Guest Interviews — 28 Minutes

INSAR 2019: Elizabeth Laugeson

Guest Interviews — 28 Minutes

INSAR 2019: Elizabeth Laugeson

Dr. Laugeson joins us from the INSAR conference in Montreal.

Dr. Elizabeth Laugeson is a licensed clinical psychologist and an Associate Clinical Professor in the Department of Psychiatry and Biobehavioral Sciences at the UCLA Semel Institute for Neuroscience and Human Behavior. Dr. Laugeson is the Founder and Director of the UCLA PEERS® Clinic, which is an outpatient hospital-based program providing parent-assisted social skills training for preschoolers, adolescents and young adults with Autism Spectrum Disorders and other social impairments. She also serves as the Training Director for the UCLA Tarjan Center for Excellence in Developmental Disabilities (UCEDD).

Frampton Gwynette: Hello, I’m Frampton Gwynette from the Autism News NetWORK coming at you from Montreal, Quebec, Canada and we have a really special guest today. I’m here with Dr. Liz Laugeson who is a basically world renowned leader in social skills training for kids and adults with autism. She’s also an author. She provides talks all over the world and trainings all over the world. In terms of frequent flyer miles, she from LA to Montreal, I came from Charleston, South Carolina to Montreal. I think that’s the record for today. That’s a lot of distance.

Elizabeth Laugeson: A lot of distance.

Frampton Gwynette: Thank you for making time during this busy meeting. Welcome.

Elizabeth Laugeson: My pleasure. Thank you. Nice to see you.

Frampton Gwynette: Yeah, you too. We’re going to take our audience back just to like the origin of PEERS, which if they don’t know PEERS is the most evidence-based social skills training program for people with autism and take us back to before PEERS even existed. How did you think to invent it?

Elizabeth Laugeson: I was at UCLA on a pre doctoral psychology internship and I was actually studying fetal alcohol spectrum disorder at the time. I was interested in developmental disabilities and autism but my specialty was really FASD and I was working on a CDC study testing the effectiveness of the social skills intervention for kids with prenatal alcohol exposure and I’d never done social skills training before. I really hadn’t had an experience with that and the interesting thing was, even though this study was focused on kids with FASD, my phone was ringing off the hook from parents of teens with autism, just looking for anything in the community, anything and there was nothing. This is 2003 in Los Angeles, which is a pretty big metropolitan area. There’s nothing, no place to send them and I thought, well that’s absolutely unacceptable. I had the idea to develop an adolescent program focusing on friendship skills for teens with autism and I was very, very lucky I was able to secure an NIH T32 postdoctoral fellowship that gave me three years of funding to develop and test the PEERS intervention.

Frampton Gwynette: That was an investment on their part before it paid off really for the whole autism world. Yeah, because you’ve taken it from really a local program to doing trainings all over the world and how did you make that huge leap from just being based out of LA to then going all over the world to train others?

Elizabeth Laugeson: Yeah. I just I’m very passionate about dissemination and I don’t define dissemination the way some I think researchers do where you publish a paper and a PEER review journal and that is a type of dissemination but I really feel like if you develop an evidence based treatment, people should be able to access it and I’m sorry, but those are your taxpayer dollars. You probably want to make sure that whatever we develop is also accessible. I’m just very, very dedicated to that and I also tend to kind of think big sometimes. I didn’t believe that people should have to come to UCLA to access this program. I wanted to share it essentially and so I started by sharing it with research colleagues so that they could also test the effectiveness and it just sort of took on a life of its own and it now is an international program.

Frampton Gwynette: Yeah, I actually was fortunate to attend the UCLA training program about five years ago now but I remember how collegial it was and for those of you who have an opportunity to go out there and get trained with delivering PEERS, I would definitely recommend doing so because one of the great things you guys did was you gave us your clinical outcome measures or research outcome measures. You use the recipe and we’ve been able to bring that to our community in Charleston, South Carolina. Yeah, we’re really grateful for that.

Elizabeth Laugeson: Well, I’m grateful for the work that you do. I mean, again, I just, I think that there’s no reason that we can’t sort of share these programs with other people and no reason to hoard that stuff to all to ourselves.

Frampton Gwynette: Yeah, absolutely, and what I think is so special about the protocol is that I’ve run a bunch of parent groups myself and it’s so easy for the parent groups to kind of devolve into a therapy session, which is important to provide parent support and education but I think you guys have really been great about coaching leaders in the parent group to stick to the protocol, right?

Elizabeth Laugeson: Yeah.

Frampton Gwynette: Which is homework and what’s the value and keeping things on track like that versus letting parents vent?

Elizabeth Laugeson: Well, there’s definitely value to venting but this isn’t group therapy. Social skills training isn’t group therapy. It’s more like a class really and we’re trying to teach concrete rules and steps of social etiquette. In this case related to friendships and handling conflict and if we sort of didn’t run a tight ship and we got off track with all the important things that parents have to say, all the important questions, it’s not that that’s not important but if we got off track, we would never accomplish our goal, which is to help their kids learn to make and keep friends. It’s not that we shut that down, it’s just that it’s not the right place in the group essentially and so what we do is we try to make ourselves available outside of the group to answer questions and to deal with other pressing issues but in general, we really do try to stay very focused on our goal.

Frampton Gwynette: Yeah, exactly. I know that you’re a big believer in parent involvement and coaching. Can you just elaborate a little bit on why that is such an important driver in the success of PEERS?

Elizabeth Laugeson: Sure. Yeah. Thanks for asking. I really strongly believe in parent coaching and having other people involved in the treatment and what we do in our program is we have these concurrent parents sessions as you know, where we’re teaching parents how to be social coaches to their kid outside of the program. Now this is a time limited program like many programs. It’s 16 weeks in length, they come once a week for 90 minutes. This is not a lot of time in the grand scheme of life but parents are there the vast majority of the time. Why wouldn’t we want to train them to be the interventionists, to be the social coach out in the real world and teach them to do the things that we would do if we were there providing that coaching. I think that’s going to be a far more effective program and also more robust, more durable, meaning that when parents are involved in treatment, the treatment never ends, right? Because they’re going to continue to provide that support long after your program’s over. To me, it’s just logical. It makes sense.

Frampton Gwynette: It’s logical but the data also backs it up because for our audience, PEERS shows efficacy out to five years or more, right?

Elizabeth Laugeson: Mm-hmm (affirmative).

Frampton Gwynette: In terms of social skills training, shows efficacy and anxiety and also parents feelings of effectiveness. When you’re impacting that whole family system, yeah, you can’t argue with the results. It’s [inaudible 00:06:15]. Cool. Well, I didn’t want to skip around too much but I had mentioned earlier that you do international trainings and of all the places you’ve traveled, do you have any favorites?

