Background: Adults with ASD experience difficulty with social communication and interaction, which negatively predicts outcomes related to academic and vocational success, mental health, and quality of life. Social skills groups seem to be a promising model for addressing social skills deficits for children, adolescents, and adults with ASD. One promising group-based intervention that targets social competence and motivation is the Social Tools and Rules for Teens (START) program. Current evidence suggests that components of the START program (e.g. peer-mediation, an emphasis on experiential learning, a motivating club-like environment, individualized and group social targets) are effective in improving the social competence and motivation of transition-aged youth with ASD. If adapted for the young adult population, the START program holds promise for targeting social competencies in college-age young adults. Method: A Randomized Control Trial design was used to assess the preliminary efficacy of the Social Tools and Rules for Transitions (START) program, a modified version of the teen program adapted for the unique socialization experiences and needs of young adults with ASD. The participants were 22 adults with ASD (aged 18-25) who were randomly assigned to the immediate treatment or the waitlist control group. At Pre- and Post-Intervention, all participants completed two standardized self-report measures, as well as video-recorded five-minute conversation probes. Videos were subsequently coded by objective coders for a variety of social behaviors, including eye contact, positive facial expression, question asking, and conversational balance, as well as overall subjective social impression. All video coders and raters were masked to study hypotheses, group assignment, and time point of videos.

Analyses: A series of two-way mixed ANOVAs were used to determine whether interactions between treatment conditions (treatment vs. waitlist) and time (pre vs. post) would reveal unique treatment effects of the START program. Additionally, correlational analyses were used to ascertain whether the specific social conversation behaviors would correlate with subjective social impressions, and whether self-report measures were associated with observed social behavior.

Results: In regard to self-report measures, analyses revealed a significant Group x Time interaction for the Social Responsiveness Scale, Second Edition (SRS-2) and a trending interaction for the Empathy Quotient (EQ), with the treatment group endorsing improvements on both measures compared with the control group. In regard to conversation behaviors, results revealed a significant interaction for conversational balance. Specifically, the treatment group spoke less and listened more after participating in the START program, which contributed to more evenly balanced conversations on average. Additionally, data trends suggested that the treatment group showed more positive facial expressions during conversation after completing the START program as compared to the control group. No significant effects were found for question asking, eye contact, or subjective social impression ratings. Correlational analyses revealed associations between the two self-report measures, but no significant correlation between self-report measures and any observational measure. The number of questions asked correlated significantly with variables related to conversational balance, as well as with eye contact. Greater use of positive facial expressions was associated with higher subjective social impression ratings.

Conclusion: Results suggest that participants of the START group experience more positive views of their own social abilities after participating completing the intervention. Participants of the START program also appear to hold more balanced conversations and show more positive affect after completing this intervention. Question asking was associated with eye contact and conversational balance and reciprocity, while subjective social impression was associated only with positive affect. Overall these preliminary results suggest that the START program for adults with ASD holds promise for improving certain social communication skills and self-perceived social competence.

Profound autism describes individuals on the autism spectrum who have co-occurring intellectual disability or minimal verbal ability and require continuous access to care. The notable underrepresentation of individuals with profound autism in the research literature has resulted in limited knowledge about their service needs and a lack of evidence-based practices tailored to these needs. This mixed-methods study sought caregiver perspectives on service needs, barriers to service access, and treatment priorities to guide future treatment development and improvement of service delivery. Quantitative findings indicated that regular socialization opportunities were the most frequently endorsed unmet service need, followed by access to primary health care services by autism-trained medical staff, social skills instruction, life skills instruction, occupational therapy, and behavioral support. Lower socioeconomic status was associated with a greater number of unmet service needs. Increased age and greater feelings of sadness were associated with higher likelihoods of needing social skills instruction, life skills instruction, and occupational therapy. Elevated emotional reactivity and higher language level were associated with greater needs for social clubs and activity groups. Thematic analysis of qualitative data revealed a pervasive shortage of individualized services to promote ongoing skill development and socialization opportunities for adolescents and adults with profound autism. Perspectives on treatment priorities indicated a need for integrated service settings with multiple trained providers, evidence-based practices for challenging behaviors and low adaptive functioning, respite care, and service navigation support. Ultimately, this integration of qualitative and quantitative findings provides new insights into service needs for adolescents and adults with profound autism to improve the accessibility and quality of clinical care.