Blythe A. Corbett, Ph.D., discusses her lab’s research on puberty, adolescence, and mental health in autistic individuals. She emphasizes puberty as a period of significant biological maturation involving several physical, biological, hormonal, and social factors. The speaker details her lab’s latest research on pubertal onset, mental health, hormonal changes, and gender identity in autistic young people compared to allistic (non-autistic) groups. Corbett repeatedly emphasizes how puberty can be particularly complex for autistic youth (especially those assigned female at birth), who are already vulnerable to change and stress. She summarizes the presentation and underscores the importance of exploring how puberty’s hormonal, psychological, and social changes interact with the autism phenotype before the Q&A.

Handouts are online HERE

In this webinar:

1:15 – Outline
5:10 – Adolescence, puberty & associated risks
9:25 – Measuring puberty
13:15 – Autistic vs. allistic pubertal onset
19:00 – Cortisol levels in autistic young people
25:25 – Depression in young people with autism
32:15 – Testosterone and development
37:00 – Gender identity
43:00 – Conclusions & future research
47:30 – Q&A

Adolescence & puberty in autism

Corbett describes autism as a neurodevelopmental condition characterized by differences in social communication (e.g., social-emotional reciprocity, non-verbal communication) and restricted, repetitive patterns of behavior, interests, or activities (e.g., insistence on sameness, sensory sensitivities) (01:35). Adolescence, she explains, is a transformative stage characterized by significant psychological, social, emotional, and hormonal shifts, typically spanning ages 10 to 24. Within this broader period of adolescence, puberty specifically marks the biological maturation that leads to reproductive capacity and further psychosocial development (5:10). For autistic individuals, who often experience challenges with social communication, adaptability to change, and sensory sensitivities, navigating these developmental milestones can be particularly complex.

The presenter explains that early onset puberty can increase the risk for mental health problems, such as anxiety, depression, and suicidality, which are already more prevalent in adolescents with autism (05:58). Until recently, research on puberty and autism has been limited. Some recent studies suggest that while social cognition might improve during puberty, social withdrawal can intensify, and about a third of youth experience significant psychosocial problems. Further, female-presenting autistic people have reported challenges with emotion regulation and heightened sensory experiences during menstruation (08:06).

• A Two-Hit Model of Autism: Adolescence as the Second Hit (Picci & Scherf, 2015)
• Changes in Maladaptive Behaviors From Midchildhood to Young Adulthood in Autism Spectrum Disorder (Anderson et al., 2011)
• Autism after Adolescence: Population-based 13- to 22-year Follow-up Study of 120 Individuals with Autism Diagnosed in Childhood (Billstedt et al., 2005)
• Autism spectrum disorders and menstruation (Hamilton et al., 2011)
• In Search of Explanations for Early Pubertal Timing Effects on Developmental Psychopathology (Ge & Natsuaki, 2009)
• Pubertal Timing, Depression, and Externalizing Problems: A Framework, Review, and Examination of Gender Differences (Negriff & Susman, 2011)
• Other-Sex Relationship Stress and Sex Differences in the Contribution of Puberty to Depression (Llewellyn et al., 2012)
• Depressive and Anxiety Symptom Trajectories From School Age Through Young Adulthood in Samples With Autism Spectrum Disorder and Developmental Delay (Gotham et al., 2015)

Puberty onset and measurements

Corbett briefly describes methods for measuring puberty, including Tanner staging (physical exam), parent report (e.g., Pubertal Development Scale), and self-report (e.g., gender-specific self-assessment questionnaire) (09:27). She outlines a recent publication by her team which found that pubertal assessments by parent or child are not reliable indices of precise pubertal staging, compared to physical exams (11:05). Corbett and her team use all three methods of measurement in their studies to compare perceived development with physical indices. The speaker touches on models and frameworks used to help understand the links between mental health, puberty, and autism.

A study published by Corbett and colleagues in 2020 shows that autistic females experience significantly earlier breast development and onset of menses compared to typically developing females, while pubertal onset for autistic males is similar to neurotypical males (13:15). A longitudinal study assessing the progression of puberty in the same participants between 10 and 15 years of age verified these findings. Corbett reiterates that pubertal onset “sets into motion a cascade of events which may magnify and further complicate an already vulnerable trajectory, especially in females (17:00).” 

• Pubertal Development Measurement in Children With and Without Autism Spectrum Disorder: A Comparison Between Physical Exam, Parent- and Self-Report (Corbett et al., 2019)
• Pubertal Timing During Early Adolescence: Advanced Pubertal Onset in Females with Autism Spectrum Disorder (Corbett et al., 2020)
• Examination of pubertal timing and tempo in females and males with autism spectrum disorder compared to typically developing youth (Corbett et al., 2022)

Altered cortisol levels in autism

The speaker describes the Hypothalamic-Pituitary-Adrenal (HPA) axis, which plays a vital role in our stress response by triggering a neuroendocrine cascade to produce cortisol. Cortisol, she continues, is a widely used biological marker found in blood and saliva (19:00). Normally, cortisol levels peak in the morning and decline throughout the day. However, Corbett’s research consistently shows that autistic children exhibit significant variability in cortisol levels, with persistently elevated evening cortisol and a “blunted slope” compared to their allistic peers. This means their cortisol doesn’t rise or drop to the same level, impacting their ability to feel energized during the day and rest well during the night (20:30). Another longitudinal study on cortisol trajectory further revealed that HPA axis maturation is impacted by age, puberty, sex, and an autism diagnosis, where females had higher overall cortisol and higher evening cortisol than the males in both groups (22:00). 

• The developmental trajectory of diurnal cortisol in autistic and neurotypical youth (Corbett et al., 2023)

Psychological well-being: depression in autistic adolescence

The presenter notes that half of all people who will suffer from mental illnesses have their onset by age 14, making adolescence a critical period for mental health, especially for autistic youth. A study conducted by Corbett and Dr. Jessica Schwarzman found that depressive symptoms are significantly higher in both autistic males and females as early as 10-13 years of age. Parents corroborated these findings, reporting higher depressive symptoms in their autistic children, especially in females (25:25). The presenter therefore asserts that screening and intervention for depressive symptoms for autistic individuals should begin very early in adolescence. She notes that symptoms were often related to interpersonal problems and feelings of worthlessness, which are crucial intervention targets (28:00).

Corbett outlines a recent longitudinal study on the trajectory of depressive symptoms which revealed that while autistic individuals reported significantly higher depression symptoms at age 10, their symptoms actually decrease through adolescence, contrasting with an increase seen in allistic youth around ages 14-15 (30:00). The speaker notes that if replicated, this data warrants significant attention, potentially pointing to earlier identification and treatment for autistic youth.