Elizabeth Laugeson: Oh, favorites?

Frampton Gwynette: Yeah.

Elizabeth Laugeson: Well, I love London. It’s such a great international city. Really great food. People don’t believe me when I say that but it really good and great theater, my favorite but actually I also really love Sydney. Sydney is a really exciting place to visit. I was just there doing a dating bootcamp actually in Sydney. They were filming a documentary about people trying to find love on the spectrum. I love that city but I also, it’s fun to go new places and exotic places. I did a training in New Delhi one time that was interesting and went to Russia and places that maybe I wouldn’t normally get to go. Every city is great. Montreal is a great city.

Frampton Gwynette: Yeah. Sure is. That’s amazing. When you started PEERS you probably had no idea that would lead you down all these different paths.

Elizabeth Laugeson: No, I did not but it’s been a pleasure.

Frampton Gwynette: Yeah, absolutely. Yeah. I know that you just coming from our presentation here in Montreal, can you just give us some highlights of some of the things that you’re presenting here at INSAR?

Elizabeth Laugeson: Yeah. Actually it kind of relates to the parent coaching question that you just asked. I just presented on a panel on social skills training, evidence based treatments that was organized by [inaudible 00:07:37], and the idea behind the session that I was presenting on is really looking at the sort of the differences in mechanisms of change when you compare a parent mediated or parent assisted program to a teacher facilitated program and so really what are the differences in outcomes and kind of the short version of the answer there is that both programs are very effective and not just statistically significant but really clinically meaningful outcomes but the parent programs have about twice the effect of a school based program.

Elizabeth Laugeson: I think it makes sense because again, we’re talking about this was for our adolescent programs and the teachers are there in this natural social [inaudible 00:08:19], it’s a very natural place to teach social skills but they’re busy and they have a lot of students to work with and they see them for maybe an hour a day in the classroom whereas parents are around a lot more and I think it does make sense that parents are more effective agents of that change but that’s kind of the short version of what I was presenting.

Frampton Gwynette: That’s cool. The parents have that investment as well.

Elizabeth Laugeson: That’s very true. Yeah. I think teachers do too but on a different level.

Frampton Gwynette: Yeah. Peter Gerhart has this awesome quote. It says ‘Anything good that ever happened in the world of autism happened because of a parent.’

Elizabeth Laugeson: Yeah, that’s true.

Frampton Gwynette: It really is true.

Elizabeth Laugeson: It really is true.

Frampton Gwynette: I was going to ask you about a case. It’s like one case but it could be a number of cases I have.

Elizabeth Laugeson: Okay.

Frampton Gwynette: I’ve got a patient whose sick 16, 17 super high functioning but definitely has autism and I would like for him to go into PEERS. His parents would like for him to go into PEERS but he’s not ready because he doesn’t want to be one of them in the group or he doesn’t have what they have. Do you have any tips about how you might try to motivate him or entice him to participate?

Elizabeth Laugeson: Yeah. Good question. You know, one of the things that’s I think really important, once kids hit adolescence, they have to want to learn these skills. I mean with little kids, you can give them rewards and reinforcers for attending social skills groups. With teenagers, it doesn’t work that way. I mean if you ever try to convince a teenager to do something they don’t want to do.

Frampton Gwynette: Not successful either.

Elizabeth Laugeson: Not successful, right? They have to be sort of intrinsically kind of socially motivated. They don’t have to say I don’t have good social skills. They don’t have to say I don’t have friends and they don’t even have to talk about their autism. I don’t really think that autism has to be part of the conversation in a social skills training group. Believe it or not. In fact, we really don’t talk about autism in our teen groups or our young adult groups.

Elizabeth Laugeson: It comes up in the parent sessions because the parents bring it up but really it’s not part of the conversation. We’re just teaching good social skills and so anyone who’s open to learning those skills I think can really benefit but if they’re not open, I’m not sure how effective that would be and I’m also not sure how ethical that would be. I would never want to force social skills onto someone that doesn’t want to learn them. Not only is it not going to be effective but I don’t think it’s really appropriate. It’s not ethical. You know, there’s a whole neuro diversity movement, right? And there’s a lot of self advocates that say, “I don’t believe in social skills training. I don’t want to have to learn these social customs. I want you to accept me for who I am.” That’s a valid argument.

Elizabeth Laugeson: There are also a lot of self advocates that do want to learn this skill, so we have to make sure they have access to effective programs but again, I’m not sure that it’s really ethical to force social skills on other people and just kind of one last thing about that, I think it’s also important for people to understand that at least in PEERS and I think this is true really for good social skills interventions. We’re not trying to change who our kids or adults are, right? We want them to be able to be who they are. What we’re trying to do really is just enhance the skills that they have so that other people can appreciate who they are and I think it’s a very important distinction.

Frampton Gwynette: Yeah, absolutely. And one of the E’s and PEERS is for enhancement, right?

Elizabeth Laugeson: That’s right.

Frampton Gwynette: It’s a great way to put it.

Elizabeth Laugeson: Yeah. It’s actually enrichment but same thing.

Frampton Gwynette: Enrichment?

Elizabeth Laugeson: Yeah.

Frampton Gwynette: Okay. Yeah.

Elizabeth Laugeson: Close enough.

Frampton Gwynette: [inaudible 00:11:37] .

Elizabeth Laugeson: Yeah.

Frampton Gwynette: Thank you for correcting me on that one.

Elizabeth Laugeson: I police too a little bit. That’s-

Frampton Gwynette: That’s right. Okay. Yeah. And we talked a little bit about working with teens and then these teens of course grow up into adults and you’ve expanded your program to include social skills training adults and how does that differ? How does your approach differ in adults versus teens or adolescents?

Elizabeth Laugeson: Yeah. Well, a lot of those skills that we teach in our adolescent program, they really transfer very nicely into adulthood. The rules for conversations are kind of the same. How you have get togethers and that sort of thing sort of remains the same. Things that are different are where you find your source of friends. For adolescents it’s through extracurricular activities at school, in clubs, maybe sports. For adults it’s a little bit harder, especially if you’re not involved in school or you’re not working, it might be harder. Their sources of friends tends to be different and also another really critical skill that we teach in adulthood is related to dating at a kid. This was a question I had really early on back in 2004 when I started to develop the program was do I include dating etiquette in my teen program?

Elizabeth Laugeson: Truthfully, I actually was really hoping I didn’t have to because it was very intimidating. The idea of teaching dating etiquette. I always joke, I know and like me teaching dating, and again I always used to joke, I still joke, it’s like me teaching dating etiquette is like the blind leading the blind. What do I know? But fortunately we’re not relying on my expertise but I did focus groups. We’re relying on research is what we’re doing, not my expertise. I did focus groups with teens and parents way back in 2014 to look at treatment priorities to see what kinds of skills they wanted to be learning and one of the questions was dating etiquette. Well, they’ve kind of prioritize these interesting … parents number one treatment priority was conversational skills. Totally makes sense, right? These are adolescents that are moving into middle school.

