Thriving through Friendships:

Improving Social Outcomes for

Young Adults with ASD

Dr. Elizabeth Laugeson

Associate Clinical Professor, UCLA
Founder and Director, UCLA PEERS Clinic
Program Director, Autism Center of Excellence, Core D
Training Director, UCLA Tarjan Center (UCEDD)
 Overview of Presentation
• Social deficits among adults with ASD
• Consequences of social deficits
• Treatment priorities related to social
outcomes for adults with ASD
• Evidence-based treatments for adults
with ASD
• Overview of PEERS® method for
teaching social skills
• Clinical examples:
– Starting conversations
– Letting someone know you like
them
• Research overview
• Resources
 Social Deficits Common Among
Adults with ASD
§ Poor social communication
§ Problems with topic initiation
§ Use repetitive themes
§ One-sided conversations
§ Poor social awareness
§ Difficulty understanding social
cues
§ Poor social motivation
§ Less involvement in social
activities
(Volkmar & Klin, 1998; Bauminger & Kasari, 2000; Orsmond, Krauss, &
§ More social isolation Seltzer, 2004; Koning & Magill-Evans, 2001; LeCouteur et al.,
1989; Marks, Schrader, Longaker, & Levine, 2000; Ghaziuddin &
§ Poor social cognition Gerstein, 1996; Twatchman-Cullen, 1998; Hemphill & Siperstein,
1990; Church, Alisanki, Amanullah, 2000; Constantino, 2005)
§ Difficulty understanding the
perspectives of others
 Poor Social Outcomes Among
Adults with ASD
§ Higher underemployment and
unemployment
§ Less post-secondary education
§ More dependence on caregivers
§ Less likely to live independently
§ Less likely to have a driver’s license
§ Greater social isolation
§ Fewer close meaningful friendships
§ Poor friendship quality
§ Fewer romantic relationships (Volkmar & Klin, 1998; Bauminger & Kasari, 2000; Orsmond,
Krauss, & Seltzer, 2004; Koning & Magill-Evans, 2001;
§ Higher incidence of comorbidities LeCouteur et al., 1989; Marks, Schrader, Longaker, &
Levine, 2000; Ghaziuddin & Gerstein, 1996;
§ Anxiety, depression Twatchman-Cullen, 1998; Hemphill & Siperstein,
1990; Church, Alisanki, Amanullah, 2000;
Constantino, 2005)
 Friendships Among Young Adults
with ASD
• Very few close reciprocal
friendships
• Poor friendship quality
• Increased social isolation upon
entering adulthood
• Less involvement in social
activities
• More online friends than real life
friends

• Peer rejection (Howlin et al., 2013; Orsmond et al., 2013;

Howlin et al., 2014; Tobin et al., 2013;
– ADHD, impulse control issues, Reichow et al., 2010)
dysregulation
• Social neglect
– Anxiety, depression
 Romantic Relationships
for Young Adults with ASD

• Fewer romantic relationships

• Less likely to marry
• Greater incidence of stalking
behavior
• Less sexual knowledge and
awareness
• Greater risk for sexual
exploitation and victimization
• Higher risk for financial (Stokes et al., 2005; Stokes et al., 2007; Howlin et al.,

exploitation 2013; Orsmond et al., 2013; Howlin et al., 2014; Tobin et

al., 2013; Reichow et al., 2010)
 Lack of Services and Research for
Adults with ASD
• Lack of evidence-based treatments to
improve social skills in adults with
ASD
• Most interventions are focused on
young children
• Research funding has historically
ignored adults with ASD
• Among the limited evidence-based
interventions for adults, most have
focused on young adults (18-24)
• Social demands change and increase
over the lifespan
• Interventions are failing to meet the
changing and increasing social (Eaves et al., 2008; Taylor et al., 2011;
demands across development Howlin et al., 2004; Hendricks et al., 2009)

