Individuals with autism spectrum disorder (ASD), even those defined as high functioning (IQ >70), have significant daily living skills (DLS) deficits that have been linked to poor adult outcome in independent living, post-secondary education, employment, and socializing with others. However, there are currently no intervention packages that target the acquisition of DLS. The resubmission of this Mentored Patient-Oriented Research Career Development Award (K23) supports the candidate's long-term goals of implementing and evaluating effective interventions that target DLS in adolescents with ASD to facilitate a successful transition to adulthood and an increased quality of life. The candidate will pursue her short-term goals by receiving mentorship and training in (1) developing and utilizing rigorous methodology to objectively measure DLS outcomes; (2) conducting randomized clinical trials (RCTs), (3) implementing advanced statistical analyses of RCTs, (4) utilizing goal attainment scaling to measure progress at the individual level, and (5) enhancing manuscript and grant writing skills. The award will be based at Cincinnati Children's Hospital Medical Center under the mentorship of Dr. Lori Stark and co-mentorship of Drs. Avani Modi, Jareen Meinzen-Derr, Judy Reaven (University of Colorado), and Lisa Ruble (University of Kentucky). The proposed research will develop, conduct, and evaluate a feasibility RCT of a group intervention, Surviving and Thriving in the Real World (STRW), to increase DLS (e.g., hygiene, cooking, laundry, and money management) in adolescents with high functioning ASD. An iterative process informed key components of the STRW intervention proposed in the K23 (e.g., specific skills targeted, use of evidence-based strategies, parental involvement, etc.). Prior to conducting the RCT, exploratory DLS outcome measures (i.e., computerized daily phone diaries, behavioral observations of targeted DLS) that directly assess DLS will be developed and piloted. A feasibility RCT of STRW will then be conducted with 56 adolescents with ASD between the ages of 14-21 and their parents. Participants will be randomized to either a STRW or control group (i.e., social skills group). Primary DLS outcomes (i.e., Vineland Adaptive Behavior Scales, 3rd Edition), secondary DLS outcomes (i.e., goal attainment scaling), and exploratory DLS outcomes (i.e., daily phone diaries, direct behavioral observations, self-report of DLS) will be assessed. The preliminary effectiveness of STRW will be compared to the control at post-treatment (Aim 1) and maintenance of treatment gains will be measured at 6-month follow-up (Aim 2). Executive functioning, social skills, psychopathology, and parenting factors will be explored to examine their effect on targeted DLS (Aim 3). A DLS intervention has the potential to directly affect current functioning and future adult outcomes in adolescents with high functioning ASD by increasing capabilities for skills that are needed to be successful in independent living and employment. This research will provide the basis for a more rigorous efficacy trial of the DLS intervention to be proposed in an R01 grant application prior to the end of this K award.
Daily living skills, which are activities that are required for everyday independence at home and in the community, are impaired in high functioning adolescents with ASD. Despite the fact that individuals with ASD who have better developed daily living skills are more likely to live independently, attend college, and be employed, there are no intervention packages that target daily living skills. This research will implement and conduct a feasibility trial of an intervention for adolescents with high functioning ASD and their parents that targets the acquisition, mastery, and generalization of daily living skills.