• Higher depressive symptoms in early adolescents with Autism Spectrum Disorder by self- and parent-report compared to typically-developing peers (Schwartzman & Corbett, 2020)
• Diagnostic- and sex-based differences in depression symptoms in autistic and neurotypical early adolescents (Schwartzman et al., 2022)
• Trajectory of depressive symptoms over adolescence in autistic and neurotypical youth (Corbett et al., 2024)

Hormonal differences

Corbett explains that imbalances in hormones such as testosterone may modulate autism phenotypes. However, there is limited research regarding variations in testosterone during adolescence in autism (34:15). She details a recent study comparing salivary testosterone between autistic and allistic groups and male vs. female participants, with considerations of developmental stage. Data show that in autistic youth, both males and females exhibited significantly elevated testosterone compared to allistic youth. While male testosterone levels rapidly increased as expected during adolescence, females initially had higher testosterone until around 11.5 years of age before plateauing. Corbett states that these findings may suggest testosterone does play a role in autism, especially during periods of hormonal change (36:00). 

• Salivary testosterone in male and female youth with and without autism spectrum disorder: considerations of development, sex, and diagnosis (Muscatello et al., 2022)

Gender diversity in autistic young people

Adolescence is a time of profound self-exploration, including gender identity, or a person’s innate sense of gender. The speaker highlights recent research suggesting a higher prevalence of gender diversity in individuals diagnosed with autism or having autistic traits compared to their allistic peers. Corbett’s team used both self-report and parent report questionnaires to confirm this finding in autistic children (37:00). Parents of autistic children reported significantly greater “gender body incongruence” in their children compared to parents of allistic children. Furthermore, within the autistic group, those assigned female at birth reported significantly more experiences of gender body incongruence than those assigned male. Self-reports from autistic youth also indicated significantly more reports of both “gender diversity” and “non-binary diversity” (40:00).

A follow-up study assessing gender diversity throughout adolescence found that gender incongruence was relatively stable across puberty in males (autistic and allistic). In contrast, autistic females endorsed greater incongruence around age 10, followed by a short plateau and then another increase. Allistic females reported the opposite pattern. Corbett summarizes these findings, highlighting the sex-based differences that indicate greater gender diversity in autistic females assigned at birth (AFAB). She also reiterates that gender identity formation is nuanced and likely influenced by pubertal progression, hormone patterns, and psychosocial factors (42:00). 

• Greater Gender Diversity among Autistic Children by Self Report and Parent Report (Corbett et al., 2023)
• Gender diversity in autistic and neurotypical youth over adolescence and puberty: A longitudinal study (Corbett et al., 2024)

Conclusions & future research

Corbett summarizes the presentation, highlighting that autistic females enter puberty earlier than autistic males and allistic groups. Autistic young people also have a higher rate and earlier onset of depression and a greater prevalence of gender diversity, especially in females. The speaker underscores the need for comprehensive measurements of psychological variables based on self-report, parent-report, and clinical-report. She emphasizes the need to identify risks and opportunities for resilience to elucidate and support the dynamic transition of puberty (43:00). 

Corbett and her team recently received funding to renew their longitudinal study of pubertal development. The renewed study aims to examine pubertal development through age 17 by observing physical development, hormones, menstruation, social communication, and internalizing symptoms. It also aims to observe the nervous system during these periods in a group of more than 300 participants (45:00). She notes an ongoing female development study before the Q&A (47:30). 

Originally published January 29th, 2025

Beth Malow, MD, shares current research updates on sleep and autism. She highlights the multifactorial nature of sleep patterns and how they affect daily functioning and core autism traits like emotion regulation. The speaker provides helpful sleep questionnaires and tips for minimizing sleep resistance and night waking. Malow outlines preliminary work from ongoing sleep education trials for parents and therapists and emphasizes the efficacy of behavior-based interventions. She provides contact information for potential study participants and notes the lack of research surrounding common medications before the Q&A. 

• Handouts are online HERE
• Articles on melatonin are HERE
• Interested in participating in research at locations described i Save n the webinar? Email the research team at sleeped@vumc.org

In this webinar:

1:00 – Introduction and case study
6:45 – Multifactorial sleep problems
12:13 – Emotion regulation and sleep
17:20 – Parent trainings for insomnia
23:00 – Sleep resistance and night waking
29:30 – Sleep education multicenter trials
36:30 – Medications
37:45 – Summary
39:00 – Q&A

Sleep in Autism

Dr. Malow notes the high prevalence of sleep problems in autistic children and how they impact both nighttime rest and daytime functioning (1:00). Various factors contribute to sleep issues in autism, which can generally be divided into biological, medical, and behavioral categories (7:45). 

Case Study

To illustrate the multifactorial nature of sleep issues, Malow presents a case study of Alex, a 10-year-old boy with autism, epilepsy, and anxiety. It takes him hours to fall asleep because he “cannot shut his brain down,” and he takes methylphenidate (Ritalin) in the morning and afternoon and lamotrigine (Lamictal) at night. Alex enjoys a soda and video games after dinner. He has restless sleep, snores loudly, and wakes multiple times at night. It’s also nearly impossible to wake Alex up in the morning for school. His teacher describes him as being sleepy as well as hyperactive in class. All of this leaves his parents exhausted and very overwhelmed (2:40). 

Due to his snoring, practitioners treated him for sleep apnea by removing his adenoids and tonsils. This helped his seizures and snoring, but the restlessness and night wakings continued (6:45). The speaker emphasizes a comprehensive approach to sleep issues that identifies co-occurring conditions, prioritizes behavioral strategies wherever possible, and uses medications sparingly. She reiterates the benefits of routines for people with autism (10:15)

Sleep, emotional regulation, behavior, and core symptoms

All daily functioning is improved when we sleep better; it’s like “hitting the reset button,” especially for emotion regulation. Malow outlines fMRI studies that show increased amygdala activation (fear and anxiety) and decreased connectivity between different parts of the brain after sleep deprivation (12:13). Similarly, in a study with more than 2,500 kids, those getting less than seven hours of sleep per night had higher severity scores for social communication and emotion regulation (15:15). The presenter asserts the significant relationship between sleep and behavior and suggests that if we improve sleep, daytime behaviors will also improve (16:35). 

Parent training for insomnia supports

In 2009, Malow published the Sleep Habits Questionnaire for Children With Autism Spectrum Disorders to help parents and caregivers manage sleep issues in autistic children (17:20). The questionnaire assesses components of successful sleep and daytime habits including exercise, abundant light, limited caffeine, limited naps, and selective bedroom use (using the bedroom only for sleeping) (19:18). The speaker describes the interaction of homeostatic and circadian rhythms throughout the day and emphasizes the importance of having the proper bedtime. For example, in Alex’s case study, 8 pm may be too early for his body to enter sleep mode, so she suggests pushing it back half an hour (21:00). 

Sleep resistance and night waking

For many autistic children, the “crying it out” method doesn’t work because the child doesn’t understand what is going on. If a child needs company to fall asleep, Malow suggests the rocking chair method, where you sit in the rocking chair with your back to the child, moving closer to the door each night until you have left the room (23:00). 

The first step in minimizing night waking is to help the child fall asleep on their own – “A child who can fall asleep on their own can go back to sleep on their own.’. It’s essential to respond quickly to distress and comfort and reassure but avoid over responding – be “brief and boring” (25:00). “Bedtime passes” can also be used as a ticket for a hug or class of water during the night. In this case, the child can use the pass or turn it in in the morning for a reward. This gives the child control over the situation and comfort, knowing they can have help if needed (26:30).