• Access to services greatly diminishes

after the age of 21
 Background about PEERS®
• International program
– Developed at UCLA in 2004
– Adolescent program has been
translated into over a dozen languages
– Used in over 35 countries
• Evidence-Based Social Skills
Programs:
– PEERS® for Preschoolers
– PEERS® for Adolescents
– PEERS® for Young Adults
 PEERS® for Young Adults
Friendship and Romantic Relationship
Skills:
• Finding and choosing good friends and
romantic partners
• Conversational skills
• Starting and entering conversations
• Exiting conversations
• Electronic communication
• Appropriate use of humor
• Get-togethers
• Dating etiquette
– Letting someone know you like them
– Asking someone on a date
– Organizing and planning a date
– General dating do’s and don’t
 PEERS® for Young Adults
Targeted Social Skills
Managing Conflict and Rejection
Skills:

• Dating etiquette
– Taking no for an answer
– Politely turning someone down for a date
– Handling unwanted sexual pressure
• Handling arguments
• Handling direct bullying
– Teasing and embarrassing feedback
– Physical bullying
• Handling indirect bullying
– Cyber bullying
– Rumors and gossip
 PEERS® Evidence-Based Methods for
Teaching Social Skills
§ Small group format
§ 10-12 adults
§ Concurrent social coaching groups
§ Caregiver-assisted
§ Didactic lessons
§ Concrete rules and steps of social etiquette
§ Ecologically valid social skills
§ Socratic method of teaching
§ Role-play demonstrations
§ Model social behavior
§ Appropriate and inappropriate demonstrations
§ Perspective taking questions
§ Behavioral rehearsal exercises
§ Practice skills with coaching
§ Homework assignments (Matson, 1984; Davies & Rogers, 1985; Fleming & Fleming, 1982;
§ Practice in natural social settings Mesibov, 1984; Gresham, Sugai, & Horner, 2001; Gralinski &
§ Helps generalize skills Kopp, 1993; Rubin & Sloman, 1984, Frankel & Myatt, 2003;
Rao, Beidel, & Murray, 2008; Laugeson et al., 2008)
§ In vivo caregiver coaching
§ Homework review
§ Individualize the treatment
 Clinical Example:
Starting Conversations
QUESTIONS:

What are most young

adults with ASD told
to do to meet new INSERT VIDEO
people?

What do many young

adults with ASD do to
meet new people?
 PEERS® Clinical Example:
Starting Conversations
1. Casually look over
2. Use a prop
3. Find a common interest
4. Mention the common
interest
– Make a comment
– Ask a question INSERT VIDEO
– Give a compliment
5. Trade information
6. Assess interest
– Are they looking at you?
– Are they facing you?
– Are they talking to you?
7. Introduce yourself
(optional)
 Clinical Example:
Asking Someone On a Date
QUESTIONS:

What are most young

adults with ASD told
to do to ask someone INSERT VIDEO
on a date?

What do many young

adults with ASD do to
ask someone on a
date?
 PEERS® Clinical Example:
Asking Someone On a Date

1. Wait for an appropriate time to

ask
2. Trade information
3. Mention your common interests
INSERT VIDEO
4. Ask what they’re doing at a
certain time (e.g., this weekend)
5. Assess their interest
6. Use common interests as a
cover story for going out
7. Exchange contact information
8. Tell them when you’ll follow-
up
 PEERS® Evidence-Base for
Positive Social Outcomes in ASD
Randomized Controlled Trial with
Young Adults with ASD
(Laugeson, Gantman, Kapp, Orenski, & Ellingsen 2015)
Randomized Controlled Trial with Young Adults with ASD
(Laugeson, Gantman, Kapp, Orenski, & Ellingsen 2015)

