The purpose of this study is to evaluate two group-based treatments: (1) the Program for Education and Enrichment of Relational Skills (PEERS), which targets social skills, and (2) Unstuck and On Target (UOT), which targets executive function skills. The interventions are two 45-minute sessions per week across 16 weeks and will be implemented by school-based staff in middle schools in North Carolina and Southern California (San Diego area). The EXPRESS team will recruit 78 schools across four cohorts, recruiting between 4 and 8 middle school students per school, for a total of approximately 468 students. The study is a cluster randomized control trial in which schools will be randomly assigned to the three groups in equal numbers: PEERS, UOT, or SAU, the control condition, which will consist of the typical programming received by the students related to social skills and executive functioning, (n=26 schools per group).
The EXPRESS research team will collect assessments from students and teachers to evaluate student outcomes before, immediately after, and then at a 6-month follow-up after the intervention for the target skills social skills and executive functioning, as well as broader educational outcomes (i.e., learning facilitators and barriers). The proximal outcomes are program specific and include a student questionnaire and observation to examine targeted social skills from PEERS and a direct student assessment and observation to examine targeted executive functioning skills from UOT. The distal measures examine generalized performance of social skills (Social Responsiveness Scale-2) and executive functioning (Behavior Rating Inventory of Executive Function-2) using teacher questionnaires, learning facilitators using student and teacher questionnaires (Academic Competence Evaluation Scale – Academic Enablers subscale) and learning barriers of interfering behaviors (Sutter-Eyberg Student Behavior Inventory-Revised) and anxiety (Anxiety Scale for Children – Autism Spectrum Disorder). Additionally, the EXPRESS team will collect data on elements related to implementation that have practical implications (e.g., social validity, fidelity of implementation, cost) for the schools in all three groups.
The primary analyses will use multilevel, hierarchical linear models (HLM) to account for the nesting of students within schools to examine differences between the three groups. To examine student-level moderation questions, the HLM will be modified to include interactions. We will also examine practical factors related to implementation such as fidelity of intervention and social validity.