Elizabeth Laugeson: It’s all about talking to people and conversing. Parents least prioritized area. Do you want to guess what it was?

Frampton Gwynette: Dating.

Elizabeth Laugeson: Yes. Dating. Teens number one treatment priority. Do you want to guess what it was?

Frampton Gwynette: It was probably flipped. It was dating.

Elizabeth Laugeson: Yes. It was dating and they’re at least priority was the conversational skills. Yes, totally opposite. A lot of people will ask why I didn’t include the dating etiquette. They’re like why did the parents win? And it was really … it wasn’t just because I didn’t want to teach it and I was intimidated. It was actually because I had a lot of parents that said they wouldn’t participate if there was a dating component.

Frampton Gwynette: It was a non starter.

Elizabeth Laugeson: Yeah. We decided that wasn’t a good idea. I think in the end that was actually the right choice because the average participant in PEERS across multiple studies is around 13, 14 and a lot of them tend to be a little bit more socially immature, really not dating yet but fast forward to adulthood that’s a whole different situation and so we definitely teach dating etiquette to our young adults. That’s probably the biggest difference between the two programs and you know what’s ironic about that? Those are now my favorite sessions to teach.

Frampton Gwynette: Is that right?

Elizabeth Laugeson: Yes, I absolutely love the sessions on dating etiquette. They’re my favorite by far.

Frampton Gwynette: Because you’ve got a lot of lively discussion or?

Elizabeth Laugeson: Oh my goodness. Absolutely. Yeah, and it’s so interesting. It’s fascinating to think there’s like ecologically valid steps that people follow for flirting, like who knew? And these were actually skills anybody could benefit from. You don’t have to have autism to benefit from this.

Frampton Gwynette: Yeah. The ecologically valid term is something that comes up along the PEERS training. Can you just explain to our audience what exactly that means?

Elizabeth Laugeson: Sure. Yeah. Ecologically valid is just the technical term for what socially successful people naturally do. A lot of social skills interventions that haven’t been tested through research, they teach what adults think that kids should do and not what actually works in reality and what the reality is that adults end up because of that giving really bad advice a lot in social situations and we don’t want to do that. Just because you have good social skills doesn’t mean you know how to teach them. You have to rely on the research. Ecological sort of valid social skills would be things that socially successful people are doing and we’re just breaking that down into concrete rules and steps of social etiquette.

Frampton Gwynette: Exactly. I think it’s important for the audience to know that PEERS, like you didn’t just pull this out of the air.

Elizabeth Laugeson: No.

Frampton Gwynette: It really was like from a bottom up where you broke everything down, tried to look at [inaudible 00:15:49], valid social skills and then studied that in the focus groups, piloted and so here we are and looking at an effective treatment, that’s what it takes because I have families who come into my office all the time and say, “What about this, what about that?” And I say, “Listen, if it’s missing the 13 or 14 years of research that’s done to have it be an evidence based modality.” I think what you’re describing, it’s just a great illustration of how something is developed and implemented.

Elizabeth Laugeson: Thank you.

Frampton Gwynette: Yeah. Absolutely. Okay, and then we ask all of our interview guests this question, I know that you’re from the West Coast and we’re from Charleston, South Carolina. I know in LA sports … there’s Lakers and then there’s Lakers. That’s it, right? But-

Elizabeth Laugeson: There’s Clippers too.

Frampton Gwynette: … Clippers. There’re other sports too but the Lakers still reign supreme, right? Maybe not.

Elizabeth Laugeson: Depends on who you talk to.

Frampton Gwynette: Yeah. I guess they missed the playoffs for a bunch of years [inaudible 00:16:44].

Elizabeth Laugeson: Yeah.

Frampton Gwynette: Yeah, but where we live, it’s all college football.

Elizabeth Laugeson: Of course.

Frampton Gwynette: We ask all of our guests, if you had to pick one, would you say Carolina or Clemson?

Elizabeth Laugeson: Oh my God, I have no idea. I’ve heard of Clemson. I’ll go with Clemson. How about Bruins? How about UCLA Bruins? Can I answer that? Yeah.

Frampton Gwynette: Okay. That’s a really good answer.

Elizabeth Laugeson: Okay. Good.

Frampton Gwynette: Yeah, that’s probably the equivalent. I guess, yeah. USCLA-

Elizabeth Laugeson: Oh yeah,.

Frampton Gwynette: Those are two big [inaudible 00:17:10], as well. Okay and then were there anything that you’ve seen here in INSAR so far that has you excited about teams that are doing research that is encouraging or exciting?

Elizabeth Laugeson: Yeah, I mean, the thing that I really … Well, it’s been disheartening over the years but it’s starting to change, is that there’s been so little research on adults with autism and the average person on the street, the face of autism is the face of a child and a lot of people don’t even realize that, no, they grow up to be adults and they still have autism. I really am pleased to see that there’s more, more research now focusing on adults. Yeah. I’d like to have been seeing this over the years. It’s a trend. Also more research on females. Autism looks different in females. Yeah, I think that that’s been heartening now to see more of that.

Frampton Gwynette: Yeah. And I’ve got a couple of questions now from your last [inaudible 00:18:09]. The gender and autism is really interesting because traditionally autism has been about a four to one ratio, male to females and that’s about what the literature shows but there’s something called camouflaging. What is social camouflaging?

Elizabeth Laugeson: I mean, if you believe in social camouflaging, essentially what it means is that females may be better at masking their autism symptoms potentially because they may be are just hardwired to be more social or maybe they’re socialized to be more socialists who you talk to and maybe it’s a bit of both or something even different. The idea is that females may fall through the cracks when it comes to receiving a diagnosis of autism but they still have a lot of significant challenges and we don’t want that to go on notice. We need to understand those gender differences more.

Frampton Gwynette: Yeah, exactly. I think that’s really a great approach because I’ve noticed in social skills groups, like I’ve actually, if I have one female who’s kind of committed and a couple of others who are on the fence, sometimes I will ask our support staff to pass along that, “Hey, can you let Mary know that there’ll be two other females possibly joining.” But they don’t all want to be the only one. It is a tough thing,

Elizabeth Laugeson: Yeah. Interestingly though, over the years I’ve been running this group for 15 years at UCLA and back when I first started running the program, we’d have maybe one girl in a group, sometimes none. That’s changed completely. I would say in a group of 10 I usually have about three or four girls. Yeah, it’s changing.