Malow notes that all of these learning materials are available for free at https://www.autismspeaks.org/tool-kit/strategies-improve-sleep-children-autism

Sleep education multicenter trials

Malow outlines a two-phased study in parents of autistic children with sleep onset delay at least 3 nights/week. In phase 1, parents were given sleep education, a pamphlet, or no intervention. In phase 2, parents were randomized into either group or individualized classes with a trained community therapist (29:30). The therapist training portion includes a manual, videos, and weekly Zoom meetings for practice and support. Following training, therapists identify families who could benefit from the program, and after consent is given, baseline assessments are completed. Therapists meet virtually to discuss challenging cases and billing issues (34:44). 

Preliminary results show that therapists achieved fidelity goals during training sessions and that parents achieved high scores in understanding, comfort, and implementation. Sleep patterns and core symptoms improved, and parents were delighted with the training overall (32:55). 

This training is now available in TN, NH, VT, GA, and CO. For more information, email the research team at sleeped@vumc.org

Medications

Malow expresses her reservations about medications due to the many side effects and unknown long-term implications. However, sometimes they are necessary. They can help manage parental overwhelm initially, but it’s good to wean off slowly as behavioral habits are adopted. Gabapentin, alpha-adrenergic agonists (clonidine), and mirtazapine are common medications that have been studied, but most others have not (36:30).

 The presenter summarizes her talk, reiterating the prevalence of sleep problems in autism and their impact on daily functioning. She emphasizes that once the root cause is identified, sleep problems are highly treatable, especially with behavioral strategies. Personalized, family-centered interventions are the most effective  (37:45). Malow touches on future research directions before the Q&A (39:00). 

Originally published March 18, 2025

Dr. Connor Kerns delivers research updates on the intersection of trauma and autism. She describes the relationship between childhood adversities, trauma, and mental health and highlights the need for trauma measurements that are specific to the autism community. The presenter considers the complexities of diagnosing PTSD in autism and details the development of the Childhood Adversity & Social Stress Questionnaire (CASS-Q). Kern’s ongoing work aims to describe the adversities of autistic youth and compare the CASS-Q PR symptom subscale to the DSM-5 PTSD descriptors. She discusses preliminary results revealing high validity and summarizes limitations and implications before the Q&A.

In this webinar:

0:30 – Disclosures and introductions
2:45 – Childhood adversity and trauma
8:00 – Experience vs diagnosis
13:00 – Complexities of diagnosis PTSD in autism
22:25 – Intersection of autism and trauma
24:00 – Childhood Adversity & Social Stress Questionnaire (CASSQ)
28:15 – Stress symptom subscale
35:45 – Preliminary results
40:35 – Adversity history profiles
47:00 – Validity and discussion
50:30 – Q&A

Childhood adversity and trauma

Kerns cites research showing that autistic individuals are more likely to experience maltreatment or adverse childhood experiences (ACE), including, but not limited to, physical, sexual, and emotional abuse, neglect, family or community violence, financial instability, loss of a loved one, and parental mental illness (2:45). The explains how DSM-5 trauma criteria don’t capture the full array of traumatic events. She provides a broader definition of stressful experiences, including any event, series of events, or set of circumstances experienced as harmful or life-threatening and that have lasting effects (4:36).

• Prevalence of adverse childhood experiences among individuals aged 45 to 85 years: a cross-sectional analysis of the Canadian Longitudinal Study on Aging (Joshi et al., 2021)
• Disability and maltreatment (Merrick et al., 2018)

Kerns emphasizes the broad array of adverse experiences that can result in trauma, which are not included in the criteria from the DSM-5. She outlines research showing a positive correlation between the number of adversities and risk for mental and physical health conditions (6:30). Interestingly, research does not consistently point to an increased prevalence of PTSD in people with autism. The speaker cites a study that found that 28% of 350 youth with autism reported a history of maltreatment, with only 2.6% having a PTSD diagnosis (8:25). Kerns summarizes research showing that autistic people are more likely to have mental health difficulties and that adverse experiences contribute to mental health issues and other trauma symptoms. However, to date, very little research has been conducted on this intersection. 

• Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study (Felitti et al., 1998)
• Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis (Alisic et al., 2014)
• Traumatic Events and Posttraumatic Stress in Childhood (Copeland et al., 2007)
• Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis (Lai et al., 2019)
• Examining Rates of Traumatic Events and Posttraumatic Stress Disorder Symptoms Among Autistic Adults (Andrzejewski et al., 2024)
• Autism Spectrum Disorder and Post-Traumatic Stress Disorder: An unexplored co-occurrence of conditions (Haruvi-Lamden et al., 2020)
• Experience of Trauma and PTSD Symptoms in Autistic Adults: Risk of PTSD Development Following DSM-5 and Non-DSM-5 Traumatic Life Events (Rumball et al., 2020)

Complexities of assessing PTSD in autism

To adequately address the assessment of PTSD in autism, we have to assess what “counts” as a traumatic event and ensure that we are measuring accurately (13:00). In a 2022 study, researchers conducted interviews with caretakers and people with autism about what they feel is traumatic. Findings highlight the need for additions to DSM criterion that include issues like social exclusion (bullying, isolation, stigma, restraint, loss of autonomy/opportunity) and traumatic incongruities (sensory trauma, reactions to change, social burnout) (14:30). Research also shows that DSM PTSD criteria lack cognitive, behavioral, and physical considerations associated with autism and that assessments rely too heavily on verbal expression (18:00). Behavioral overlap between traumatic symptoms and characteristics of autism, like emotional outbursts and social isolation, also make it difficult to diagnose. Kerns reiterates the need to approach the construct of traumatic stress and its assessment with care and intent (20:00). She warns that autism can overshadow PTSD, but there is also the potential to over-pathologize autism.

• Expert consensus regarding indicators of a traumatic reaction in autistic youth: a Delphi survey (Kerns et al., 2022)

Intersection of autism and trauma

Kerns breaks the experience of trauma down into three phases: 1) adversities, 2) experience appraisal and effect, and 3) traumatic reactions. She describes a 2015 study that proposed autism may influence the type and amount of adversities youth experience as well as how they appraise and respond to those experiences, including their susceptibility to and expression of PTSD. Results showed that being autistic changes the rate and type of adversity, affects how one experiences them, and dictates which experiences will have lasting psychological distress. The speaker highlights that autism changes the way PTSD is expressed, underscoring the need for a measure tailored to the autism community  (22:25). She lists publications that show how autism moderates each phase of trauma: 

 Criterion/adversity events: 

• Disparities in adversity among children with autism spectrum disorder: a population-based study (Berg et al., 2016)
• Traumatic Childhood Events and Autism Spectrum Disorder (Kerns et al., 2015). 
• Brief Report: Examining the Association of Autism and Adverse Childhood Experiences in the National Survey of Children’s Health: The Important Role of Income and Co-occurring Mental Health Conditions (Kerns et al., 2017)

