work.
[00:08:00.920]So most of these programs do not
[00:08:03.590]include teens in the treatment.
[00:08:05.750]So they may be focused more on imparting knowledge
[00:08:08.130]to the parents, and other care providers,
[00:08:10.440]and don't actually involve the teens, themselves.
[00:08:13.910]A lot of the programs don't teach ecologically valid
[00:08:16.580]social skills, so that means they're not being taught
[00:08:19.440]social skills that would actually apply,
[00:08:21.570]and be every day life.
[00:08:22.680]If some of the programs also fail to teach social
[00:08:29.740]skills to through methods that highlight
[00:08:33.150]shared strengths and weaknesses.
[00:08:35.770]So that's something that's important for us,
[00:08:38.070]is to use the strengths in our population,
[00:08:41.020]to offset the weaknesses that we are trying to target.
[00:08:44.960]Some programs don't include homework assignments,
[00:08:47.440]this is really crucial, because you know you could be
[00:08:51.090]talking to someone, in a weekly treatment program,
[00:08:55.200]where if they're not going to be practicing those skills
[00:08:58.460]weekly, there's not a lot of change that you're going to see
[00:09:01.430]at the end of the intervention.
[00:09:04.950]And, they also found that
[00:09:06.870]a lot of the skills being taught,
[00:09:08.540]do not generalize to other settings.
[00:09:10.530]So this kind of ties into, you know, if you're not
[00:09:12.530]being to teaching ecologically valid skills,
[00:09:15.250]or having them practice homework assignments,
[00:09:17.220]a lot of the skills will not generalize to other settings.
[00:09:20.650]Some programs don't include caregivers in the treatment.
[00:09:23.440]So this is kind of the other, going in the other direction,
[00:09:26.770]then not including adolescents in the treatment.
[00:09:29.846]It's only focused on some of these programs only
[00:09:33.040]focused on the teens, and won't factor into the other
[00:09:36.290]supportive adults in their life in the treatment.
[00:09:40.190]And a lot of them do not access treatment outcome,
[00:09:42.470]so it's really hard to see if patients that went through
[00:09:46.760]those programs actually are reporting any success
[00:09:50.630]at the end of the treatment.
[00:09:54.290]So just to give you a little bit of background about PEERS,
[00:09:57.070]before we go into the format,
[00:09:59.200]This is an international program
[00:10:00.940]that was developed at UCLA in 2004.
[00:10:05.030]So, it's been about 13, almost 14 years now.
[00:10:08.650]We started with the adolescent program,
[00:10:12.440]and this has now been translated into
[00:10:14.240]over a dozen languages, and it has been used in several
[00:10:17.520]different countries, I think 25 at last count.
[00:10:21.810]We also have evidence based social skills in our clinic
[00:10:26.404]for pre-schoolers, so that's actually four to six
[00:10:28.160]year olds, either in pre-school or kindergarten
[00:10:31.610]and they are focused on PEER skills at this age,
[00:10:35.150]as a means to develop their social skills.
[00:10:38.300]Apart from our treatment program for adolescents
[00:10:42.110]and their care providers, we also have an adolescent
[00:10:44.520]program that is used for school based professionals.
[00:10:47.650]So educators within to those school setting,
[00:10:51.536]that can apply this program while the teen is at school.
[00:10:55.920]And then we also have PEERS for young adults,
[00:10:58.750]and this a program that is pretty similar to the teen
[00:11:01.680]program, except it has some additional lessons on dating.
[00:11:06.310]Which is something that our young adults
[00:11:08.640]are very interested in.
[00:11:14.130]So, the development of the methods that we use in the
[00:11:19.440]PEERS program comes from research.
[00:11:21.970]And what a lot of the research cited here,
[00:11:24.150]has suggested that these are some of the key points
[00:11:26.790]in having a successful social skills program.
[00:11:30.470]So we use a small class format,
[00:11:32.610]which is about 10-14 students, at most.
[00:11:36.010]So that it's not over-whelming both for the people
[00:11:39.990]within the treatment group, as well as for the providers.
[00:11:43.410]We use didactic lessons to teach very concrete rules
[00:11:47.260]and steps of social etiquette.
[00:11:49.350]So this is, talking about
[00:11:51.370]strengths or weaknesses, for instance.
[00:11:53.200]About using the strengths and weaknesses of our population.
[00:11:57.980]People on the autism spectrum love steps and rules,
[00:12:01.240]and love following them when they are very concrete.
[00:12:04.090]So this, something that we use
[00:12:06.680]to our advantage in this program.
[00:12:09.640]We have, want to make very sure that we're using
[00:12:11.710]ecologically valid skills.
