The Science of Making Friends for Autistic Youth: Lessons from the UCLA PEERS Program

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).