Traumatic event experiences:

• Child maltreatment in autism spectrum disorder and intellectual disability: results from a population-based sample (McDonnell et al., 2019)
• A population-based examination of maltreatment referrals and substantiation for children with autism spectrum disorder (Fisher et al., 2019)
• A Systematic Review of Polyvictimization among Children with Attention Deficit Hyperactivity or Autism Spectrum Disorder (Hellström, 2019)
• Exploring potential sources of childhood trauma: A qualitative study with autistic adults and caregivers (Kerns et al., 2022)
• A Systematic Review of the Assessment and Treatment of Posttraumatic Stress Disorder in Individuals with Autism Spectrum Disorders (Rumball et al., 2019)

Traumatic stress outcomes:

• Identification of Post-Traumatic Stress Disorder in Individuals with Autism Spectrum Disorder and Intellectual Disability: A Systematic Review (Kidahl et al., 2019)
• Anxiety and Trauma-Related Disorders in Children on the Autism Spectrum (Ng-Cordell et al., 2022)
• A Systematic Review of the Assessment and Treatment of Posttraumatic Stress Disorder in Individuals with Autism Spectrum Disorders (Rumball et al., 2019)
• The Effects of Psychological Trauma on Children with Autism Spectrum Disorders: a Research Review (Mehtar & Mukkages, 2011)

Childhood Adversity & Social Stress Questionnaire (CASS-Q)

The presenter introduces the Childhood Adversity & Social Stress Questionnaire (CASS-Q), which measures adverse (stressful or traumatic) experiences and trauma symptoms in autistic youth via parent and self-report surveys. She details the mixed-method development approach for the CASS-Q and provides an overview of the CASS-Q PR (parent)  (24:00). Kern’s ongoing work aims to describe frequencies and characteristics of adversities in autistic youth and examine the extent to which CASS-Q PR symptom subscale reflects DSM PTSD descriptors (32:15). In her study, 729 parents took an initial query for trauma and those who reported ongoing trauma symptoms (n=298) completed the CASS-Q PR traumatic stress symptom subscale. Subscale items focus on changes in functioning following an event and include DSM domains and suicidality, regression of skills, increased self-injurious behavior, and increased reliance/reassurance seeking (28:15). All 729 parents also completed a 20-item adversity questionnaire measuring the frequency and impact of seven (7) autism-indicated and thirteen (13) traditionally-assessed adversities (31:00).

Preliminary results

Results show the most common adversities include bullying, death of a loved one, and many of the autism-indicated adversities like sensory stressors, being talked down to and made to feel like they don’t belong, being distressed by a continual change in daily life, and meltdowns and anxiety/hopelessness following social interactions (35:45). Adversities with the largest relative impact were not the most prevalent, underscoring the complexity of trauma in autism (38:00). Kerns notes that both traditional and autism-related adversities were positively correlated with behavior problems and outlines three profiles of adversity history: Low-level (~45%), Moderate (~47%), and Complex (~8%) (40:35) Parents who completed the symptom subscale reported the same types of adversities at a higher rate of occurrence (6 vs 3).

Kerns asserts that trauma in autism seems to fit the DSM 5 criteria, with some additional symptoms. In autism, she continues, we see many of the same criteria clustered in slightly different ways and with elevated reactivity. The speaker provides evidence for convergent and discriminant validity (47:00). 

Conclusion

Kerns asserts that these findings provide initial support for the validity of the CASS-Q measure. Some of the autism-nominated symptoms were the most likely to be endorsed and have the most impact, supporting the measurement’s capacity for tailored approaches. She underscores that bullying was the most common detrimental adversity affecting this group (48:00). Study limitations and future directions are outlined (49:00) before the Q&A (50:30).

Laurie A. Vismara, Ph.D., BCBA-D, R.B.A. (Ont.) details caregiver strategies for building infant social interaction. She introduces the Infant Start Manual, an extension of the Early Start Denver Model. The speaker outlines contemporary research on early-in-life autism support strategies and underscores the need for collaborative, family-centered support tactics for parents and caregivers. Vismara details six (6) infant learning characteristics, how they present, and what caregivers can do to foster these social communication skills during infancy.

Handouts are online HERE (.zip)

In this webinar: 

1:30 – Introduction
6:10 – Infant Start Manual
11:40 – Research findings
17:55 – Infant learning characteristics
20:25 – Attentional flexibility
27:10 – Object use
33:00 – Prelinguistic development
36:55 – Combined, pragmatic communication
42:25 – Speech
47:30 – Social attention and engagement
54:20 – Tips for baby learning
58:00 – Resources

Introduction

Vismara introduces the Infant Start Manual, an extension of the Early Start Denver Model that focuses on infant social interactions (1:30). She highlights the need for innovative, flexible approaches to support strategies that match the needs, goals, and priorities of parents and caregivers. The speaker outlines specific language used in the talk and notes presentation learning objectives (4:20). The vision of the Infant Start Manual is to facilitate families in their caregiving journey with interactive early-in-life topics aimed at infant social communication vulnerabilities (6:10). The manual provides supports through family-centered coaching and does not substitute for a diagnosis, fix, or cure. The Infant Start Model can be accessed freely at esdmonline.com/about in the Encouraging Infant Communication and Play Manual (Rogers & Vismara). Free access is for personal use only and should not be posted online. 

What the research says

Research on the efficacy of early-in-life autism supports is still emerging. Studies show mixed results across high (10-15 hrs/week) and low-intensity (0.5 – 3 hrs/week) supports delivered by parents and clinicians. All studies aim to teach caregiving skills for social and joint engagement through play and other activities. Results show improvements in caregiving domains, infant proximal behaviors, and interactive styles for caregivers. In contrast, infant autism domains show minimal changes (13:00). One pilot study of the Infant Start has been published. Overall, caregivers shared positive perspectives on content and delivery techniques, and infant vulnerability around social characteristics diminished over time compared to families that did not participate (11:40). 

Vismara posits that the cumulative benefits of small initial changes in interaction become more apparent over time, meaning the full impact of these interventions cannot yet be measured. However, these studies provide an opportunity to understand the acceptability of these support mechanisms from diverse caregiver perspectives, which will allow for the creation of individualized, culturally aligned support systems (15:00). 