[00:12:13.250]So again, these are skills that we think would
[00:12:16.360]be practical, and applicable in their everyday world.
[00:12:20.750]We use role-play demonstrations, to model social behavior.
[00:12:23.860]So we do inappropriate demonstration to highlight
[00:12:26.950]errors that people make, and then we use appropriate
[00:12:30.158]role play demonstrations to show how the steps
[00:12:33.890]should actually be implemented.
[00:12:35.650]This really helps, these role plays really help,
[00:12:38.190]especially with paying attention to the social cues,
[00:12:41.010]and on verbal language that we want our teens to be
[00:12:46.730]practicing in their everyday life.
[00:12:49.110]And then, we always use perspective taking questions,
[00:12:52.170]to target social cognition and interior of minds.
[00:12:54.890]So, just putting themselves in the other person's shoes,
[00:12:58.280]to understand what that interaction was like.
[00:13:02.030]Then we go on to having behavioral rehearsal exercises,
[00:13:04.850]so the teens are broken up into groups of two and threes,
[00:13:08.150]they practice the skills with each other,
[00:13:10.750]while the coaches, or the treatment team is available
[00:13:13.680]around them to help them through that first practice.
[00:13:18.000]We use homework assignments every week,
[00:13:20.110]so this is meant for them to practice the skills
[00:13:23.220]they learned in the class,
[00:13:24.300]in their natural social setting,
[00:13:26.380]whether it's at school or in their extra-curricular
[00:13:28.780]activities, and this is really what helps generalize
[00:13:32.370]the skills of cross settings,
[00:13:34.400]and we do have the parent and/or teacher coaching
[00:13:37.940]component, as we found this to be one of the most
[00:13:40.640]beneficial aspects of our program, as to have another
[00:13:44.210]supportive adult coach them through the week on these
[00:13:47.170]skills, review and remind them,
[00:13:49.480]practice some of the skills with them.
[00:13:54.500]So, in terms of just the didactic lesson that we
[00:13:57.230]use in our program, you know we've developed a set of rules,
[00:14:00.390]and steps of social behaviors.
[00:14:02.760]So we teach them these ecologically valid skills,
[00:14:07.210]in the form of these rules, mostly in the terms of steps,
[00:14:12.140]which we call the "Do's" in our program.
[00:14:14.870]And then we have rules around the social errors committed
[00:14:18.280]by, especially those on the autism spectrum,
[00:14:21.980]and we call them, the "Don'ts", so these are
[00:14:24.580]we create rules around the Don'ts, so they, that,
[00:14:28.130]would prevent them from engaging in these social errors.
[00:14:33.870]And we also break down these steps into concrete parts.
[00:14:37.140]So as you can see in the picture, right here,
[00:14:41.700]you know, we have the steps, these are very specific
[00:14:44.670]concrete steps that we break down for them to follow.
[00:14:52.250]So moving on to the curriculum of the Teen PEERS group.
[00:14:56.640]I'm going to focus on the teen program, which is our
[00:14:58.630]most popular program right now.
[00:15:04.187]A huge focus in our program is on conversational skills.
[00:15:07.450]So this could involve one-on-one conversation,
[00:15:10.960]group conversations, and we break it down differently
[00:15:15.470]for each type, because the rules are going to be
[00:15:17.810]different for each type.
[00:15:19.250]But a lot of the focus is going to be on
[00:15:21.070]trading information, so that they can find a common interest
[00:15:24.800]As I mentioned before, common interests are really how
[00:15:27.330]people connect with their friends.
[00:15:29.170]So finding that common interest is very crucial
[00:15:31.800]in developing friendships.
[00:15:33.670]We also focus a lot on having sort of a more equitable
[00:15:39.549]give and take on conversations, so having it be that
[00:15:41.512]reciprocal, that's another skill that's focused on.
[00:15:44.280]And, another huge area of emphasis
[00:15:47.790]is on non-verbal communication.
[00:15:49.550]So not just being attention to non-verbal communication,
[00:15:52.660]but also using appropriate non-verbal communication.
[00:15:57.470]We also talk about electronic communication.
[00:15:59.740]Cause this is a pretty frequently used communication
[00:16:02.820]platform, a conversation platform by our teens.
[00:16:06.567]So, even, you know, knowing how to make appropriate
[00:16:10.010]phone calls, voice mails, emails, text messages,
[00:16:14.830]using social media appropriately,
[00:16:19.110]there's going to be different rules
[00:16:20.610]about each of those types, how many attempts you can make,
[00:16:24.410]how many, when you should pull back or stop,
[00:16:29.240]those are going to be different.
