The increasing population of adults with ASD is described as a challenging public health issue. Longitudinal studies of intellectually able adults with autism have shown consistent and persistent deficits across cognitive, social, and vocational domains, indicating a significant need for effective treatments for these functional disabilities. The cognitive and social skill deficits that are core features of the autism diagnosi have been identified as major challenges to employment success for adults with ASD. As the neurobiological basis of autism is further investigated, new interventions are focusing on remediating the core deficits specific to social and cognitive dysfunction in ASD. Impairments in information processing and executive functioning are considerable in individuals with ASD as in other conditions (i.e. schizophrenia), but are often ignored targets of treatment. Social cognition and social skills are also severely impacted in ASD and strongly associated with functional outcomes. This study builds on the innovative, bi-directional approach to translational research that attends to community needs at the onset of treatment development and utilizes community-based participatory research methods. The primary goal of this application is to develop a novel, integrated community-based intervention, Supported Employment, Cognitive Enhancement, Social Skills (SECESS) which will augment an existing community supported employment practice with an adapted evidence-based cognitive compensatory training (CCT) for schizophrenia and traumatic brain injury and a commonly used social skills training (Social Thinking at Work) to help adults with ASD improve the necessary "soft skills" to find and keep competitive work. The proposed SECESS model and this research application were prepared as a joint effort of our research-community ACHIEVE (Active Collaborative Hub for Individuals with ASD to Enhance Vocation and Education) group.
The aims are to 1) Standardize the SECESS program by developing an employment specialist intervention manual and corresponding program workbook for consumers with ASD, and develop a corresponding training protocol that can be implemented within the community vocational rehabilitation system to provide initial training and ongoing coaching for employment specialists to reach and sustain intervention fidelity. 2) Conduct a pilot RCT study (n=40) to examine the feasibility, acceptabilit, and implementation procedures (recruitment, randomization, retention &training strategies) of SECESS and to obtain estimates of effects of outcomes which include cognitive skills, social skills, work, functioning and quality of life to support a future large-scale effectiveness trial. Exploratory analyses will be conducted to examine associations, such as sequential relationships, between variables (potential mediator effects) as well as ASD characteristics and outcomes (potential moderator effects) to further understand the potential application of the model to a heterogeneous population of ASD.
This study has the potential to make a significant public health impact by increasing skills, functioning and employment outcomes for adults with Autism Spectrum Disorders (ASD) in community vocational service settings and advancing the science on improving specific behavioral targets: cognitive and social cognitive abilities by developing and testing an integrated supported employment, cognitive enhancement and social skill intervention. It will explore the heterogeneity of the study population of adults with ASD and intervention impact along with the associations between cognitive and social cognitive skills on each outcome variable. These results will make a significant contribution to the very minimal services research conducted on adults with ASD.