Autism Treatment in the First Year of Life: A Pilot Study of Infant Start, a Parent-Implemented Intervention for Symptomatic Infants (Rogers et al., 2014)

Autistic and autism community perspectives on infant and family support in the first two years of life: Findings from a community consultation survey (Bent et al., 2024)

A Developmental Social Neuroscience Perspective on Infant Autism Interventions (Dawson et al., 2023)

Feasibility and acceptability of a caregiver-mediated early support program, delivered online, for infants at elevated familial likelihood for autism: A feasibility randomized controlled trial (Meera et al., 2024)

The Earlier, the Better? An In-Depth Interview Study on the Ethics of Early Detection with Parents of Children at an Elevated Likelihood for Autism (Jan-Vanaken et al., 2023)

Preemptive interventions for infants and toddlers with a high likelihood for autism: A systematic review and meta-analysis (Hampton et al., 2021)

Efficacy of very early interventions on neurodevelopmental outcomes for infants and toddlers at increased likelihood of or diagnosed with autism: A systematic review and meta-analysis (McGlade et al., 2023)

Parent-Mediated Interventions for Infants under 24 Months at Risk for Autism Spectrum Disorder: A Systematic Review of Randomized Controlled Trials (Law et al., 2022)

Infant learning characteristics

The presenter emphasizes that babies come ready to explore, learn, and respond just as caregivers have intuitive skills to nurture, love, and protect. Both shape and influence the others’ actions, resulting in a communication “dance” of synchronized rhythmic steps and movements. No matter who is leading, both sides must be aware of the other and sensitive to each other’s movements and what they mean (17:55). When there is a “misstep,” the dance may stop, and working to regain that attention and engagement is where the Early Start Manual comes in. Vismara outlines six (6) infant learning characteristics, how they present in infants, and how to strengthen caregiver-baby social interactions. 

Attentional flexibility

Attentional flexibility refers to babies’ ability to pay attention to people, objects, and experiences that they find interesting, even when there are distractions. Babies do this when they pick up and explore objects, move from one toy to the next, watch people doing things, or shift focus when something new is introduced (20:25). Attentional flexibility helps babies gather information, build on their learning experiences, and filter out distractions to stay on task.

The speaker provides play recommendations for supporting attentional flexibility (23:15). She suggests offering toys or materials that encourage exploration and interactive play. Holding pieces to your face and naming or commenting about them before you give them to the baby can help them orient your voice to your face. She suggests helping babies complete goals, adding playful sounds, hand gestures, or body movements to help call attention back to you, and giving babies choices for which objects they want to play with (25:15). 

Object use

Babies are naturally curious about objects, and playing with them allows them to explore, try out new behaviors, express ideas, and receive feedback. Vismara explains that babies develop play through patterns of repeated actions, called schemas, which are constantly changing and overlapping (27:10). During play, she suggests taking turns with the same object(s) to create a back-and-forth dance (baby does, you do – repeat) which encourages skill adoption and lets babies know that you are part of the activity/conversation. It is also helpful to be face-to-face during play, to set up toys and spaces in visually clear ways that are not over-stimulating, and to follow babies’ play before leading with your own (29:10). The speaker provides a resource table with play schema definitions and ideas (31:20).

Prelinguistic development

Vismara explains that baby communication begins with crying, which lets caregivers know the baby is hungry, uncomfortable, or upset. This quickly develops into “talking bodies” communication, where babies use their facial expressions, bodies, actions, and gestures to communicate in many different ways (33:00). We chat back to babies when we name and describe things, hold or point to things, copy sounds and expressions, and add silly sounds, hand gestures, or movements to play routines.

To support prelinguistic development, the speaker again suggests playing face-to-face with the baby and talking about everything. Describe what you are doing as you go through routines and make your own “talking body” stand out to babies with playful sounds and exaggerated facial expressions and movements (34:15). It is important to give babies time to respond and for you to put words to their communication methods (35:35). The presenter shows a resource table with activity ideas for strengthening talking bodies.

 Combined, pragmatic communication

Bundling communication behaviors is a critical step in the infant communication journey. Combining face, body, and voice makes communication more efficient and complex, allowing for information retention, skill expansion, and relationship building. Caregivers naturally encourage bundling when we model back-and-forth conversations with babies. For example, when a baby smiles and makes a sound, a caregiver can comment on what excited them (36:55). Vismara suggests giving babies time to think of what they want to say and going with the communication methods that the baby is naturally using. The speaker suggests starting with any two bundles (voice and body, face and voice, etc.) and being flexible, remembering you can always try again later. She warns against holding out for specific communication bundles and underscores working with the babies’ strengths (39:30). The speaker provides another resource table on encouraging bundling through daily routines. 

Speech

Baby babbling is a universal aspect of early speech development that unfolds across several stages and serves as a stepping stone to first words. Babbling is a continuous string of sounds that express babies’ emotions and desire to talk. They often mimic words and language qualities such as tone, pitch, and accent (42:25). To support speech development, Vismara suggests talking to babies and then pausing for them to listen and respond. It’s essential to interpret the intent of what babies say and to keep the conversation going as long as they wish to babble. Helpful tips include mouthing games, imitating baby, and using props to encourage sounds (44:45). The presenter shares a resource table with activities that encourage baby sounds and potential props that you can use to promote conversations. 

Social attention and engagement

Human beings are born with the need and desire to connect with the people around us. We can see this social-emotional connection through babies’ visual attention to people, desire for attention, and drive to start interactions (47:30). Early signs of the social-emotional journey include turning toward familiar faces, turning away when overwhelmed, following faces or objects, and responding to people in their environment. Caregivers can foster this bonding by pausing an activity to cue a response from the baby. For example, hold out a toy, show the play action, and wait for baby to say, “I like this, do it again” (reach, look, smile, move body, make sound) (50:00). 

The speaker reminds viewers to respect babies’ preferences and that it may take some detective work to find their comfort zone inside activities. It helps to repeat your actions when babies are watching and read their cues for what makes them smile. Tips for finding their comfort zone include changing movement pace, adjusting voice and animation, and moving closer or backing up until they feel comfortable. Once you find their smile, create a predictable routine for setting up the fun and pausing for a reaction from the baby before continuing the action (51:15). 

Tips for baby learning

The presenter reminds viewers to build on babies’ interests and experiences with other ideas only after you can follow their play patterns. Building on their preferences can include showing different ways to play with their favorite toys, increasing interaction, and introducing new toys and songs they may like. She notes that not all ideas are winners on the first try but that bridging their interests with new ideas will create understanding and participation through which their skills can expand. Vismara underscores the importance of active play and urges caregivers to expand their involvement in baby interactions (54:20). 

The speaker reiterates that the Infant Start Model is about supporting families with programs and resources that build off of dynamic, authentic early learning experiences. She asserts the need for researchers, families, and clinicians to think deeply about what early autism care looks like and to listen intently to what families are telling us to create collaborative, culturally-informed strategies (55:41). Vismara provides links to manuals, videos, and other resources as well as an Infant Start workshop for professionals (58:55).

Originally posted on October 8, 2024

Patricia Wright, PhD, MPH, and Katie Curran, MAAP, introduce Proof Positive – The Autism Well-being Alliance. The speakers describe positive psychology, its impact on well-being, and why it matters for autistic people and their communities. Curran details four skills to help with thinking positively and provides suggestions for practicing and applying them to daily life. The speakers emphasize the lack of focus on positive emotions in autism care and how this plays into isolation and mental health issues. They affirm that individuals “can control [their] own well-being” by employing positive psychology and training their minds to build on the things that go well each day. Wright and Curran outline Proof Positive’s free learning and teaching resources before the Q&A. 