[00:16:30.330]So we break it down by each type,
[00:16:32.440]and we touch a little bit upon on-line safety,
[00:16:34.600]cause we want to make sure that if our teens are using
[00:16:37.080]this form of electronic communication,
[00:16:39.600]that they are also aware of how to keep themselves safe.
[00:16:44.410]Choosing appropriate friends
[00:16:45.870]is the next aspect of our program.
[00:16:48.350]We find a lot of our teens struggle even with identifying
[00:16:51.390]what they are, as we call it, what their tribe is.
[00:16:55.450]What is the kind of peer group
[00:16:57.080]that they're going to connect with the most.
[00:16:59.150]What their sources of friends are going to be.
[00:17:01.580]And so we talk to them about that.
[00:17:03.730]Talk to them about different types of peer groups,
[00:17:05.800]different types of interests that they may have.
[00:17:07.990]And how, help them identify the people
[00:17:11.320]that they might connect with the most.
[00:17:13.320]And then based on that, we also talk about what are
[00:17:15.570]the extra-curricular activities they should be involved in,
[00:17:18.457]and to find the source of friends based on their interests.
[00:17:22.040]So, that would be a big topic to talk about.
[00:17:26.130]Both with our teens as well as in the parent group,
[00:17:28.620]which is finding good sources of friends.
[00:17:33.600]Other communication skills that we talk about,
[00:17:36.010]are appropriate use of humor.
[00:17:38.120]So, you know, humor is a really good thing,
[00:17:41.810]a lot of the times, but often it could also be
[00:17:45.030]very off-putting to our peers.
[00:17:47.650]Especially if it's not used appropriately.
[00:17:52.290]So we want to make sure our teens are paying attention
[00:17:55.240]to the feedback that they are getting
[00:17:56.900]about their sense of humor.
[00:17:59.170]Especially if that's something to preventing them
[00:18:02.510]from connecting with their peers, or making friends.
[00:18:07.290]We talk about peer entry strategies.
[00:18:09.380]So as I mentioned before, it's going to different
[00:18:11.420]when it's individual conversations, one on one with
[00:18:14.010]another person, or when it's entering a group conversation,
[00:18:17.980]like at school, or at a party.
[00:18:21.140]Peer exit strategies are also different.
[00:18:23.240]So, we talk about that as well.
[00:18:24.830]You know, exiting a conversation is going to be very
[00:18:27.390]different, if the conversation went well.
[00:18:30.280]And it's going to be very different if it didn't go well,
[00:18:32.510]or if it was awkward.
[00:18:33.690]So we talk about all the different
[00:18:35.150]exiting conversation strategies.
[00:18:39.510]We talk to our teens about good sportsmanship.
[00:18:41.920]So, you know, just some skills that we want to make sure
[00:18:45.360]keep their peers interested in them,
[00:18:49.730]and interested in hanging out with them in the future.
[00:18:52.090]So, just not being a sore loser, being a good sportsman,
[00:18:55.610]playing nicely, following the rules.
[00:18:58.120]Those are some of the key lessons within this topic.
[00:19:02.580]And then, a huge piece of the puzzle in this group,
[00:19:06.130]is going to be in having get-togethers with people.
[00:19:09.080]So that's really the main way
[00:19:11.080]to develop close, meaningful friendships.
[00:19:13.640]At once you developed your conversational skills,
[00:19:16.330]and you identified your sources of friends,
[00:19:18.500]and you've stopped making some of the errors
[00:19:21.057]that you were previously making,
[00:19:22.780]is then in hanging out with more with people
[00:19:24.760]that you are interested in getting to know better.
[00:19:27.030]So, this happens in the form
[00:19:28.820]of get-togethers with our teens.
[00:19:30.580]And so, we go over the rules and steps for being a good
[00:19:33.870]host, as well as being a good guest, when they're
[00:19:36.570]having get-togethers with their friends.
[00:19:40.400]We talk about some peer conflict situations.
[00:19:43.550]Like handling arguments with our friends.
[00:19:45.810]Now, if our teens have developed
[00:19:47.790]one or two close friendships,
[00:19:49.750]we don't want them to lose those friendships
[00:19:52.280]because of an argument or disagreement that they
[00:19:54.280]did not know how to resolve.
[00:19:56.100]So we basically give them the communication tools
[00:19:59.560]on how to resolve a conflict amicably in this lesson.
[00:20:05.580]The remaining lessons in our program
[00:20:07.300]focus on some peer rejection issues,
[00:20:09.860]like teasing, physical bullying,
[00:20:13.260]cyber bullying, rumors and gossip.
[00:20:15.500]Unfortunately this is something that's happening a lot.
