As individuals with autism spectrum disorders (ASD) transition to adulthood, there is a steep decline in existing, evidence-based interventions at a time when new challenges arise. Two particular challenges faced by young adults with ASD are (a) developing functional adult relationships and (b) poor health outcomes, including the risk of sexual victimization, which is three times higher than the rate of the general population. During adolescence and emerging adulthood, relationships outside the family begin to include intimate partners, and the ?difficulties developing, maintaining, and understanding relationships? that characterize ASD in the DSM-5 severely limit functioning in these adult relationships. Related problematic behaviors limit independence by reducing access to housing, community participation, and employment. This two-year R03 will conduct the formative work needed to develop a behavioral intervention to improve social function and health outcomes, and decrease victimization risk, for young adults with ASD. Improving functioning in adult relationships and health outcomes is critical for independence of adults with ASD. Specifically, the proposed project has the following scientific goals: (1) to determine which ASD-specific social cognitive factors mediate access to, and skillful use of, information about adult relationships and intimate behaviors in ASD; (2) to conduct a needs assessment in close collaboration with young adults with ASD, their parents, and education and health service providers about goals and preferences for intervention format and content; (3) to develop the initial treatment manual that integrates critical stakeholder perspectives and goals with evidence-based information about methods and content. Throughout the study, we will work in close collaboration with adults with ASD and their family members by forming an advisory board. Project goals will be addressed using a set of established measures of knowledge, behavior, and motivation related to intimate relationships and health. Sixty young adults with ASD, 60 parents and 15 service providers will provide information about the particular challenges faced by young adults with ASD in sexual and romantic functioning and provide recommendations for desirable features of an intervention targeting these challenges. In addition, we will evaluate social communication and social cognition as potential ASD-specific factors that contribute to intimate functioning and knowledge. In the second year, we will use this information to develop the intervention manual and obtain feedback about each session and the overall program from a stakeholder advisory board including a small group of young adults with ASD and their parents. The long-term objective of this project is aligned with NIMH's goal of developing and testing strategies to interrupt negative trajectories for young adults with ASD, including preventing or ameliorating contact with the criminal justice system, treating and reducing victimization, and improving the likelihood of independent living.
Adulthood is marked by decreasing services at a time when a higher level of functioning is demanded for independent living from individuals with autism spectrum disorders (ASD). Two particular challenges faced by young adults with ASD are (a) social functioning in adult relationships, and (b) poor health outcomes, including the high risk of victimization. This two-year study has the goal of developing an intervention to target knowledge and skills necessary for forming adult relationships and reducing the risk of adverse health outcomes, including victimization, for individuals with ASD to increase independent functioning in adulthood.
