Date Presented 04/05/19
This study examined the effects of a group-delivered, vocational social skills intervention among young adults with high-functioning autism. Participants made statistically significant improvements in social function, self-efficacy, and psychological wellness. Results support this program as a Level III evidence-based intervention, and highlight the need for additional development, validation, and application of manualized, psychosocial interventions in OT.
Primary Author and Speaker: Annemarie Connor
Contributing Authors: Connie Sung, Alicia Strain, Songtian Zeng, Sarah Fabrizi
PURPOSE: Although substantial resources have been allocated to addressing the medical and behavioral needs of children with autism, research examining interventions targeting the postsecondary transition needs of young adults with autism has lagged. Within the larger body of vocational research, the link between social functioning and employment success has been well-established; yet, social skills deficits often remain significant and lifelong challenges for individuals with autism. Further, individuals with high-functioning autism (HFASD) exhibit high rates of co-occurring anxiety and depression (Croen et al., 2015). These symptoms create barriers to employment; while, in turn, long-term under-employment and job loss are linked to depression, psychiatric hospitalizations, substance abuse, and violence (Dooley, 2003). Group interventions hold promise, but empirically-validated and manualized approaches are not common in the occupational therapy social skills literature. Recognizing this need, and noting the bidirectional relationships between social functioning, self-efficacy, and psychological wellness, this study examined the efficacy of an empirically-derived, manualized, vocational social skills intervention (Assistive Social Skills & Employment Training; ASSET) for young adults with HFASD.
DESIGN: In this quasi-experimental, time-series study, a convenience sample of 26 students with a mean age of 20.40 (SD = 1.50), with autism, without intellectual disability (M = 96.3; SD =17.90), completed the ASSET program. Thirty-one individuals were screened and 28 (90%) were eligible to participate.
METHOD: Self-report instruments were used to measure program effects before, immediately after, and two months post intervention. Missing cases were excluded using pairwise deletion before paired-sample t-tests were conducted to compare mean differences.
RESULTS: Participants made statistically significant and clinically meaningful improvements in social function, self-efficacy, and psychological wellness after completing the intervention. Specifically, ASSET was associated with statistically significant, medium-sized changes in social function immediately post and approximately two months thereafter; statistically significant improvements in general self-efficacy, with large improvement noted immediately after the program and medium improvement at two-month follow-up; statistically significant and very large improvements in perceived empathy self-efficacy and social self-efficacy immediately post intervention; and statistically significant and clinically medium-sized improvement in anxiety two months post. While depression showed a similar trend of improvement, these changes were not statistically significant at post or follow-up.
CONCLUSION: Our results provide Level III evidence that ASSET can: (1) partially meet the need for manualized, evidence-based interventions that address work-related social skill development, (2) bolster confidence in the ability to generalize learned skills, and (3) decrease levels of anxiety typically spurred by social interaction among young adults with HFASD. As the ASSET constructs are theoretically derived from Social Cognitive Career Theory (SCCT; Lent & Brown, 1996), our results partially validate the use of SCCT to guide research and interventions with this population. Further, the study is congruent with AOTA Vision 2025, which calls for increased professional engagement in community-based health promotion and prevention. As a community-based program designed to address the transition needs of adult students with HFASD, ASSET targets an emergent area in occupational therapy practice (Glennon, 2016). Future research, employing larger samples and more rigorous research designs are needed to further validate ASSET.
References
Croen, L. A., Zerbo, O., Qian, Y., Massolo, M. L., Rich, S., Sidney, S., & Kripke, C. (2015). The health status of adults on the autism spectrum. Autism, 19(7), 814-823. doi:10.1177/1362361315577517
Dooley, D. (2003). Unemployment, underemployment, and mental health: Conceptualizing employment status as a continuum. American Journal of Community Psychology, 32(1/2), 9-20. https://doi.org/10.1023/A:1025634504740
Lent, R. W., & Brown, S. D. (1996). Social cognitive approach to career development: An overview. Career Development Quarterly, 44(4), 310-321. http://dx.doi.org/10.1002/j.2161-0045.1996.tb00448.x
Glennon, T. (2016). Survey of college personnel: Preparedness to serve students with autism spectrum disorder. American Journal of Occupational Therapy, 70(2): 7002260010p1-7002260010p6. doi:10.5014/ajot.2016.017921