Handouts are online HERE

In this webinar:

1:00 – Proof Positive and the need for positive psychology
5:00 – What is positive psychology
14:00 – PERMA + Snapshot for well-being
18:30 – What Went Well?
27:45 – Jolts of Joy
30:43 – Broaden and Build vs. Fight or Flight
39:44 – Showcase the Good
48:20 – Q &A

Background

Patricia Wright, PhD, MPH, Executive Director at Proof Positive, introduces The Autism Well-Being Alliance, a nonprofit dedicated to improving the well-being of autistic people and their families, providers, and communities. By intersecting positive psychology with autism services, Proof Positive spreads the science and skills of happiness (1:00). She notes high rates of underemployment and mental health issues in autistic adults and underscores how difficult it is to find and retain social service providers. Over the last decade, the demand for these roles has increased 41%, and the U.S. healthcare system is experiencing major staff shortages. Although well-being is a relatively new term within autism care vocabulary, Wright underscores its importance and potential for quality of life management (3:00). 

Why Positive Psychology

Katie Curran, MAPP, Chief Well-being Officer at Proof Positive, says that those who practice positive psychology experience increased well-being and life satisfaction, better sleep, stronger relationships, less depression, and more success in school and work (5:00). Positive psychology considers the components of a life full of purpose and what makes life worth living. In other words, Curran continues, it asks, “Who are you at your best, and how do we get more of it?” Over thirty years of research, six elements critical to human thriving have arisen (8:10): 

1. Positive emotions – A sense of inspiration; a wide variety of positive emotions felt most days
2. Engagement – A good sense of what interests you; ability to spend time in flow and follow interests
3. Relationships – Other people matter, and relationships are critical to who we are and how we navigate the good and bad times
4. Mattering – A sense that your life has meaning and purpose; a feeling of connection to something larger than yourself. 
5. Accomplishment – Having a healthy sense of where you are going in the future; you have goals you are pursuing, and you believe you can achieve them
6. Physical health – Sleep, nutrition, and movement are key to maintaining happiness; when we move, our muscles pump food to the brain.

These six aspects of human thriving, referred to as PERMA+, are critical to understanding and empowering people to impact their well-being. 

To explore the research behind these elements, visit Proof Positive’s Science Page. 

Skills for well-being support

Curran asserts that “You can control your well-being” and outlines four practical tools that enhance well-being skills. 

#1 – PERMA+ Snapshot

The PERMA+ Snapshot asks you to stop and reflect on your well-being around once a week (14:00). Proof Positive offers a well-being survey that helps measure well-being and provides suggestions about skills to practice. The speaker emphasizes that no matter where you are on the scales, you are improving your well-being simply by taking time to take this survey because you are telling yourself that you are important and worth spending time and energy on (17:30). She suggests referring back to the PERMA+ survey for snapshots and tracking personal well-being.

#2 – What Went Well?

The goal of this exercise is to train your brain to mindfully notice, remember, and track the good things that happen each day (18:30). The presenter notes that left on their own, our brains default to spotting danger and things that have gone wrong as a means of self-preservation and protection. However, we need to shift our focus and ensure that every day, we intentionally focus on things that have gone well. 

To practice What Went Well, Curran suggests using a journal or gratitude app on your device and setting a time to write down at least three things that went well each day. It’s also helpful to consider what made each good thing special and to share your list with a family member or friend (22:55). The presenter notes that people who do this exercise before bed fall asleep faster and sleep longer but also that anxiety tends to be worse first thing in the morning. Therefore, she continues, it can be good to capture What Went Well before bed and then read the list in the morning (23:40). The speaker provides a few more tips and free teaching resources from the Proof Positive Website. 

#3 – Jolts of Joy

The Jolts of Joy exercise teaches us to intentionally experience higher levels of well-being and bursts of positive emotions across the day (27:45). Curran describes the negativity bias, noting that across 130 languages, six of the seven shared words to describe emotions are negative – again due to survival because fear keeps us alive (30:45). Barbara Frederickson was the first researcher to ask what good our positive emotions are and why we feel hope. She discovered that where negative emotions trigger a fight or flight response, positive emotions trigger the broaden and build response. “Broaden and Build’ refers to how our minds open up for creativity and problem-solving when we feel good. The presenter explains it as the opposite of tunnel vision (related to stress), where our vision expands and we see more of the world around us. Because growth is a critical part of the human experience, positive emotions are just as essential to survival as negative ones (31:50). 

Practicing jolts of joy can be a solitary or group activity. Carrun suggests listing 10 ways you experience positive emotions, be it cat videos, family photo albums, music, etc. It is good to include a variety of positive emotions in the list. Place your list where it’s easy to see, and then be sure to engage in a minimum of three (3) Jolts of Joy every day (35:45). The presenter underscores the importance of positive emotions, noting that many emotion regulation programs do not include these in the curriculum (39:00). 

#4 – Showcase the Good

Responding to other people’s good news in a way that enhances their joy and enables them to relive the positive experience is a critical differentiator between thriving relationships (39:45). Shelley Gable’s research shows that there are four ways people tend to respond to good news and that three of the styles are detrimental to relationships where only one boosts them. The four response styles are outlined below using the example of responding to a child who got a 90% on their math test (39:45):

1. Passive – Quiet, understated support.
   1. “Hey, look! I got a 90% on my math test!”
   2. “Great Job.”
2. Passive Destructive – You ignore the information altogether or “change the channel.”
   1. “Hey, look! I got a 90% on my math test!”
   2. “Do you have your cleats? It’s almost time for soccer.” or “Oh, where is your sister? She got a 100% on her history test.”
3. Active Destructive – Someone brings good news, and you squish it – a literal joy killer.
   1. “Hey, look! I got a 90% on my math test!”
   2. “A 90%? I thought we studied so hard! What did you get wrong?”
4. Active Constructive – Authentically engaged and asking questions
   1. “Hey, look! I got a 90% on my math test!”
   2. “Wow! Great job! We studied so hard for that! What did your teacher say? How do you feel?”

Curran highlights that when we Showcase the Good, both parties experience increases in trust, belonging, and intimacy. How we celebrate the good together is at the center of positive relationships. To practice Showcasing the Good, the speaker suggests sharing good news, leaning in when someone else shares their good news, asking questions to help that person relive their experience, and utilizing your own strengths to show interest (what are you curious about? Let that guide your questions and observations) (46:00). 

Proof Positive provides free learning and teaching resources for parents, school teachers, and professionals to help intersect positive psychology with autism care strategies. Each skill has an associated resource bundle that you can use to boost positive thinking and well-being. Curran and Wright thank the attendees before opening the Q&A (48:20). 

Originally posted September 24, 2024

Xinru Page, Ph. D., discusses the benefits and challenges of using social media for autistic young adults. She cites recent survey studies involving autistic people, support networks, and field sites and highlights how social media are not designed with neurodiversity in mind. The speaker considers the importance of supportive communities and repetition in online safety mediation and problem-solving for adults with autism. Page gives guidelines for working with young adults on social media and outlines a social media literacy course currently in its fourth iteration. She provides acknowledgments and study sign-up details before the Q&A.

Ph.D. candidate Kristen Chapman moderates the presentation and summarizes attendee responses after each section.