Frampton Gwynette: No, that’s awesome. And I wanted to see if you’re seeing another change or trend going on. I remember you had mentioned how the state of the art of research is so heavy on genetics, millions and maybe billions on that but then in terms of behavioral interventions, it’s like hundreds of thousands and do you see that tide turning at all?

Elizabeth Laugeson: Well, this conference is a good example of how the tide is turning. It is true that millions of dollars go into autism research every year but if you look at the kind of the pie chart of where it all goes, it’s really heavy on genetics and basic science and really trying to understand the causes of autism and it’s probably not just one cause but if you’re a person that has autism or you care about someone that has autism, you probably want to know what you can do now. In terms of that pie chart, the treatment piece is pretty small and even smaller for adolescents and adults. I do see that changing though. When I first started coming to this conference, I think it was back in 2006 was in Seattle. It was a small conference, maybe 500 people and it was really all very basic science and I didn’t understand half of, not even half of what I was hearing.

Elizabeth Laugeson: I was giving a talk, it was my very first talk at INSAR. It was IMFAR then and it was with Kathy Lord and Pat Howland and by the way, I was a postdoc and I felt like major imposter syndrome. Like what am I doing presenting with Kathy Lord and Pat Howland did they get this right? But the room was packed because we were … I’m sure Pat and Kathy had a lot to do with that but we were also … it was the only intervention session in the entire conference and it was packed and there was such … and there was a line out the door, people wanting to talk to all of us about these interventions and this has changed a lot and there are a lot more sessions here now, more posters about people doing intervention research. Yes, the tide is changing for sure.

Frampton Gwynette: Yeah. That’s exciting.

Elizabeth Laugeson: Yeah.

Frampton Gwynette: Because parents and families, they want something now.

Elizabeth Laugeson: Yeah.

Frampton Gwynette: Plus when you look at the risks of behavioral interventions, they’re so low. You know?

Elizabeth Laugeson: I know and when you think of how far we’ve come in autism research, probably the greatest strides, the greatest achievements to come in the intervention piece, right? In terms of what we know works. It’d be nice to get more funding to support that research.

Frampton Gwynette: Yeah, absolutely. And you are so blessed to be at UCLA where there’s just like giant after giant in the field there. Do you have a chance to collaborate with McCracken and Cancer Aid?

Elizabeth Laugeson: Oh yeah. We’re one big happy family now. It’s great. I still like pinch myself that I’m at UCLA because it’s an amazing center to work in. The Center for Autism Research and Treatment and you know, a lot of centers they don’t have an autism center or if there is an autism center, you might have one kind of main PI that’s sort of running the show and at UCLA we have practically like a dozen of them and they’re all really leaders in their field and we’re very good about collaborating. We have an autism center of excellence so we all collaborate on that. You asked about Jim McCracken, he and I have a study looking at the use of l-DOPA as an adjunct to PEERS. Looking at the benefit of l-DOPA working in the l-DOPA system. Connie-

Frampton Gwynette: The idea there is like to enhance concentration or?

Elizabeth Laugeson: Well, l-DOPA … yeah, it’s making it more rewarding. This is basically the idea of that socializing more … It’s very innovative, cutting edge. That was all Jim’s idea but I was happy to be a part of it. We also collaborate with Amanda Gulsrud at The Child and Adult Neuro Developmental Clinic and we have a college to career transition program now. It’s called PEERS for careers and we’re doing a lot of exciting work in the area of employment now. There are lots of cross collaborations. I work with some neuro imagers at UCLA, [inaudible 00:23:35], and [inaudible 00:23:36], doing imaging, looking at kind of how the neuro pathways in the brain change as a result of this treatment.

Frampton Gwynette: Yeah, and I know that you have found a bio marker, you know, through EEG and now you’re looking at functional connectivity…

Elizabeth Laugeson: Well, I can’t say credit for the biomarker. That was Amy Van Vecke. Brilliant scientist at Marquette University. The first really to find a biomarker of treatment outcome in social skills training. Yeah, it’s really cool.

Frampton Gwynette: Yeah. That’s where somebody completes the treatment and you can actually see it using a biological tool. In this case it’s measuring brainwave.

Elizabeth Laugeson: Yeah, she saw changes in the social brain as a result of treatment. Really cutting edge cool stuff.

Frampton Gwynette: Cool. I wanted to ask you just maybe one or two more questions. We had touched on this a little bit earlier but Autism News NetWORK is a program for adults with autism and I think you’ve done a great job at explaining how important that is to focus on adults and then, but do you have any topics that you might recommend that we cover or any advice for the Autism News NetWORK team?

Elizabeth Laugeson: Yeah, well I love that you’re focusing on adults. I think that that’s just … it’s an area that gets forgotten or ignored. I love that. One of the areas that I think needs more exploration, both in terms of a discussion but also research is gender identity. This is a big, big topic and it’s something I’ve noticed that’s changed over the years and we run, I think you know this but we run two back to back teen groups every week to back to back young adult groups and our earlier group is all people on the spectrum essentially and our later group is kind of what I call general clinic group. Yeah. There might be have people with ADHD or depression or anxiety, maybe sometimes people with autism but more general and it’s interesting that I would say every other cohort in my autism groups, both teen and young adult, I have someone that is transitioning essentially and I don’t have that in my general clinic group. Clinically, something feels like there’s something going on here.

Frampton Gwynette: Absolutely. I gave a talk on this recently, not only looking at gender like male female ratios but also gender identity in the Bible belt, which is where I am because a lot of parents for families might come from a traditional Christian background and the big struggle is, okay, if my child’s going to transition, how do I still go to church with my child [inaudible 00:25:59]? And there’s a lot of ways to approach that and as a believer, I’m always looking for a way to support the individual but the data does show that rates of gender identity or gender variance are multiples of what it is in the general population. If you look at patients with autism, gender identity issues are higher and then if you go to a gender identity clinic and you look at that cohort rates of autism traits are higher and it’s still unclear about what the cheesing out, there’s folks with gender variance struggle socially because of their transition issues or there’s a lot to be worked through but in my clinics, I’ve seen six, seven, eight cases and it’s definitely another layer of complexity.

Elizabeth Laugeson: Yeah. I think there’s something there and we need … it’s good to start a discussion I think about that and then figure out how to effectively support these individuals.

Frampton Gwynette: Yeah, absolutely. Well, if you’re looking for a guru on social skills, look no further. Dr. Elizabeth Laugeson really literally wrote the book on how to provide social skills training. It’s called The PEERS Manual. She also is the author of The Science of Making Friends. There’s a couple of others, right?

Elizabeth Laugeson: Yeah. I got a few.