[00:20:18.720]For our teens these days, especially at school,
[00:20:22.200]so we want to make sure that they know strategies
[00:20:25.150]to handle each type of situation.
[00:20:27.250]We do have different approaches to each type,
[00:20:31.020]so we focus on those strategies,
[00:20:32.880]as well as on how to avoid becoming
[00:20:35.290]the target of teasing or bullying behaviors.
[00:20:38.040]So that may involve utilizing some embarrassing feedback
[00:20:41.570]that they get, or changing a bad reputation that they
[00:20:44.350]may already be stuck with at school,
[00:20:47.370]and we guide them through
[00:20:48.890]the appropriate ways to do that, through our program.
[00:20:52.870]And finally we end with a graduation,
[00:20:55.930]which is more of a celebration of the accomplishments
[00:20:58.500]of our teen thus far, as well as a guiding lesson for
[00:21:03.180]the parents and the caregivers involved in the program,
[00:21:06.400]on where to go next from here.
[00:21:08.090]So what kind of skills to continue focusing on,
[00:21:10.640]what is some additional areas they may need help with,
[00:21:13.930]we discuss all of that at the end of the program.
[00:21:19.640]So, the format of our weekly lessons
[00:21:22.210]includes a 30 minute homework review,
[00:21:24.520]so this is where we troubleshoot any
[00:21:26.620]problems that came up during the week,
[00:21:28.840]and it gives us an opportunity to individualize the
[00:21:31.670]treatment for each of the participants in our group
[00:21:34.800]programs, so whatever their specific issues or concerns
[00:21:38.870]or problems are coming up, we can tailor our problem
[00:21:43.300]solving strategies a little bit more during this interview.
[00:21:47.970]Then we have a 30 minute didactic instruction on all
[00:21:50.810]the topics that I mentioned in our curriculum
[00:21:55.128]in the format that I mentioned as well.
[00:21:56.540]The steps, the rules, the role plays, and the modeling.
[00:21:59.600]And then we have our socialization activity
[00:22:01.950]for the remaining 30 minutes, which is basically,
[00:22:04.250]they are trying to rehearse the skills with each other,
[00:22:07.510]with our team that do provide them
[00:22:10.190]feedback through our coaching.
[00:22:15.020]So, I'm going to briefly move on to the research
[00:22:18.270]background on our programs, so the evidence base that
[00:22:23.460]we have that this is an effective program for both
[00:22:26.040]teens and adults, was established across multiple studies,
[00:22:31.470]so especially with our autism spectrum.
[00:22:37.060]Youth, both teens and as well as adult,
[00:22:39.750]we demonstrated that this is an effective program
[00:22:43.190]over and above other social skills programs,
[00:22:45.900]or a wait list in helping them develop better social skills.
[00:22:52.870]Our studies have also been replicated by other researchers.
[00:22:57.389]So, we have some collaborators, as well as other
[00:23:00.000]people that are interested in this program
[00:23:02.530]that have replicated some of the findings,
[00:23:06.542]the treatment outcome findings of peers
[00:23:09.080]in their social groups as well.
[00:23:13.340]This includes a study using EEG,
[00:23:18.510]so finding some neuro changes, as well as in
[00:23:21.730]Autism Spectrum Disorder as following the PEERs intervention
[00:23:25.540]and we have a study done by a Korean group,
[00:23:30.010]that the was the one used to establish,
[00:23:32.830]their version of the PEERS program,
[00:23:35.390]adapted for teen with ASD in South Korea.
[00:23:44.210]And then, lastly,
[00:23:45.160]these are some studies that we looked at,
[00:23:47.500]not just in Autism Spectrum,
[00:23:48.940]but also for evidence-base in ADHD,
[00:23:52.127]and this is found to be an effective program
[00:23:54.100]for that population as well.
[00:23:56.840]As well as in terms of long-term treatment outcome.
[00:23:59.630]So one year following treatment,
[00:24:01.880]as well as five years following treatment.
[00:24:04.190]And we generally found a positive trend,
[00:24:06.630]especially the treatment gained seemed to hold very well,
[00:24:10.060]a year following treatment.
[00:24:12.336]There is a slight drop from the one year time point
[00:24:14.760]to five year time point.
[00:24:15.860]But the five year time point still is much higher
[00:24:18.660]than when they started out with before the program.
[00:24:21.900]So very promising long term findings.
[00:24:28.160]In terms of a future research,
[00:24:29.980]we are very interested in implementing this new program
[00:24:35.880]that we got some funding for,
[00:24:39.282]to disseminate our findings in schools for teens with ASD.