Handouts are online HERE (.pdf)

In this webinar:

2:35 – Background
4:45 – Research & presentation outline
7:38 – Social media outcomes
12:07 – Number 1: Literal interpretation of the interface
16:00 – Number 2: Suggestions as instructions
19:55 – Number 3: Always engaging with content
25:15 – Number 4: Clear expectations
30:55 – Support networks
36:55 – Mediation timing and outcomes
47:50 – Recommendations for working with young adults on social media
53:00– Social media literacy course
57:40 – Q&A

Introduction

Social media can connect people to communities, potential employees, and other resources crucial for successfully navigating the world. However, people with autism experience more online harassment and harm than the general population (2:35). Page acknowledges preferences for person-first and identity-first language within the autism community, noting that her studies assume the language her participants use (3:50). The presenter outlines data collection methods for a recent survey study including interviews, observations, and feedback from autistic people (with and without intellectual disability), support networks (family, service providers), and field sites (day programs, community members) (4:45). 

• Perceiving Affordances Differently: The Unintended Consequences When Young Autistic Adults Engage with Social Media (Page et al., 2022)
• Towards Digital Independence: Identifying the Tensions between Autistic Young Adults and Their Support Network When Mediating Social Media (Cullen et al., 2024)

Outcomes of social media use

For people with autism, the most frequently cited positive outcomes of social media were social connection, especially with people who moved away, and interest-based immersion, or the ability to focus on a special interest with others who are passionate about the same thing (7:38). Negative outcomes include risk of physical harm due to misinterpreting intent, social/relational damage due to not understanding social etiquette, and psychological harm like increased anxiety from intense rumination about online communications (10:17). 

Autism traits that aren’t supported by social media

Many of these outcomes, Page explains, could be avoided if social media were designed with neurodiversity in mind. She describes common autism characteristics not supported by social media rules or interfaces: 

Number 1: Literal interpretation of the interface

Interpreting things in a literal sense is a common characteristic of people with autism. The speaker explains how taking things at face value can lead to dangerous interactions with deleterious parties online (12:07). Many study participants report that it can be difficult to understand what labels like “friend” on social media mean. For example, assuming that a “Facebook friend” is the same as a “real-life friend” can create tensions in relationships (14:07).  

Number 2: Suggestions as instructions

Many autistic people follow online prompts as if they were directions. For example, the Facebook status section asks, “What’s on your mind?” or the comments section asks, “Respond” or “Write an Answer.” When read as instructions, these can lead to oversharing about work or personal life online, affecting employment and relationships (16:00). Likewise, in the profile section, many people with autism share too much sensitive information, assuming that if it asks for an email or current residence, that you have to provide it (18:50). 

Number 3: Always engaging

Page explains that numerous study participants cited a need to respond to everything that appears on the interface, which can lead to anxiety and stress (19:55). Similarly, many autistic adults report feeling stressed by other people’s conflicts and often comment on the amount of drama online. The speaker highlights that the ability to “just ignore” it does not apply to many autistic people’s lived experiences (21:45). Respondents also describe uncertainty and anxiety related to the ambiguity of check marks and a lack or misinterpretation of feedback from other users online (22:45). 

Number 4: Clear expectations

In many cases, people with autism expect friends to be completely accessible online and feel like they’re not liked when their friends post photos of them hanging out with other people. Page reminds viewers that social media allows us to see things we wouldn’t otherwise, which makes it challenging to manage the feeling that you’re friends, so you should be doing everything together (25:15). The speaker notes single rule-based decision-making and how this can be dangerous. For example, a female only accepts friend requests from other females and not males (thinking this will keep her safe), although people frequently lie about their identities online. Many autistic people also assume a single audience and may post things publicly that could lead to unintended consequences (27:30).

Chapman summarizes attendees’ responses to the first part of the presentation (29:17). 

How adults with autism are supported by their networks

Page explains that most study participants were open about online issues with caseworkers and care staff by default. They even talk openly about instances where they may have done something unusual and ask their parents’/caretakers’ opinions (30:55). Support networks are critical to the well-being of autistic adults, and siblings can be a huge source of support because the power dynamic is balanced. The speaker describes how communities can detect problems and work together to support autistic young adults. For example, someone says, “Hey, you should check on [name], they’ve been making some odd posts online.” (32:35). 

Having people who understand privacy rules and online safety involved in care strategies for autistic youth and adults is critical (34:15). Many study participants cited rules about what to share and who to friend that are externally defined (e.g., I won’t do this because my family told me so, or this person will get upset). These results underscore the importance of defining rules and providing guidelines for online interactions. Page iterates the need for ongoing conversations around online safety to support learning via repetition (35:20). 

Timing of mediation

Immediate mediation for online safety is more effective than delayed support. For example, care staff report that, even though clients share what happens to them online, it’s after the fact, so there is little they can do to support them at that point (36:55). However, clients who can reach out to an adult sibling or parent to ask about what’s happening can troubleshoot in real-time and understand more about the situation. Page reiterates the importance of having someone to reach out to in real-time (online or in person) and having parents or others checking social media regularly to scan for conflicts and safety (38:45). 

Benefits of mediation

The benefits of online safety mediation included socio-emotional co-regulation (both parents and young adults learned more about each other), digital literacy (real-time troubleshooting), collective effort for safety (staff and family work together), and general alignment and understanding of specific problem points for the individual (39:20). 

Tensions of mediation

A significant tension of social media mediation is the general overwhelm that support networks feel across the U.S. Social media is often low on the list due to other physical needs that take priority (42:15). Page highlights the balance between safety and independence and suggests avoiding taking kids off of social media altogether. She notes that young adults who felt someone would remove their social media were far less likely to be open about their experiences. The speaker underscores that social media is a lifeline to social interests and community and that many individuals shut down due to the threat of losing this connection (43:40).

Chapman summarizes attendee responses to this point in the presentation (45:00). 

Recommendations for working with young adults on social media

The presenter outlines six recommendations for working with young autistic adults on social media and online safety:

Number 1: Establish a common vocabulary

• Understand what it means to be a “friend” and take time to define anything on the interface labeled as “friend” or any other social relationship. 
• Understand what the message indicators mean (sent, received, read) (47:50).

Number 2: Understand audience and purpose

• Purposefully consider online audiences and know how to set privacy settings accordingly (e.g., public vs. friends vs. private posts). 
• Understand that posts can be interpreted differently than intended.

Number 3: Cooling-off period before reacting

• Do not post, comment, or message immediately when you are upset or feeling a strong emotion. 
• Take a pause period and, where possible, consult with an ally for advice on the situation (50:30).

Number 4: Do not take content at face value

• Understand that someone sending you a friend request isn’t necessarily telling you the truth.
• Check for spelling errors, missing profile pictures, and other signs of fake accounts. 
• Where possible, consult with an ally to understand whether to accept friend requests. 

Number 5: Do not follow the interface prompts without a good reason 

• Ask why you would want to share or do something instead of following online prompts as directions. 
• Even though they’re worded like instructions, they are meant to show what you could do (52:25). 

