Effectiveness of Adapted Program for the Education and Enrichment of Relational Skills (PEERS) in Adolescents with ASD

= 7.80) of 98 adolescents (Mean age = 14.39, SD = 1.80) with ASD were recruited from two schools of Islamabad and one school of Rawalpindi via purposive sampling. Results: Findings demonstrated signi�cant improvements in social skills knowledge of adolescents with adopted PEERS, F (1, 93) = 36.38, p<.001 . Conclusions : Results indicated that PEERS is an effective program to enhance the overall socialization of Pakistani Adolescents with ASD.

Pakistani adolescents' adaptive behavior skills, social skills, and quality of play by involving primary careers such as parents and teachers. Objective of this study was to evaluate the effectiveness of the adapted UCLA PEERS model in experimental group. Hypothesis states that there is likely to be a signi cant improvement in post social skill knowledge with respect to pre assessment, after the training of participants of with adapted UCLA PEERS model in experimental group.

M E T H O D S
1.9% had considerable cognitive handicap [5,6]. Adolescence phase can be di cult for children with ASD since they are more motivated to socialize with their peers but also more aware of their social disability [7]. Poor social skills often lead to peer rejection and victimization, inadequate social support, a lack of ful lling friendships, feelings of loneliness and isolation, di culties in school and work, and the development of anxiety and mood disorders [8,9]. This vulnerable demographic needs thorough social skills training during adolescence. Social skills intervention programs for adolescents with ASD are becoming more popular, however research suggests they do not improve social outcomes [10]. Programs that show potential have limited generalization and short treatment advantages [11,12]. Reichow and Volkmar reviewed evidence-based social skills therapies and found many treatment delivery strategies that could improve social outcomes for ASD patients [12]. Applied behavior analysis, naturalistic methods, parent and family participation, peer training, group therapy, visual aids, and video modelling can help teach social skills. Behavioral rehearsal exercises, coaching with performance feedback in small groups, and time-limited social skills instruction using behavioral modelling and role-play demonstrations are all effective intervention strategies for teaching social skills [13]. Evidence-based treatment manuals, didactic training using social etiquette norms and stages, and in-person socialization homework assignments improve treatment outcomes for adolescents with ASD [14][15][16]. Clinical investigations have indicated that the PEERS program improves social functioning in adolescents with ASD. The Program for the Education and Enrichment of Relational Skills (PEERS) uses CBT teaching methods. UCLA's evidence-based social skills curriculum teaches relationship development, peer dispute, and peer rejection. Laugeson et al., found that adolescents who participated in the program had improved social skills as reported by parents, increased knowledge of social skills, and increased frequency of hosted peer get-togethers compared to a waitlist control group [15]. Treatment gains were maintained ve years later [17]. Another study found that adolescents who participated in the PEERS program improved their social cognition, social awareness, social motivation, assertiveness, cooperation, responsibility, knowledge, and responsiveness in these areas, reduced autistic mannerisms, and increased peer interactions [18]. Thus, Overall, the PEERS program has had favorable results, although more research is needed as it is still young. This study examines the program's in uence on a Pakistani community. Hence present study aimed to adapt and introduce the adapted UCL A PEERS model in educational setups in Pakistani schools in order to improve Experimental research design and purposive sampling technique was used in the present study for the recruitment of the participants. Total 98 parents and 63 teachers of 98 adolescents with ASD were recruited from two schools of Islamabad and one school of Rawalpindi. An introductory session has been conducted in a group to inform the participants about the purpose of the study (See table 1 for complete descriptive statistic). A total of 57 parents of 57 adolescents with ASD and 31 teachers of these adolescents showed their interest to be part of an experimental group (EG). Whereas, remaining 41 parents of 41 adolescents with ASD and 32 teachers of these adolescents became part of the control group (CG). Adolescents (who were able to communicate verbally and had been diagnosed with mild ASD), Parents and teachers of adolescents with mild ASD diagnosis, who were pro cient in English language, and those who provided signed consent form to take part in the adapted version of UCLA PEERS, were included in the study. Children, adolescents and adults (who weren't able to communicate verbally and had been diagnosed with moderate to severe ASD), and Parents and teachers of children, adolescents and adults with other intellectual or neuro-developmental disability (e.g. ADHD, severe ASD), and who were not pro cient in English language. Study use demographic data sheet constructed by author that include age, gender, education, family system, socioeconomic status, occupation and number of children. Moreover, the TASSK questionnaire that was originally that was developed by Norris et al., was used to measure pre and post assessment of social skill knowledge of participants [19]. Scores range from 0 to 26, with higher scores indicating stronger understanding of adolescent social skills. The test is treatment-sensitive, with a Cronbach's alpha of 0.56 [20]. This study included total of 98 parents and 63 teachers of 98 adolescents with ASD which were recruited from two schools of Islamabad and one school of Rawalpindi. An introductory session with each parent and teacher has been conducted in a group form, to inform the participants about the purpose of the study. Parents and teachers were the main participants, who participated in the adapted