Frampton Gwynette: She’s got a few. You can find her books on Amazon and I’d encourage you to look those up but also if you have a chance to go to a PEERS training, it’s definitely worth it because you will be able to bring an evidence based treatment to your patients. Yeah, as you can tell, I’m a fan and I just want to thank Dr. Laugeson for repeating with us today.

Elizabeth Laugeson: My pleasure. Thank you.

Frampton Gwynette: Yeah, thank you. And we’ll say goodbye here from Montreal for the Autism News NetWORK. Thanks.

Frampton Gwynette: Hello, I’m Frampton Gwynette from the Autism News NetWORK coming at you from Montreal, Quebec, Canada and we have a really special guest today. I’m here with Dr. Liz Laugeson who is a basically world renowned leader in social skills training for kids and adults with autism. She’s also an author. She provides talks all over the world and trainings all over the world. In terms of frequent flyer miles, she from LA to Montreal, I came from Charleston, South Carolina to Montreal. I think that’s the record for today. That’s a lot of distance.

Elizabeth Laugeson: A lot of distance.

Frampton Gwynette: Thank you for making time during this busy meeting. Welcome.

Elizabeth Laugeson: My pleasure. Thank you. Nice to see you.

Frampton Gwynette: Yeah, you too. We’re going to take our audience back just to like the origin of PEERS, which if they don’t know PEERS is the most evidence-based social skills training program for people with autism and take us back to before PEERS even existed. How did you think to invent it?

Elizabeth Laugeson: I was at UCLA on a pre doctoral psychology internship and I was actually studying fetal alcohol spectrum disorder at the time. I was interested in developmental disabilities and autism but my specialty was really FASD and I was working on a CDC study testing the effectiveness of the social skills intervention for kids with prenatal alcohol exposure and I’d never done social skills training before. I really hadn’t had an experience with that and the interesting thing was, even though this study was focused on kids with FASD, my phone was ringing off the hook from parents of teens with autism, just looking for anything in the community, anything and there was nothing. This is 2003 in Los Angeles, which is a pretty big metropolitan area. There’s nothing, no place to send them and I thought, well that’s absolutely unacceptable. I had the idea to develop an adolescent program focusing on friendship skills for teens with autism and I was very, very lucky I was able to secure an NIH T32 postdoctoral fellowship that gave me three years of funding to develop and test the PEERS intervention.

Frampton Gwynette: That was an investment on their part before it paid off really for the whole autism world. Yeah, because you’ve taken it from really a local program to doing trainings all over the world and how did you make that huge leap from just being based out of LA to then going all over the world to train others?

Elizabeth Laugeson: Yeah. I just I’m very passionate about dissemination and I don’t define dissemination the way some I think researchers do where you publish a paper and a PEER review journal and that is a type of dissemination but I really feel like if you develop an evidence based treatment, people should be able to access it and I’m sorry, but those are your taxpayer dollars. You probably want to make sure that whatever we develop is also accessible. I’m just very, very dedicated to that and I also tend to kind of think big sometimes. I didn’t believe that people should have to come to UCLA to access this program. I wanted to share it essentially and so I started by sharing it with research colleagues so that they could also test the effectiveness and it just sort of took on a life of its own and it now is an international program.

Frampton Gwynette: Yeah, I actually was fortunate to attend the UCLA training program about five years ago now but I remember how collegial it was and for those of you who have an opportunity to go out there and get trained with delivering PEERS, I would definitely recommend doing so because one of the great things you guys did was you gave us your clinical outcome measures or research outcome measures. You use the recipe and we’ve been able to bring that to our community in Charleston, South Carolina. Yeah, we’re really grateful for that.

Elizabeth Laugeson: Well, I’m grateful for the work that you do. I mean, again, I just, I think that there’s no reason that we can’t sort of share these programs with other people and no reason to hoard that stuff to all to ourselves.

Frampton Gwynette: Yeah, absolutely, and what I think is so special about the protocol is that I’ve run a bunch of parent groups myself and it’s so easy for the parent groups to kind of devolve into a therapy session, which is important to provide parent support and education but I think you guys have really been great about coaching leaders in the parent group to stick to the protocol, right?

Elizabeth Laugeson: Yeah.

Frampton Gwynette: Which is homework and what’s the value and keeping things on track like that versus letting parents vent?

Elizabeth Laugeson: Well, there’s definitely value to venting but this isn’t group therapy. Social skills training isn’t group therapy. It’s more like a class really and we’re trying to teach concrete rules and steps of social etiquette. In this case related to friendships and handling conflict and if we sort of didn’t run a tight ship and we got off track with all the important things that parents have to say, all the important questions, it’s not that that’s not important but if we got off track, we would never accomplish our goal, which is to help their kids learn to make and keep friends. It’s not that we shut that down, it’s just that it’s not the right place in the group essentially and so what we do is we try to make ourselves available outside of the group to answer questions and to deal with other pressing issues but in general, we really do try to stay very focused on our goal.

Frampton Gwynette: Yeah, exactly. I know that you’re a big believer in parent involvement and coaching. Can you just elaborate a little bit on why that is such an important driver in the success of PEERS?

Elizabeth Laugeson: Sure. Yeah. Thanks for asking. I really strongly believe in parent coaching and having other people involved in the treatment and what we do in our program is we have these concurrent parents sessions as you know, where we’re teaching parents how to be social coaches to their kid outside of the program. Now this is a time limited program like many programs. It’s 16 weeks in length, they come once a week for 90 minutes. This is not a lot of time in the grand scheme of life but parents are there the vast majority of the time. Why wouldn’t we want to train them to be the interventionists, to be the social coach out in the real world and teach them to do the things that we would do if we were there providing that coaching. I think that’s going to be a far more effective program and also more robust, more durable, meaning that when parents are involved in treatment, the treatment never ends, right? Because they’re going to continue to provide that support long after your program’s over. To me, it’s just logical. It makes sense.

Frampton Gwynette: It’s logical but the data also backs it up because for our audience, PEERS shows efficacy out to five years or more, right?

Elizabeth Laugeson: Mm-hmm (affirmative).

Frampton Gwynette: In terms of social skills training, shows efficacy and anxiety and also parents feelings of effectiveness. When you’re impacting that whole family system, yeah, you can’t argue with the results. It’s [inaudible 00:06:15]. Cool. Well, I didn’t want to skip around too much but I had mentioned earlier that you do international trainings and of all the places you’ve traveled, do you have any favorites?

Elizabeth Laugeson: Oh, favorites?

Frampton Gwynette: Yeah.

Elizabeth Laugeson: Well, I love London. It’s such a great international city. Really great food. People don’t believe me when I say that but it really good and great theater, my favorite but actually I also really love Sydney. Sydney is a really exciting place to visit. I was just there doing a dating bootcamp actually in Sydney. They were filming a documentary about people trying to find love on the spectrum. I love that city but I also, it’s fun to go new places and exotic places. I did a training in New Delhi one time that was interesting and went to Russia and places that maybe I wouldn’t normally get to go. Every city is great. Montreal is a great city.

