The Friends Project: Optimising social competency in youth with acquired brain injuries and cerebral palsy: A randomised controlled trial

Abstract

Objective: To compare efficacy of the PEERS® (Program for the Education and Enrichment of Relational Skills) social skill group program to usual care on social competence and friendship skills of adolescents with a brain injury. Design: Waitlist randomised control trial. Method: Thirty-six high-school attending adolescents with a brain injury, either an acquired brain injury (≥12 months post; n=19) or cerebral palsy (n=17) were recruited across two sites. After baseline assessments, participants (18 males; mean age 14y, SD 1y8 m) were randomly allocated to either the 14 weeks of PEERS® group (90 mins/wk with concurrent parent group) or the waitlisted usual care control group. PEERS® comprised didactic lessons, role play and behavioural modelling strategies paired with weekly homework. The primary outcome was the Social Skills Improvement System Rating Scales (SSIS-RS) administered separately to adolescents and caregivers. Secondary outcomes included the Quality of Socialization Questionnaire (QSQ; frequency of gettogethers), Social Responsiveness Scale-2nd Edition (SRS-2; reciprocal social behaviour) and Test of Adolescent Social Skills Knowledge-Revised (TASSK). Outcomes between and within groups were compared by fitting a regression model using Generalised Estimating Equations to baseline and follow up measurements. Results: Groups were equivalent at baseline. There was no difference between groups on the parent reported SSIS-RS (social skills or problem behaviour subscale), however the student-reported SSIS-RS (social skills subscale) showed a trend to greater improvements following PEERS® compared to control group (EMD 6.6; 95% CI: -0.4-13.7, p=0.07). The PEERS® group demonstrated significantly greater improvements on the secondary outcome, the TASSK (EMD 6.3; 95% CI: 3.7-8.9; p<0.001) compared to control group. Parent-reported SRS-2 showed a trend to fewer problems with reciprocal social behaviour, indicated by lower scores (EMD-4.5; 95% CI: -9.9-0.8; p=0.099). The PEERS® group had significant improvements between baseline and follow-up on the TASSK (EMD 6.7, 95% CI4.9, 8.5: p<0.001), parent-reported social skills on the SSIS-RS (EMD 6.3, 95% CI 2.1, 10.5: p=0.003), and SRS-2 (EMD -4.4 95% CI -8.0, -0.0: p=0.02). The control group demonstrated no significant within group differences on any outcome. Conclusion: In this first RCT of PEERS® in this population in Australia, we found that PEERS® led to positive changes in social skills knowledge, social competency and reciprocal social behaviour for adolescents with brain injuries. Importantly, adolescents with brain injuries were able to retain the information learnt. PEERS® offers a clinical program that can be delivered to improve social functioning in adolescents with brain injuries.L6316059822020-05-04 <br />