R E S U L T S
Results showed the adolescents who received UCLA PEERS intervention showed signi cant improvement in social skills knowledge in post assessment, as compared to the pre assessment (Table 2). However, no change was observed in social skills knowledge for the adolescents who did not receive the UCLA PEERS intervention across pre a post assessments with F (1, 93) = 41.23, p<.001.
UCLA PEERS program and they were assigned activity sheets and homework assignments to deliver the learned social skills to the adolescents with ASD. After taking formal permission from the original author, PEERS program manual was adopted according to indigenous culture. Afterward, the adapted UCLA PEERS program was implemented on the parents and teachers of adolescents. Aim of the study was described in terms of con dentiality concerns, anonymity of the participants and their right to withdraw from participating in the adapted UCLA PEERS program. Pre assessment of participants was done on social knowledge questionnaire. The Adapted UCLA PEERS model included 14 weekly sessions (1 session per week). These sessions mainly involved parents and teachers to enhance the comprehensive knowledge, understanding and quality of socialization of adolescents with ASD. A trained therapist, who was certi ed in UCLA PEERS model by the developer of original UCLA PEERS model (Dr. Laugeson), educated the parents and teachers about conversational skills, peer relationships, rejection and problem-solving skills and therapist provided homework assignments to both teachers and parents along with the activity sheets throughout the intervention phase. Afterward the post assessment was done on same participants. Ethical considerations were considered particularly while conducting this research. Permission and approval from the Research Ethics Board, Institutional Review Board, author of the scales and signi cant authorities was taken before conducting research. Every participant of the research received a consent form along with the brief description about the aim of the present research. Only those participants were considered as the part of study who were interested to take part in the present research. Table 1 shows Mean ± SD and frequency(%) of demographic characteristics of participants.   Adolescents maintained their social skills knowledge six months following the session. The teenagers also improved socially, including social responsiveness and autism symptoms. In a recent study, Mandell compared PEERS to a control group getting normal treatment [32]. The study randomly allocated 152 ASD teenagers to the PEERS program or the control group. The PEERS course helped teenagers grasp emotions and social norms better than the control group. Hence, it's been proved that the UCLA PEERS model is an effective treatment plan to improve social skills knowledge in adolescents with ASD.
Current study aimed to adapt and introduce the adapted UCLA PEERS model in educational setups in Pakistani schools in order to improve Pakistani adolescents' adaptive behavior skills, social skills, and quality of play by involving primary careers such as parents and teachers. This was done in order to assist Pakistani adolescents with ASD in a manner that was more accurate and consistent. Children with autism will bene t from this technique since it will help them become resourceful enough to speak, grasp, and carry on a good discussion. Present study hypothesized that there would be a signi cant improvement in post social skill knowledge with respect to post assessment after the training of participants with adapted UCLA PEERS model in experimental group. The interaction effects of groups (EG & CG) and assessments (pre & post) was found to be signi cant with the knowledge of social skills of adolescents with ASD ( Figure 1). Results showed the adolescents who received UCLA PEERS intervention showed signi cant improvement in social skills knowledge in post assessment, as compared to the pre assessment (Table 2). Several studies reported that UCLA PEERS improved social skills knowledge [21-23] and social skills [24] after participation in UCLA PEERS intervention [25][26]. Another comparative study revealed that UCLA PEERS is an evidence-based social skills training which resulted in The results of two-way mixed factorial ANOVA showed that the signi cant main effect for Groups (EG & CG) across social skills knowledge for adolescent with autism spectrum disorder.

C O N C L U S I O N S
The results concluded that the adapted UCLA PEERS intervention is an effective measure to enhance social skills knowledge, quality of socialization and social dimensions along with the improved general health. Quantitative tools were used to gather data, but a mixed approach could have provided more insight. Adolescents could have shared their stance with parents and teachers, and 1-5 years of follow up is needed to examine the longterm effectiveness of the program. Moreover, explorations of cross-cultural validation trials are needed. This research DOI: https://doi.org/10.54393/pjhs.v4i04.708

Saima and Amin R
Effectiveness of Adapted PEERS® in adolescents with ASD Pre and Post assessments was done on social skills knowledge across experimental (EG) and control Groups (CG) of the adolescent with ASD. The interaction effects of groups (EG & CG) and assessments (pre & post) was found to be signi cant with the knowledge of social skills of adolescents with ASD ( Figure 1). will make a contribution to the treatment of children with ASD who have impairments in their social skills. It will provide valuable information for parents, teachers, psychologists, and mental health workers to practice the UCLA PEERS model to develop social skills, adaptive behavior skills, and the quality of play in children. It will also make it easier for mental health professionals to deal with a decline in developing social skills. The ndings of this study will have a lasting effect on Pakistani society, particularly in the areas of autism spectrum disorder (ASD) management and the improvement of teenagers' overall social functioning.