The Friends Project: A randomised controlled trial of a group social skills program, PEERS®, in young people with acquired brain injuries and cerebral palsy

Abstract

Background and Objective(s): Young people with brain injuries often experience social functioning difficulties which continue into their adult life. The objective of this study was to test the efficacy of the PEERS® (Program for the Education and Enrichment of Relational Skills) group social skills program on improving social competence, knowledge and friendship skills compared to usual care. Study Design: Waitlist randomised control study. Study Participants & Setting: Participants with a diagnosis of acquired brain injury (ABI; minimum 12 months post injury) or cerebral palsy (CP) were identified through research and hospital databases in two sites (Sydney and Brisbane, Australia). Thirty-six adolescents (mean age 14y, SD 1y 8mo; 19 ABI; 17 CP; 18 males) were included. Materials/Methods: Participants were randomly allocated to receive PEERS® (90 minutes/week for 14 weeks with concurrent parent group) or waitlist usual care control after completing baseline assessments. PEERS® included didactic teaching, behavioural modelling and role play alongside weekly homework. Both adolescents and caregivers separately completed the primary outcome of the Social Skills Improvement System Rating Scales (SSIS-RS). Secondary outcomes comprised Test of Adolescent Social Skills Knowledge-Revised (TASSK), Social Responsiveness Scale-2nd Edition (SRS2) and Quality of Socialization Questionnaire (QSQ). Between and within group outcomes at baseline, immediate follow up (14 weeks) and retention (26 weeks) were compared using linear mixed modelling. Results: Eighteen adolescents were allocated to immediate PEERS® and completed the intervention with 82% attendance rate. At 14 weeks, there was 100% retention for PEERS® and 83% for waitlist, and at 26 weeks there was 94% retention for PEERS® and 67% for waitlist. Groups were equivalent at baseline. There were no between group differences on the parent or student SSIS-RS (social skills or problem behaviour subscales). PEERS® compared to control group achieved significantly greater improvements on the TASSK between baseline and 14 weeks (estimated mean difference [EMD] 6.25, CI 3.85, 8.66; p<0.001) which were maintained at 26 weeks (EMD 7.5, CI 5, 10; p<0.001). Compared to control group, PEERS® led to a significant increase in parent reported hosted (EMD 1.18, CI 0.28, 2.09; p=0.02) and invited (EMD 1.21, CI 0.41, 2.03; p<0.01) get-togethers at 14 weeks (QSQ), with invited get-togethers maintained at 26 weeks (EMD 1.24, CI 0.40, 2.11; p<0.01). Conclusions/Significance: As the first RCT of PEERS® in adolescents with brain injuries, this study investigates a program which could be used clinically to improve social functioning. Results of the trial showed that adolescents with brain injuries could learn and retain social knowledge and increase numbers of hosted and invited social get-togethers with friends.L6338698222021-01-13 <br />