Frampton Gwynette: Yeah. Sure is. That’s amazing. When you started PEERS you probably had no idea that would lead you down all these different paths.

Elizabeth Laugeson: No, I did not but it’s been a pleasure.

Frampton Gwynette: Yeah, absolutely. Yeah. I know that you just coming from our presentation here in Montreal, can you just give us some highlights of some of the things that you’re presenting here at INSAR?

Elizabeth Laugeson: Yeah. Actually it kind of relates to the parent coaching question that you just asked. I just presented on a panel on social skills training, evidence based treatments that was organized by [inaudible 00:07:37], and the idea behind the session that I was presenting on is really looking at the sort of the differences in mechanisms of change when you compare a parent mediated or parent assisted program to a teacher facilitated program and so really what are the differences in outcomes and kind of the short version of the answer there is that both programs are very effective and not just statistically significant but really clinically meaningful outcomes but the parent programs have about twice the effect of a school based program.

Elizabeth Laugeson: I think it makes sense because again, we’re talking about this was for our adolescent programs and the teachers are there in this natural social [inaudible 00:08:19], it’s a very natural place to teach social skills but they’re busy and they have a lot of students to work with and they see them for maybe an hour a day in the classroom whereas parents are around a lot more and I think it does make sense that parents are more effective agents of that change but that’s kind of the short version of what I was presenting.

Frampton Gwynette: That’s cool. The parents have that investment as well.

Elizabeth Laugeson: That’s very true. Yeah. I think teachers do too but on a different level.

Frampton Gwynette: Yeah. Peter Gerhart has this awesome quote. It says ‘Anything good that ever happened in the world of autism happened because of a parent.’

Elizabeth Laugeson: Yeah, that’s true.

Frampton Gwynette: It really is true.

Elizabeth Laugeson: It really is true.

Frampton Gwynette: I was going to ask you about a case. It’s like one case but it could be a number of cases I have.

Elizabeth Laugeson: Okay.

Frampton Gwynette: I’ve got a patient whose sick 16, 17 super high functioning but definitely has autism and I would like for him to go into PEERS. His parents would like for him to go into PEERS but he’s not ready because he doesn’t want to be one of them in the group or he doesn’t have what they have. Do you have any tips about how you might try to motivate him or entice him to participate?

Elizabeth Laugeson: Yeah. Good question. You know, one of the things that’s I think really important, once kids hit adolescence, they have to want to learn these skills. I mean with little kids, you can give them rewards and reinforcers for attending social skills groups. With teenagers, it doesn’t work that way. I mean if you ever try to convince a teenager to do something they don’t want to do.

Frampton Gwynette: Not successful either.

Elizabeth Laugeson: Not successful, right? They have to be sort of intrinsically kind of socially motivated. They don’t have to say I don’t have good social skills. They don’t have to say I don’t have friends and they don’t even have to talk about their autism. I don’t really think that autism has to be part of the conversation in a social skills training group. Believe it or not. In fact, we really don’t talk about autism in our teen groups or our young adult groups.

Elizabeth Laugeson: It comes up in the parent sessions because the parents bring it up but really it’s not part of the conversation. We’re just teaching good social skills and so anyone who’s open to learning those skills I think can really benefit but if they’re not open, I’m not sure how effective that would be and I’m also not sure how ethical that would be. I would never want to force social skills onto someone that doesn’t want to learn them. Not only is it not going to be effective but I don’t think it’s really appropriate. It’s not ethical. You know, there’s a whole neuro diversity movement, right? And there’s a lot of self advocates that say, “I don’t believe in social skills training. I don’t want to have to learn these social customs. I want you to accept me for who I am.” That’s a valid argument.

Elizabeth Laugeson: There are also a lot of self advocates that do want to learn this skill, so we have to make sure they have access to effective programs but again, I’m not sure that it’s really ethical to force social skills on other people and just kind of one last thing about that, I think it’s also important for people to understand that at least in PEERS and I think this is true really for good social skills interventions. We’re not trying to change who our kids or adults are, right? We want them to be able to be who they are. What we’re trying to do really is just enhance the skills that they have so that other people can appreciate who they are and I think it’s a very important distinction.

Frampton Gwynette: Yeah, absolutely. And one of the E’s and PEERS is for enhancement, right?

Elizabeth Laugeson: That’s right.

Frampton Gwynette: It’s a great way to put it.

Elizabeth Laugeson: Yeah. It’s actually enrichment but same thing.

Frampton Gwynette: Enrichment?

Elizabeth Laugeson: Yeah.

Frampton Gwynette: Okay. Yeah.

Elizabeth Laugeson: Close enough.

Frampton Gwynette: [inaudible 00:11:37] .

Elizabeth Laugeson: Yeah.

Frampton Gwynette: Thank you for correcting me on that one.

Elizabeth Laugeson: I police too a little bit. That’s-

Frampton Gwynette: That’s right. Okay. Yeah. And we talked a little bit about working with teens and then these teens of course grow up into adults and you’ve expanded your program to include social skills training adults and how does that differ? How does your approach differ in adults versus teens or adolescents?

Elizabeth Laugeson: Yeah. Well, a lot of those skills that we teach in our adolescent program, they really transfer very nicely into adulthood. The rules for conversations are kind of the same. How you have get togethers and that sort of thing sort of remains the same. Things that are different are where you find your source of friends. For adolescents it’s through extracurricular activities at school, in clubs, maybe sports. For adults it’s a little bit harder, especially if you’re not involved in school or you’re not working, it might be harder. Their sources of friends tends to be different and also another really critical skill that we teach in adulthood is related to dating at a kid. This was a question I had really early on back in 2004 when I started to develop the program was do I include dating etiquette in my teen program?

Elizabeth Laugeson: Truthfully, I actually was really hoping I didn’t have to because it was very intimidating. The idea of teaching dating etiquette. I always joke, I know and like me teaching dating, and again I always used to joke, I still joke, it’s like me teaching dating etiquette is like the blind leading the blind. What do I know? But fortunately we’re not relying on my expertise but I did focus groups. We’re relying on research is what we’re doing, not my expertise. I did focus groups with teens and parents way back in 2014 to look at treatment priorities to see what kinds of skills they wanted to be learning and one of the questions was dating etiquette. Well, they’ve kind of prioritize these interesting … parents number one treatment priority was conversational skills. Totally makes sense, right? These are adolescents that are moving into middle school.

Elizabeth Laugeson: It’s all about talking to people and conversing. Parents least prioritized area. Do you want to guess what it was?