[00:24:44.560]So we plan to develop over a hundred role play videos
[00:24:46.890]that can be used in schools to teach some of these
[00:24:52.140]social skills in that setting.
[00:24:56.250]We have some interest in doing,
[00:24:58.540]this is a program that was originally developed for
[00:25:02.410]high-functioning individuals and focused on more of
[00:25:04.930]the social nuances that they struggle with.
[00:25:07.720]But we are interested in also adapting this program
[00:25:10.920]for teens with intellectual disabilities,
[00:25:13.420]or lower functioning individuals on how we can help
[00:25:16.140]them with their social skills as well.
[00:25:18.830]We are also interesting in developing something that
[00:25:21.820]we like to call Club PEERS for now.
[00:25:24.540]Which mainly would be a maintenance program,
[00:25:27.250]with some booster sessions that teens can maybe come to
[00:25:31.520]over in the summer, to maintain their long-term treatment
[00:25:34.500]gains after they have completed the initial program.
[00:25:40.610]We also have taught and worked on developing Camp PEERs,
[00:25:44.210]which would be a summer program, which would be a briefer
[00:25:46.600]intervention that people could do over the summer with us.
[00:25:50.930]And since we get a lot of interest in the dating component
[00:25:55.430]of our young adult program, we are going to in the future,
[00:25:59.480]be expanding on that aspect of our program,
[00:26:01.860]and just having a PEERS for dating skills.
[00:26:05.350]And more recently we received some funding,
[00:26:08.330]that we are going to start using a PEERS for careers program
[00:26:13.040]We will actually be testing out, that out in the coming fall
[00:26:17.860]and that's going to be a program to help you transition
[00:26:20.890]from college to young adulthood, and focusing especially
[00:26:25.110]on their job career relevant skills.
[00:26:32.840]So, in the last few minutes what I would like to do, is,
[00:26:36.740]give you an example of how some of our lessons are taught.
[00:26:40.210]So, this is going to be a clinical example on how we
[00:26:44.150]teach the skills for entering group conversation.
[00:26:47.410]So we would start out by asking some questions,
[00:26:50.940]you know, we use socratic methods,
[00:26:52.787]or we ask questions in our groups,
[00:26:57.090]and have our teens help generate
[00:26:59.960]the answers to these questions.
[00:27:02.820]So, a question would start with something like,
[00:27:06.477]"What are most children and teens
[00:27:08.030]"told to do to meet new people?"
[00:27:11.620]So think about that.
[00:27:12.919]Think about the advice that most children or teens
[00:27:15.530]are given by adults to meet new people.
[00:27:20.370]So they may be told to,
[00:27:21.860]just go say hi to them,
[00:27:23.210]Or just go introduce yourself,
[00:27:25.410]walk up there, and introduce yourself.
[00:27:28.760]Right?
[00:27:30.210]But in reality, what do most successful
[00:27:33.880]children or teens do in this situation?
[00:27:39.120]Well our teens are children with autism spectrum
[00:27:41.440]might do things like go up, interrupt the conversation,
[00:27:45.790]start just talking about their topic of interest,
[00:27:48.970]not really paying attention
[00:27:50.160]to what the conversation skill there.
[00:27:53.699]What the conversational topic that was going on was.
[00:27:57.080]But, our teens are kids with
[00:28:01.210]that lack successful social skills,
[00:28:04.100]don't usually do things like this.
[00:28:05.950]They don't up and say hi, and introduce themselves.
[00:28:09.370]For that matter, most adults don't do that either.
[00:28:12.470]So think about when you're meeting a new person,
[00:28:15.330]or at a party trying to join in on a conversation,
[00:28:18.330]you don't really start out by saying,
[00:28:19.997]"Hi, I'm Aarti."
[00:28:23.709]Or introducing yourself, or just saying hi.
[00:28:29.060]That's not with most people do.
[00:28:32.345]So what do most people do?
[00:28:34.800]So what we start on next then with is,
[00:28:38.670]watching a bad role play.
[00:28:39.920]Okay, so we are going to watch a bad role play here.
[00:28:43.240]And we are going to see what our character Elina,
[00:28:47.330]does wrong, in entering this group conversation.
[00:28:53.999]If I can find my cursor, right there.
[00:28:56.310]So watch this role-play,
[00:28:57.410]and think about what Elina is doing wrong.
[00:29:01.430]Hey, Jordan you will never guess,
[00:29:02.640]I saw Dave at my favorite sushi restaurant this weekend.
[00:29:05.060]No way, what restaurant was it?
[00:29:06.160]Just the one right around the corner.
[00:29:08.130]Oh, I've been meaning to try that place.
