Improving Amount of Detail and on-Topic Question-Asking in Adults with ASD Using a Visual Framework and Self-Management

Background:  Research shows promise that behavioral interventions can improve social conversation in adults with Autism Spectrum Disorder (ASD). Additionally, research demonstrates that individuals with autism may have strengths in visual processing, and incorporating visual strengths into behavioral interventions may lead to improvement. Self-management techniques that teach multiple communicative behaviors (such as question asking and amount of detail) using a visual component have been shown to lead to improved reciprocal conversation in children with ASD, but it is unclear if this type of intervention can improve these skills in adults.

Objectives: The purpose of the current study is to see whether this type of intervention will lead to empirically measurable improvements in both rates of question-asking and appropriate amount of detail.

Methods:  Participants included three adults between the ages of 25 and 42 years diagnosed with ASD according to DSM-5 criteria. Participants demonstrated significant impairments in social communicative functioning level and social competence. A multiple baseline design across participants was used to assess the effects of the self-management intervention program on participants’ amount of detail and question asking. During intervention, the visual framework outlined a conversational turn, which is defined in the framework as responding to the question, adding 1-3 details to the response, then asking an on-topic question. There were 10 boxes on the visual framework in which the participant self-managed their conversation points for successfully completing both components. Conversation probes with novel peers were collected every three sessions in conditions similar across baseline and intervention. Dependent measures included (1) appropriate amount of detail, defined as 1-3 supplemental pieces of information that is on-topic, focused, and relevant to the conversation; and (2) percentage of number of on-topic questions, defined as any question that elicits new information from conversational peers that is on-topic and relevant to the conversation.

Results:  Preliminary results indicate that all participants improved their amount of detail and percentage of on-topic questions in the context of a multiple baseline design. Specifically, Participant 1 increased from a mean percentage of appropriate amount of detail from 33% of intervals to 70% of intervals and increased percentage of on topic questions asked from 5% to 36% of the total conversation. Participant 2 increased from a mean percentage of appropriate amount of detail of 57% of intervals to 92% of intervals and increased mean percentage of on topic questions asked from 17% to 31%. Participant 3 increased from a mean percentage of appropriate amount of detail from 61% of intervals to 88% of intervals and increased mean percentage of on topic questions asked from 27% to 39% of trials. These preliminary data show medium to large effect sizes. Generalization data will be collected one month after completion of the intervention.

Conclusions: Preliminary results show promise that this type of intervention may be effective in improving amount of detail and number of on-topic questions among adults with ASD. The results suggest that future research on improving reciprocal conversation in adults with ASD may be highly profitable.