Frampton Gwynette: Dating.

Elizabeth Laugeson: Yes. Dating. Teens number one treatment priority. Do you want to guess what it was?

Frampton Gwynette: It was probably flipped. It was dating.

Elizabeth Laugeson: Yes. It was dating and they’re at least priority was the conversational skills. Yes, totally opposite. A lot of people will ask why I didn’t include the dating etiquette. They’re like why did the parents win? And it was really … it wasn’t just because I didn’t want to teach it and I was intimidated. It was actually because I had a lot of parents that said they wouldn’t participate if there was a dating component.

Frampton Gwynette: It was a non starter.

Elizabeth Laugeson: Yeah. We decided that wasn’t a good idea. I think in the end that was actually the right choice because the average participant in PEERS across multiple studies is around 13, 14 and a lot of them tend to be a little bit more socially immature, really not dating yet but fast forward to adulthood that’s a whole different situation and so we definitely teach dating etiquette to our young adults. That’s probably the biggest difference between the two programs and you know what’s ironic about that? Those are now my favorite sessions to teach.

Frampton Gwynette: Is that right?

Elizabeth Laugeson: Yes, I absolutely love the sessions on dating etiquette. They’re my favorite by far.

Frampton Gwynette: Because you’ve got a lot of lively discussion or?

Elizabeth Laugeson: Oh my goodness. Absolutely. Yeah, and it’s so interesting. It’s fascinating to think there’s like ecologically valid steps that people follow for flirting, like who knew? And these were actually skills anybody could benefit from. You don’t have to have autism to benefit from this.

Frampton Gwynette: Yeah. The ecologically valid term is something that comes up along the PEERS training. Can you just explain to our audience what exactly that means?

Elizabeth Laugeson: Sure. Yeah. Ecologically valid is just the technical term for what socially successful people naturally do. A lot of social skills interventions that haven’t been tested through research, they teach what adults think that kids should do and not what actually works in reality and what the reality is that adults end up because of that giving really bad advice a lot in social situations and we don’t want to do that. Just because you have good social skills doesn’t mean you know how to teach them. You have to rely on the research. Ecological sort of valid social skills would be things that socially successful people are doing and we’re just breaking that down into concrete rules and steps of social etiquette.

Frampton Gwynette: Exactly. I think it’s important for the audience to know that PEERS, like you didn’t just pull this out of the air.

Elizabeth Laugeson: No.

Frampton Gwynette: It really was like from a bottom up where you broke everything down, tried to look at [inaudible 00:15:49], valid social skills and then studied that in the focus groups, piloted and so here we are and looking at an effective treatment, that’s what it takes because I have families who come into my office all the time and say, “What about this, what about that?” And I say, “Listen, if it’s missing the 13 or 14 years of research that’s done to have it be an evidence based modality.” I think what you’re describing, it’s just a great illustration of how something is developed and implemented.

Elizabeth Laugeson: Thank you.

Frampton Gwynette: Yeah. Absolutely. Okay, and then we ask all of our interview guests this question, I know that you’re from the West Coast and we’re from Charleston, South Carolina. I know in LA sports … there’s Lakers and then there’s Lakers. That’s it, right? But-

Elizabeth Laugeson: There’s Clippers too.

Frampton Gwynette: … Clippers. There’re other sports too but the Lakers still reign supreme, right? Maybe not.

Elizabeth Laugeson: Depends on who you talk to.

Frampton Gwynette: Yeah. I guess they missed the playoffs for a bunch of years [inaudible 00:16:44].

Elizabeth Laugeson: Yeah.

Frampton Gwynette: Yeah, but where we live, it’s all college football.

Elizabeth Laugeson: Of course.

Frampton Gwynette: We ask all of our guests, if you had to pick one, would you say Carolina or Clemson?

Elizabeth Laugeson: Oh my God, I have no idea. I’ve heard of Clemson. I’ll go with Clemson. How about Bruins? How about UCLA Bruins? Can I answer that? Yeah.

Frampton Gwynette: Okay. That’s a really good answer.

Elizabeth Laugeson: Okay. Good.

Frampton Gwynette: Yeah, that’s probably the equivalent. I guess, yeah. USCLA-

Elizabeth Laugeson: Oh yeah,.

Frampton Gwynette: Those are two big [inaudible 00:17:10], as well. Okay and then were there anything that you’ve seen here in INSAR so far that has you excited about teams that are doing research that is encouraging or exciting?

Elizabeth Laugeson: Yeah, I mean, the thing that I really … Well, it’s been disheartening over the years but it’s starting to change, is that there’s been so little research on adults with autism and the average person on the street, the face of autism is the face of a child and a lot of people don’t even realize that, no, they grow up to be adults and they still have autism. I really am pleased to see that there’s more, more research now focusing on adults. Yeah. I’d like to have been seeing this over the years. It’s a trend. Also more research on females. Autism looks different in females. Yeah, I think that that’s been heartening now to see more of that.

Frampton Gwynette: Yeah. And I’ve got a couple of questions now from your last [inaudible 00:18:09]. The gender and autism is really interesting because traditionally autism has been about a four to one ratio, male to females and that’s about what the literature shows but there’s something called camouflaging. What is social camouflaging?

Elizabeth Laugeson: I mean, if you believe in social camouflaging, essentially what it means is that females may be better at masking their autism symptoms potentially because they may be are just hardwired to be more social or maybe they’re socialized to be more socialists who you talk to and maybe it’s a bit of both or something even different. The idea is that females may fall through the cracks when it comes to receiving a diagnosis of autism but they still have a lot of significant challenges and we don’t want that to go on notice. We need to understand those gender differences more.

Frampton Gwynette: Yeah, exactly. I think that’s really a great approach because I’ve noticed in social skills groups, like I’ve actually, if I have one female who’s kind of committed and a couple of others who are on the fence, sometimes I will ask our support staff to pass along that, “Hey, can you let Mary know that there’ll be two other females possibly joining.” But they don’t all want to be the only one. It is a tough thing,

Elizabeth Laugeson: Yeah. Interestingly though, over the years I’ve been running this group for 15 years at UCLA and back when I first started running the program, we’d have maybe one girl in a group, sometimes none. That’s changed completely. I would say in a group of 10 I usually have about three or four girls. Yeah, it’s changing.

Frampton Gwynette: No, that’s awesome. And I wanted to see if you’re seeing another change or trend going on. I remember you had mentioned how the state of the art of research is so heavy on genetics, millions and maybe billions on that but then in terms of behavioral interventions, it’s like hundreds of thousands and do you see that tide turning at all?