!
 PEERS® Research Snapshot:
Caregiver-Assisted for Young Adults with ASD
(Laugeson, Gantman, Kapp, Orenski, & Ellingsen 2015)
 PEERS® Research Snapshot:
Caregiver-Assisted for Young Adults with ASD
(Laugeson, Gantman, Kapp, Orenski, & Ellingsen 2015)
 PEERS® Research Snapshot:
Caregiver-Assisted for Young Adults with ASD
(Laugeson, Gantman, Kapp, Orenski, & Ellingsen 2015)
 PEERS® Research Snapshot:
Caregiver-Assisted for Young Adults with ASD
(Laugeson, Gantman, Kapp, Orenski, & Ellingsen 2015)
 Final Thoughts
• Improving social outcomes in young
adults with ASD is possible
• Evidence-based treatments to improve
friendship and romantic relationships
exist
– Developed at UCLA
– Disseminating treatments worldwide
– Certified trainings are available
– Published manuals and books available to the
public
• More evidence-based treatment are
needed to improve social outcomes in
adults across the lifespan with ASD:
– Employment
– Romantic relationships
– Sexual health and safety
– Independent living
Current Research Opportunity
Cross Cultural Validation and
Replication of PEERS®
 Future Research Opportunities:
College to Career Transition Program
• PEERS for Careers (Fall Quarter 2018)
– 10 week course
– Two 90-minute weekly classes
– 3 unit class
– Focused on employment skills
– Concurrent career coaching group with
undergraduate students
• UCLA Internship (Winter Quarter
2019)
– On-campus employment opportunities
– Support via UCLA CAN Clinic
– Ongoing career coaching from
undergraduate students
• Externship (Spring Quarter 2019)
– Off-campus employment opportunities
– Support via UCLA CAN Clinic
– Ongoing career coaching from
undergraduate students
 Future Research Opportunities:
PEERS for Dating
• 16-week group-based social skills intervention focused on developing and maintaining
romantic relationships for adults with ASD
• Concurrent dating coach sessions
• Recruitment begins Winter 2019

Proposed Curriculum

1. Choosing and finding appropriate people to date

2. Starting conversations
3. Maintaining conversations
4. Entering and exiting conversations
5. Electronic communication
6. Online dating
7. Letting someone know you like them
8. Asking someone on a date
9. Handling rejection
10. Going on dates
11. Dating do’s and don’ts
12. Handling sexual pressure
13. Relationship boundaries
14. Physical contact and sexual activity
15. Conflict resolution
 PEERS® for Young Adults
Caregiver-Assisted Treatment
• Certified Trainings at UCLA:
– July 30 – August 1, 2018
– Research scholarships are available
• 16-week curriculum
• Weekly 90-minute young adult
sessions and caregiver sessions
• Social coaching handouts
• Addresses core deficits for ASD
• Focuses on friendship and
relationships skills and handling
peer rejection and conflict
• Teaches ecologically valid social
skills
 PEERS® for Adolescents
Parent-Assisted Treatment
• Certified Trainings at UCLA:
– September 5 -7, 2018
– Research scholarships are available
• 14-week curriculum
• Weekly 90-minute teen sessions
and parent sessions
• Parent handouts
• Addresses core deficits for ASD
• Focuses on friendship skills and
handling peer rejection and conflict
• Teaches ecologically valid social
skills
 PEERS® for Adolescents
School-Based Curriculum
• Certified Training at UCLA
– June 27 - 29, 2018
– Research scholarships are available
• Teacher-facilitated curriculum
• 16-week program
• Daily lesson plans
• Focuses on friendship skills and
strategies for handling peer
rejection and conflict
• Includes weekly comprehensive
parent handouts
• Evidence-based treatment for ASD
– Middle school
– High school
 The Science of Making Friends:
Helping Socially Challenged Teens and Young Adults
(Laugeson, 2013)

