The Effects of Internalizing Symptoms and Attentional Difficulties on Adolescent Outcomes of the PEERS Intervention

The Program for the Education and Enrichment of Relational Skills (PEERS) is effective at improving the social skills of autistic youth. However, few studies have examined the suitability of PEERS for youth with comorbid mental health concerns. Research suggests that autistic youth are highly likely to have co-occurring disorders such as internalizing and attentional disorders, which are linked with poorer social skills in autistic youth. The current study explores the effects of internalizing symptoms and attentional difficulties on outcomes of the PEERS intervention by examining the relationship between these symptoms and 3 composite outcome variables (i.e., social awareness, social interaction, social communication) before and following the intervention. 61 autistic youth ages 12–17 who completed the PEERS program were included in the analysis. Composite outcome variables were calculated using z-score transformations. Paired-samples t-tests examined changes between the pre- and post-intervention timepoints for the three composite variables. All showed an increase from pre- to post-treatment, with moderate to large effect sizes, indicating significant improvement in social skills following the intervention. Hierarchical regression was used to examine whether internalizing symptoms or attentional difficulties predicted participants’ social awareness, interaction, and communication at pre- and post-treatment. Findings from these analyses indicated that gains from pre- to post-treatment in the social interaction domain were potentially hindered by internalizing symptoms but not attentional difficulties. Social awareness was potentially reduced at pre-treatment with higher attentional difficulties, although this effect did not persist following intervention. Social communication did not appear to be affected by either internalizing symptoms or attentional difficulties at either time point. In sum, findings indicate that PEERS is generally suitable for adolescents experiencing comorbid internalizing symptoms and attentional difficulties, as elevated levels of symptoms did not consistently limit gains made from pre- to post-intervention. As such, the present study contributes to a broader understanding of the efficacy of the PEERS intervention. Future work will examine the efficacy of the PEERS program with youth who have confirmed diagnoses of internalizing and attentional disorders.