Surviving and Thriving in the Real World: A Daily Living Skills Intervention for Adolescents with ASD

Background:  Adolescence is a time of critical milestones, and those with autism spectrum disorder (ASD), even those who are high functioning (IQ >70), have difficulties successfully transitioning to the adult world in areas such as independent living and employment (Hume et al., 2014). In one study, 46% of parents reported that adults with high functioning ASD required “extensive help” completing activities of daily living, which impacted their ability to maintain employment (Farley et al., 2009). Daily living skills are everyday activities such as personal hygiene, cooking, cleaning, and managing money. Daily living skills were the only significant factor that predicted a positive outcome in adulthood for individuals with ASD, and have been linked to a more successful outcome in college, employment, and independent living (e.g., Klinger et al., 2015). Despite their importance, the daily living skills of adolescents with high functioning ASD fall far below what would be expected based on their IQ and chronological age (Duncan & Bishop, 2015). However, daily living skills can be taught using empirically-based strategies. Currently, there are no evidence based intervention packages that target the acquisition of daily living skills in adolescents with high functioning ASD.

Objectives:  The primary aim of the current study was to develop and evaluate the intervention package, Surviving and Thriving in the Real World (STRW), to increase critical daily living skills in adolescents with high functioning ASD. A pre-post trial was conducted in order to refine tools for measuring individual progress on targeted daily living skills (i.e., goal attainment scaling), maximize recruitment and retention strategies, finalize the intervention protocol, determine efficacy, and assess feasibility and acceptability.

Methods:   The pre-post trial consisted of 8 adolescents with ASD between 14-18 years and their parents. All participants had IQs>70 and met criteria for ASD on the ADOS-2. Information on daily living skills was collected using (1) the Vineland Adaptive Behavior Scales, 2^nd Edition and (2) a goal attainment scale that was created for each adolescent from a parent interview that assessed skills in the goals targeted in the STRW intervention. STRW consists of 12 group sessions with adolescents and their parents that targets skills in the areas of hygiene, cooking, laundry, and money management. Data on factors such as acceptability, feasibility, and satisfaction were collected after each assessment. Daily living skills will be re-evaluated after completion of STRW.

Results: The pre-post trial for STRW is currently being conducted and will be completed by February. Statistical analyses will be conducted to examine predictors, primary outcomes, and feasibility, acceptability, and satisfaction.

Conclusions:  The current study is the first step in the development and evaluation of a daily living skills intervention for high functioning adolescents with ASD. The results of the pre-post trial of STRW will determine initial efficacy and evaluate acceptability, feasibility, and satisfaction. A daily living skills 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, college, and employment.