• Parent book
• Friendship skills
• Handling peer rejection
and conflict
• Parent section
– Narrative lessons
– Social coaching tips
• Chapter summaries for
teens and young adults
• Chapter exercises /
homework
• Companion DVD
– Role-play videos
• Mobile App: FriendMaker
– Virtual social coach
 UCLA PEERS® Clinic
• Preschool Groups
– Tuesdays 3:30 – 5:00 PM
• Children 4-6 years of age
• Autism Spectrum Disorder
• Adolescent Groups
– Middle and high school
– Wednesdays 4:30 – 6:00 PM
• Autism Spectrum Disorder
– Wednesdays 6:30 – 8:00 PM
• ADHD, depression, anxiety, etc. UCLA PEERS® Clinic
• Young Adult Groups (310) 26-PEERS
– Mondays 4:30 – 6:00 PM [email protected]
– Mondays 6:30 – 8:00 PM
www.semel.ucla.edu/peers/
• 18-35 years of age
• Autism Spectrum Disorder and other
social challenges
 Acknowledgements
Funding Support
NIMH U54-MH-068172 (Sigman, PI)
NIH T32 MH17140 (Leuchter, PI) Research Assistants
Semel Scholar Award (Laugeson, PI)
Friends of the Semel Institute (Laugeson, PI) Georgia Yu, M.A. Haley Goodman Cara Lam
Dali Tung Hira Asif Fernanda Samaia
Organization for Autism Research (Gantman, PI) Gozi Egbuonu
Shapell & Guerin Family Foundation (Laugeson, PI) Jan Stolpe, M.A. Angela Dahiya, M.A.
Dawn Mitchell, M.A. Jin Lee, Psy.D. Jennifer Majdick, M.A.
Organization for Autism Research (Laugeson, PI) Amanda Lenvin
Rosanna Rivero, M.A. Victoria Boone
Lang Family Foundation (Laugeson, PI) Cordelia Ross Bethany Wu
Mary Goodarzi, Ph.D. Victorya Jewett
Alex Friedman, M.A. Kristine McGlennen
Sarah Tsai
Research Collaborators Sarah Bohlman, M.A. Jeff Rudie, M.D., Ph.D. Ana Mendoza
Fred Frankel, Ph.D., ABPP (co-developer) Lindsay Henry, M.A. Natalie Colich Yuan Zhang
Andrew Leuchter, M.D. (post-doc mentor) Summer Vilkins Dana Lieberman, Ph.D. Rhideeta Jalal
Alex Gantman, Psy.D. Maile Adolphson Horn, M.A. Siena Whitham, Ph.D. Flor Canales
Catherine Mogil, Psy.D. Michelle Jackson, Psy.D. Allison Vreeland Ido Michaeli, SLP
Helena Johnson, Ph.D. Sarah Taylor, M.A. Lucy Vo Leilani Forby
Josh Mandelberg, M.D. Melissa Wasserman, M.A. Chloe Koeffler Peggy Hsieh
Steven Kapp, Ph.D. Lindsey Hughes, M.A. Alea Baron, Psy.D. Megan Hanson
Kaely Orenski, Psy.D. Ellie Mellon Laura Knoll, M.A. Allison Ganel
Mina Park, Ph.D. Daniel Janulaitis, M.A. Ahoo Karimian, M.A. Gabe Aviera
Enjey Lin, Ph.D. Rohini Bagrodia, M.A. Kathleen Jorgenson, M.A. Jordan Albright
Jilly Chang, Ph.D. Kathryn Fitzpatrick Rebecca Fountain, M.A. Eslin Saporta
Jennifer Sanderson, Psy.D. Tiana Bayrami, M.A. Erin Cornack, M.A. Niki Bahri
Ruth Ellingsen, Ph.D. Jason Tinero Emily Chen, M.A. Caroline McDonough
Aarti Nair, Ph.D. Elizabeth Shipley, Psy.D. Kandyse Christopher Sarah Tsai, MA
Vindia Fernandez, Ph.D. Khadija Noorbhai Devi Beck-Pancer Preston Johnson
Courtney Bolton, Ph.D. Catherine Wallace Ben Schwartman, Ph.D. Steven Lograsso
Marlene Cabrera Elan Javanfard, M.A. Jade-Remington Rebil
Administrative Support Renee Doe Meredith Kalies, M.A. Phoebe Josephson
Alexandra Walsh Meagan Cronin, M.A. Haley Goodman
Yasamine Bolourian, M.A. James Yang, M.A.
Marina Avetisian Lyndsay Brooks, M.A.
Jessica Hopkins Mera West
Eugene Kutasevich, M.A. David Diaz, M.A. Noha Zaki
Shannon Bates, Psy.D.
Maricella Campuzano, M.A. Cecilia Costa, M.A. Nicky de Nocker
Lara Tucci, Psy.D.
Leijing Zhang, M.A. Crystal Ferrendelli, M.A. Nicole Yeroushalmi
Ashley R. Dillon, Ph.D. Danielle Mund
Steven Scott Erin Santos, M.A.
Clare Gorospe
Tricia Choy Danielle Missler, M.A.
Jessie Sanchez, M.A.
Elina Veytsman
Morgan Joliffe
Nicole Rosen
 www.semel.ucla.edu/peers/
[email protected]
310-26-PEERS
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