Elizabeth Laugeson: Well, this conference is a good example of how the tide is turning. It is true that millions of dollars go into autism research every year but if you look at the kind of the pie chart of where it all goes, it’s really heavy on genetics and basic science and really trying to understand the causes of autism and it’s probably not just one cause but if you’re a person that has autism or you care about someone that has autism, you probably want to know what you can do now. In terms of that pie chart, the treatment piece is pretty small and even smaller for adolescents and adults. I do see that changing though. When I first started coming to this conference, I think it was back in 2006 was in Seattle. It was a small conference, maybe 500 people and it was really all very basic science and I didn’t understand half of, not even half of what I was hearing.

Elizabeth Laugeson: I was giving a talk, it was my very first talk at INSAR. It was IMFAR then and it was with Kathy Lord and Pat Howland and by the way, I was a postdoc and I felt like major imposter syndrome. Like what am I doing presenting with Kathy Lord and Pat Howland did they get this right? But the room was packed because we were … I’m sure Pat and Kathy had a lot to do with that but we were also … it was the only intervention session in the entire conference and it was packed and there was such … and there was a line out the door, people wanting to talk to all of us about these interventions and this has changed a lot and there are a lot more sessions here now, more posters about people doing intervention research. Yes, the tide is changing for sure.

Frampton Gwynette: Yeah. That’s exciting.

Elizabeth Laugeson: Yeah.

Frampton Gwynette: Because parents and families, they want something now.

Elizabeth Laugeson: Yeah.

Frampton Gwynette: Plus when you look at the risks of behavioral interventions, they’re so low. You know?

Elizabeth Laugeson: I know and when you think of how far we’ve come in autism research, probably the greatest strides, the greatest achievements to come in the intervention piece, right? In terms of what we know works. It’d be nice to get more funding to support that research.

Frampton Gwynette: Yeah, absolutely. And you are so blessed to be at UCLA where there’s just like giant after giant in the field there. Do you have a chance to collaborate with McCracken and Cancer Aid?

Elizabeth Laugeson: Oh yeah. We’re one big happy family now. It’s great. I still like pinch myself that I’m at UCLA because it’s an amazing center to work in. The Center for Autism Research and Treatment and you know, a lot of centers they don’t have an autism center or if there is an autism center, you might have one kind of main PI that’s sort of running the show and at UCLA we have practically like a dozen of them and they’re all really leaders in their field and we’re very good about collaborating. We have an autism center of excellence so we all collaborate on that. You asked about Jim McCracken, he and I have a study looking at the use of l-DOPA as an adjunct to PEERS. Looking at the benefit of l-DOPA working in the l-DOPA system. Connie-

Frampton Gwynette: The idea there is like to enhance concentration or?

Elizabeth Laugeson: Well, l-DOPA … yeah, it’s making it more rewarding. This is basically the idea of that socializing more … It’s very innovative, cutting edge. That was all Jim’s idea but I was happy to be a part of it. We also collaborate with Amanda Gulsrud at The Child and Adult Neuro Developmental Clinic and we have a college to career transition program now. It’s called PEERS for careers and we’re doing a lot of exciting work in the area of employment now. There are lots of cross collaborations. I work with some neuro imagers at UCLA, [inaudible 00:23:35], and [inaudible 00:23:36], doing imaging, looking at kind of how the neuro pathways in the brain change as a result of this treatment.

Frampton Gwynette: Yeah, and I know that you have found a bio marker, you know, through EEG and now you’re looking at functional connectivity…

Elizabeth Laugeson: Well, I can’t say credit for the biomarker. That was Amy Van Vecke. Brilliant scientist at Marquette University. The first really to find a biomarker of treatment outcome in social skills training. Yeah, it’s really cool.

Frampton Gwynette: Yeah. That’s where somebody completes the treatment and you can actually see it using a biological tool. In this case it’s measuring brainwave.

Elizabeth Laugeson: Yeah, she saw changes in the social brain as a result of treatment. Really cutting edge cool stuff.

Frampton Gwynette: Cool. I wanted to ask you just maybe one or two more questions. We had touched on this a little bit earlier but Autism News NetWORK is a program for adults with autism and I think you’ve done a great job at explaining how important that is to focus on adults and then, but do you have any topics that you might recommend that we cover or any advice for the Autism News NetWORK team?

Elizabeth Laugeson: Yeah, well I love that you’re focusing on adults. I think that that’s just … it’s an area that gets forgotten or ignored. I love that. One of the areas that I think needs more exploration, both in terms of a discussion but also research is gender identity. This is a big, big topic and it’s something I’ve noticed that’s changed over the years and we run, I think you know this but we run two back to back teen groups every week to back to back young adult groups and our earlier group is all people on the spectrum essentially and our later group is kind of what I call general clinic group. Yeah. There might be have people with ADHD or depression or anxiety, maybe sometimes people with autism but more general and it’s interesting that I would say every other cohort in my autism groups, both teen and young adult, I have someone that is transitioning essentially and I don’t have that in my general clinic group. Clinically, something feels like there’s something going on here.

Frampton Gwynette: Absolutely. I gave a talk on this recently, not only looking at gender like male female ratios but also gender identity in the Bible belt, which is where I am because a lot of parents for families might come from a traditional Christian background and the big struggle is, okay, if my child’s going to transition, how do I still go to church with my child [inaudible 00:25:59]? And there’s a lot of ways to approach that and as a believer, I’m always looking for a way to support the individual but the data does show that rates of gender identity or gender variance are multiples of what it is in the general population. If you look at patients with autism, gender identity issues are higher and then if you go to a gender identity clinic and you look at that cohort rates of autism traits are higher and it’s still unclear about what the cheesing out, there’s folks with gender variance struggle socially because of their transition issues or there’s a lot to be worked through but in my clinics, I’ve seen six, seven, eight cases and it’s definitely another layer of complexity.

Elizabeth Laugeson: Yeah. I think there’s something there and we need … it’s good to start a discussion I think about that and then figure out how to effectively support these individuals.

Frampton Gwynette: Yeah, absolutely. Well, if you’re looking for a guru on social skills, look no further. Dr. Elizabeth Laugeson really literally wrote the book on how to provide social skills training. It’s called The PEERS Manual. She also is the author of The Science of Making Friends. There’s a couple of others, right?

Elizabeth Laugeson: Yeah. I got a few.

Frampton Gwynette: She’s got a few. You can find her books on Amazon and I’d encourage you to look those up but also if you have a chance to go to a PEERS training, it’s definitely worth it because you will be able to bring an evidence based treatment to your patients. Yeah, as you can tell, I’m a fan and I just want to thank Dr. Laugeson for repeating with us today.

Elizabeth Laugeson: My pleasure. Thank you.

Frampton Gwynette: Yeah, thank you. And we’ll say goodbye here from Montreal for the Autism News NetWORK. Thanks.

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