[00:29:10.310]Yeah, it's so close by.
[00:29:11.510]I feel bad that I'd never gone,
[00:29:12.810]but I went, and it was so good.
[00:29:14.480]Nice! What did you guys get?
[00:29:16.050]I got the spicy tuna with crispy rice.
[00:29:18.080]Mm, yeah, it looked awesome.
[00:29:20.020]Have you guys ever been roller skating?
[00:29:22.690]Sorry, uh, I just got the regular salmon roll.
[00:29:25.050]There's this new skate rink that just opened up.
[00:29:27.490]It's really fun.
[00:29:28.323]What did you get?
[00:29:29.156]Um, just the salmon roll, it was plain, but so good.
[00:29:31.360]How about Thursday nights, do that night?
[00:29:34.270]A lot of people go to it.
[00:29:35.976]I've been meaning to go there,
[00:29:37.193]I haven't been able to try it out.
[00:29:38.260]It's really, really fun.
[00:29:40.010]There's also this other place.
[00:29:41.742]What would you get if you went?
[00:29:42.965]Have you ever roller skated?
[00:29:43.798]I'm sorry, what?
[00:29:44.892]What would you get if you went?
[00:29:46.255]It's really cool, it's like right by the water,
[00:29:48.020]and lots of people go.
[00:29:50.130]All right, and then we go on to first talk about
[00:29:54.002]what did Elina do wrong in entering
[00:29:56.910]that group conversation?
[00:29:58.230]So they may generate responses such as,
[00:30:00.600]well she interrupted them,
[00:30:02.580]she just kept talking about her topic,
[00:30:04.850]she really wasn't talking about
[00:30:06.150]what they were talking about,
[00:30:08.080]or she wasn't being a, they looked annoyed,
[00:30:10.750]and she wasn't paying attention to that.
[00:30:13.750]Then we go and into perspective taking questions.
[00:30:16.090]So, we'll say, what was that like for the group.
[00:30:18.800]So they might say,
[00:30:21.020]oh, that was really annoying,
[00:30:22.540]or frustrating,
[00:30:26.389]and not a very pleasant experience.
[00:30:29.170]Then we would ask them,
[00:30:30.290]what did the group think of Elina?
[00:30:32.410]And they might say,
[00:30:33.243]well, she was rude,
[00:30:34.650]she was kind of strange,
[00:30:37.864]or, that's what they might say in that context.
[00:30:41.250]And then finally we would ask them would the group
[00:30:43.210]want to talk to Elina again after this.
[00:30:46.476]And they might say, no probably not.
[00:30:47.360]Because she definitely talked to them about
[00:30:49.800]what they originally were talking about.
[00:30:56.360]So then we move on to talking about what are the actual
[00:30:59.130]steps for entering a group conversation appropriately.
[00:31:02.410]So, first we want them to watch and listen.
[00:31:05.120]So, we want them to be watching the group that they
[00:31:07.600]want to engage with from a distance.
[00:31:11.060]Using a prop is very helpful in this situation.
[00:31:13.600]Most of us sort of naturally do this,
[00:31:16.517]so we might use our phones for example,
[00:31:20.380]while we're hanging out, or kind of ease-dropping
[00:31:23.834]on the conversation, we'll be browsing through our phones,
[00:31:27.180]and so phones are usually really good prop for this.
[00:31:30.980]Then we want to be listening to the topic
[00:31:32.830]while they're doing that.
[00:31:35.175]Right so, we want to basically identify
[00:31:36.620]some common interests.
[00:31:37.660]So are they talking about some topic
[00:31:39.590]that we might be interested in joining in on,
[00:31:43.410]or we might have some questions about,
[00:31:45.110]or we may have something to share?
[00:31:47.780]So that's gonna be really important,
[00:31:50.316]is identifying the common interests
[00:31:52.080]that you can join the conversation on.
[00:31:55.640]Then to show that you're interested
[00:31:57.230]in what they're talking about,
[00:31:58.340]we want them to be making periodic eye contact.
[00:32:01.040]So not staring them down,
[00:32:02.650]but just every now and then looking over in their direction
[00:32:05.670]to show that you're interested.
[00:32:08.680]It's usually, we'll say, you know, it's helpful
[00:32:10.520]to watch to see if you know someone in that conversation.
[00:32:13.140]Cause if there is someone that you know,
[00:32:14.960]maybe if they know you a little bit,
[00:32:17.040]if they like you,
[00:32:18.280]they're going to be more accepting of you
[00:32:19.780]in that conversation,
[00:32:20.840]so that usually helps,
[00:32:22.550]to join in on a conversation
[00:32:24.380]where there is someone you already know.