Number 6: Remember that what people say and do is not always clear

• Remember that just because the technology makes it look like someone has read your message does not mean they have or are available to answer. 
• When you read something that upsets you, talk to an ally to see if it might mean something different than you think. 

Page reiterates that these recommendations require ongoing conversations to reinforce these ideas and learn about their experiences, individual pain points, and how the community can support them. 

Social media literacy course (4th iteration)

The speaker outlines aspects of a social media literacy course currently in its fourth iteration, including social media norms, privacy settings, how to identify fake profiles, types of social media groups and associated interactions, misinformation, and social media vs. reality. The course provides educational slides on each topic and practice modules for navigating each situation (53:00). 

Initial results from the fourth iteration show that repeated practice questions and gamification help autistic adults with and without intellectual disabilities learn (56:16). Future plans for this research include covering more social media platforms and enrolling more field sites. Page gives acknowledgments and provides sign-up links for interested participants before the Q&A (57:40). 

Dr. Elizabeth Laugeson discusses the importance of friendships during development and the prevalence of peer rejection and neglect across populations. She introduces The Program for the Education and Enrichment of Relational Skills (PEERS®), a parent-assisted social skills training program initially developed in 2004 for children and young adults experiencing difficulty with social interactions. The speaker walks through two skill snapshots, showing how combining role-play videos, collaborative questions, and peer practice helps participants learn and get comfortable with new skills. Laugeson outlines research underscoring the efficacy of PEERS® programs across groups and explains how online PEERS® delivery yields the same results as in-person training. She provides a list of free resources and thanks before the Q&A. 

Handouts are online in PDF format HERE

In this Webinar: 

1:30 – Speaker introduction & disclosures
3:05 – Peer rejection and neglect
11:15 – PEERS® programs
14:14 – Targeted skills
18:00 – Skill snapshot: Peer entry/engagement
29:00 – Skill snapshot: Handling teasing
33:40 – Research outcomes
39:20 – Telehealth delivery
45:20 – Resources
55:30 – Q&A

Friendships and social skills

Laugeson notes common social differences experienced by autistic children and teens, including difficulty with social communication and quality friendships (3:05). She explains that meaningful friendships predict later life adjustment, buffer the impact of stressful life events, and are positively correlated with self-esteem and independence (9:45). However, research suggests that around 30% of all youth experience social rejection (seeking out peers and being pushed away) or neglect (avoiding peers though they want to have friends), underscoring the importance of teaching social skills to autistic and allistic (non-autistic) youth (6:28). 

• The Science of Making Friends 

PEERS® programs background

The Program for the Education and Enrichment of Relational Skills (PEERS®) is a parent-assisted social skills program for teens and young adults. Individuals who benefit from the PEERS® programs want to learn social skills often applicable to instances of peer rejection or peer neglect (4:20). The  PEERS® programs are one of the only evidence-based (12:45), cross-culturally validated (14:14) training programs available in more than twelve languages across 150 countries. Targeted skills within PEERS® programs include finding and choosing good friends/partners, conversational skills, humor, online communication, conflict management, and rejection skills, to name a few (14:40). Laugeson highlights that learning social skills must be voluntary and neuro-affirming. These programs do not attempt to change a person but to enhance their social interactions to help others know how great they are (16:15). 

Skill snapshots

Peer entry

Laugeson gives a snapshot of social skills training for peer entry or engaging another person in conversation. The PEERS® programs use role-play videos as examples of socially risky and not risky scenarios (18:00). She shares a role-play video where Jordan is watching a music video on her phone in the library. Elaina walks in, introduces herself, and then begins talking to Jordan, who is visibly frustrated because she is trying to watch a video. After the role-playing video, participants discuss what Elaina did that was a little risky, how that made Jordan feel, and whether or not they think Jordan will want to speak with Elaina again (20:00). 

According to research, the most effective way to start conversations is to casually look over (not too direct), find a common interest, mention the common interest, exchange information, assess interest using behavioral indicators, and finally, introduce yourself if necessary (23:15). After youth discuss these steps, they watch a second role-play video demonstrating less risky social interactions. In the second role-play, Elaina comments on the music video Jordan is watching, and they trade information about the artist’s songs and upcoming concerts before exchanging names (26:00). Following the second role-play, PEERS® participants can assess which steps Elaina followed and what that experience was like compared to the first (28:00). After the videos and discussions, participants practice these social skills with one another to reinforce learning and comfort. 

Handling teasing

Laugeson explains that advice generally offered about handling teasing is not ecologically valid, as ignoring aggressors or walking away makes people look weak, and telling an adult means you tried to get someone in trouble, which is most likely worse (29:00). Instead, PEERS® modules focus on short teasing comebacks that make the teaser feel like what they are doing doesn’t bother you. Comeback phrases may include things like “Whatever,” “Who cares?” or “Is that supposed to be funny?” and “Tell me when you get to the funny part.” Laugeson notes that they don’t provide a “risky” role-play video for teasing as this could be traumatizing for some people (30:55). Video of successful teasing navigation appears at minute 53:40. 

Research outcomes

PEERS® programs show positive results across multiple groups, including autism, ADHD, depression, anxiety, intellectual disability, cerebral palsy, brain injury, and psychosis (33:40). A recent meta-analysis specific to autism found large effect sizes in pre- to post-test social skills knowledge and social responsiveness scales across all studies (34:50). Similarly, a recent randomized controlled trial found an 11 point standard score improvement in social skills and responsiveness following PEERS® program completion. Parent and teen reports also show increased social engagement following the program (37:00). 

• Improving Social Knowledge and Skills among Adolescents with Autism: Systematic Review and Meta-Analysis of UCLA PEERS® for Adolescents (Zheng et al., 2021)
• Evidence-Based Social Skills Training for Adolescents with Autism Spectrum Disorders: The UCLA PEERS Program (Laugeson et al., 2012)

Telehealth delivery

PEERS® programs were also adapted for online delivery in response to COVID-19. Online programs are similarly structured, with an additional group get-together each week (39:20). Changes in social responsiveness, social skills knowledge, and overall social skills significantly increased following online programs and problem behaviors were reduced considerably (41:25). Researchers found no significant differences in social skills outcomes between online and in-person training (41:25). Laugeson asserts that, although online learning isn’t everyone’s first choice, telehealth delivery significantly increases accessibility to learning these critical social skills (44:40).

• Efficacy of PEERS® for Adolescents via Telehealth Delivery (Estabillo et al., 2022)

Conclusion

The presenter outlines ongoing randomized controlled trials for PEERS® for Careers and PEERS® for Dating (45:20). She discusses clinical services available at the UCLA PEERS® clinic, including weekly meetings for caregivers and young adults, PEERS® boot camps, and educational groups available worldwide via Zoom (48:00). She provides a list of free resources including role-play videos on the UCLA PEERS® YouTube channel, autistic-led T.V. shows, and the free PEERS® app that teaches social skills through gamified steps and achievements (49:55). Laugeson provides thanks and acknowledgments before the Q&A (55:30).