[00:32:27.740]We also have to point out to our teens
[00:32:29.273]that we want to make sure that they are talking nicely.
[00:32:31.660]We don't want them to be joining in on conversations
[00:32:34.580]where someone might be having a debate, or an argument,
[00:32:37.750]and things can get heated.
[00:32:39.280]It's really not the appropriate time to join a conversation,
[00:32:42.270]or if they're talking about something personal,
[00:32:44.910]that would also not be an appropriate time to talk.
[00:32:48.400]So once they identified the topic,
[00:32:50.170]we then want them to wait for a pause in the conversation.
[00:32:54.010]Now there's never going to be a perfect pause,
[00:32:56.050]but you know, just a slight little break,
[00:32:57.820]maybe in the flow of conversation where they can get in,
[00:33:01.290]and they're not interrupting too much.
[00:33:04.400]We want them to move closer,
[00:33:07.630]when they start to join the conversation,
[00:33:09.740]rather than shout from across the room, for example.
[00:33:13.200]So we give them the general rule of thumb
[00:33:15.130]that it should be an arm's length away,
[00:33:17.000]but that they shouldn't be measuring this arm's length,
[00:33:20.070]cause that would kind of be strange or odd to be doing that.
[00:33:23.810]So just kind of an estimate,
[00:33:25.170]they move in a little bit closer,
[00:33:27.000]and then we want to make sure that they join
[00:33:28.970]the conversation, like make a comment,
[00:33:31.600]or ask a question that is on topic.
[00:33:34.350]So, not what Elina was doing, which was talking about
[00:33:36.730]a completely different thing,
[00:33:38.100]but join in on the conversation on topic, right?
[00:33:43.830]So, we also want to talk to them about some non-verbal
[00:33:49.070]cues to assess interest during conversational entry.
[00:33:52.760]So, there's three key features here.
[00:33:55.830]So we want to be looking for verbal signs.
[00:33:58.690]First, that is, are they talking to you?
[00:34:02.280]And if they are talking to you,
[00:34:04.488]are they talking nicely?
[00:34:06.140]Are they asking you questions?
[00:34:08.040]Versus are they giving you short answers,
[00:34:10.280]or not asking you any questions,
[00:34:12.530]like they're not really interested in talking to you.
[00:34:15.570]Second, we want to pay attention to eye contact.
[00:34:18.200]So, we ask them, are they looking at you?
[00:34:20.730]And if they are looking at you,
[00:34:21.920]are they smiling along, are they nodding?
[00:34:24.330]Are they making eye contact?
[00:34:26.809]Or, are they looking confused?
[00:34:28.480]Making faces?
[00:34:29.650]Rolling their eyes at you?
[00:34:30.530]Or not making eye contact?
[00:34:32.370]So we wouldn't want that.
[00:34:34.420]So we want to make sure that they are paying attention
[00:34:36.020]to what kind of eye contact they're getting.
[00:34:38.350]And then, third, we want to be
[00:34:40.590]paying attention to body language.
[00:34:42.170]So, we ask them, are they facing you?
[00:34:44.830]So good body language would be they're opening the circle,
[00:34:48.270]which is turning around, you know, with their shoulder,
[00:34:51.950]and including you into the circle.
[00:34:54.210]And bad body language would be closing the circle.
[00:34:57.520]So, kind of giving you the cold shoulder.
[00:34:59.300]Turning away from you,
[00:35:00.350]excluding you from the conversation.
[00:35:03.160]So, those are some of finding out important
[00:35:05.240]non-verbal cues here, right?
[00:35:08.350]So once we've talked to them about the steps,
[00:35:10.470]the rules, to enter a conversation appropriately,
[00:35:13.260]we go over a good role play.
[00:35:17.190]So this is going to be our good role-play
[00:35:19.060]in entering a group conversation.
[00:35:21.070]And we're going to watch and see this time
[00:35:23.110]what Elina does right in entering this group conversation.
[00:35:31.460]So, Jordan, you will never guess,
[00:35:32.650]I saw Dave at my favorite sushi restaurant this weekend.
[00:35:35.220]Nice! What restaurant was it?
[00:35:36.520]Um, just the one right around the corner.
[00:35:38.490]Oh, I've been meaning to check that place out.
[00:35:40.610]Yeah, it's so close by, and I've never gone,
[00:35:42.680]but I went, and it was really good.
[00:35:44.797]Oh, what did you guys get?
[00:35:45.970]I got a spicy tuna roll and I loved it.
[00:35:48.437]So you got the spicy tuna roll?
[00:35:50.090]That's what I always get!
[00:35:51.440]Yeah, how good is it?
[00:35:52.310]It's so good there.
[00:35:53.630]Have you guys tried the rainbow roll there?
[00:35:55.380]I haven't!
[00:35:56.480]No, I actually got the salmon roll.
[00:35:58.050]Oh, okay, that's good too. Yeah.
[00:35:59.690]The rainbow roll is their specialty.
[00:36:01.363]Cool!
[00:36:02.196]I'll try it.
[00:36:03.461]If you were going to go, what would you get?
[00:36:04.555]I would get the California roll,
[00:36:05.830]it's my favorite.
[00:36:06.790]I tried that one there actually,
[00:36:08.320]it's really good.
[00:36:09.620]Nice!
[00:36:12.610]All right, so after the role play,
[00:36:14.620]we first discuss what Elina did right in entering
[00:36:17.770]the group conversation this time.
[00:36:19.710]So, they will say she followed all the steps.
[00:36:22.180]She used a prop, which was her phone.
[00:36:24.930]She keep looking over and listening.
[00:36:27.340]Made periodic eye contact.
[00:36:30.220]When she was ready to join in on the topic,
[00:36:33.040]seemed like she knew what they were talking about.
[00:36:35.440]She moved in closer,
[00:36:37.560]and when there was a pause,
[00:36:39.380]she joined in on topic, this time,
[00:36:42.100]so she started talking about exactly
[00:36:44.300]the same topic they were talking about,
[00:36:46.110]which was sushi restaurants,
[00:36:48.860]so that was a good peer entry role play.
[00:36:53.170]Then we again talk about our perspective taking questions.
[00:36:55.940]So what was that like for the group?
[00:36:58.160]And this time, they might say,
[00:37:00.240]it was fine, normal, pleasant.
[00:37:03.430]What did the group think of Elina?
[00:37:05.170]They might say, she was nice, you know, normal, sweet.
[00:37:11.100]And then, would the group want to talk to Elina again,
[00:37:14.090]after this interaction.
[00:37:15.590]They say, yeah, probably, she seemed great,
[00:37:18.210]so, likely to talk to her again.
[00:37:21.540]So, those are our perspective taking questions,
[00:37:24.140]that we run to after each role play
[00:37:26.760]with our teens, our youth.
[00:37:32.860]To wrap up, I just want to highlight some of the resources
[00:37:35.670]that we have in our clinics,
[00:37:37.130]so, this one right here, is the manual that we use,
[00:37:42.410]the treatment manual that we use in our clinic,
[00:37:44.832]with teens, with the teens in our group,
[00:37:50.200]in our adolescent group.
[00:37:52.480]This has been translated into the Korean version,
[00:37:55.950]that we don't use here, but our collaborators do.
[00:37:59.700]We have the school based curriculum,
[00:38:01.990]for educators and school professionals,
[00:38:04.610]that is also focused on adolescents.
[00:38:08.050]We have a Friend mMker app,
[00:38:09.730]that's useful for our families,
[00:38:11.950]as well as our teens, I mean our patients,
[00:38:14.700]and other providers.
[00:38:16.470]This is a phone app, or smart tablet app,
[00:38:19.710]you can download it on any smart phone, or smart tablet,
[00:38:25.465]and it basically has all the topics,
[00:38:28.390]all the main steps and rules related to each topic,
[00:38:31.760]and some of the role plays,
[00:38:33.360]so this is a good tool for our patients,
[00:38:36.270]to kind of review and rehearse their skills,
[00:38:39.170]during the week,
[00:38:40.003]or before they do their homework assignments.
[00:38:43.680]Our latest addition is our young adult manual,
[00:38:46.820]so that is, as I mentioned before, pretty similar
[00:38:49.750]to the teen manual and teen programs,
[00:38:52.280]except for that it has additional lessons on dating skills.
[00:38:56.960]And, the final one right here,
[00:38:59.390]the science of making friends,
[00:39:00.877]is our parent resource.
[00:39:02.410]So, it's a book that helps guide parents through
[00:39:06.370]coaching their teens through there social life.
[00:39:09.130]So, all of these are pretty much available, through Amazon.
[00:39:13.640]And, the Friend Maker app
[00:39:14.540]is available through any of the app stores.
[00:39:20.550]You can also find additional information about
[00:39:22.550]our program on our website,
[00:39:24.340]and on our social media platform.
[00:39:27.520]Any other questions, or information that you may need,
[00:39:30.440]you can get through contacting us directly at our email,
[00:39:34.950]or calling us.
[00:39:39.030]And that's it.
[00:39:40.010]Thank you.

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Overview of the UCLA Peers Program

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