It's Not Just a Guy Thing: Identifying Socially Valid Interventions to Address the Complex Needs of Adolescent Girls with ASD

Background: Females with Autism Spectrum Disorders (ASD) are a vulnerable population at risk for internalizing symptoms (Solomon, et al., 2012) and increased social impairment during adolescence (McLennan et al., 1993), yet this population remains understudied,with females representing less than 15% of participants in ASD samples across published intervention studies (Watkins et al., 2014). Despite growing evidence for social skills programs targeting adolescents and young adults (Tse et al., 2007; Laugeson et al., 2009 & 2011), there are no published intervention studies specifically targeting females with ASD and interventions rarely address co-occurring internalizing symptoms. A 4:1 prevalence in males (Fombonne, 2003) and later diagnosis in females (Begeer et al, 2013) results in a predominantly male pool for research and a gap in understanding girls with ASD (IACC, 2010). Limited research in this population, changes in social demands across development, and the importance of positive social and emotional health, suggest a critical need for interventions that address the complex needs of adolescent females with ASD. Research is needed to determine whether current interventions are appropriate for females (Kirkovski et al, 2013; Koenig & Tsatsanis, 2005; Rivet & Matson, 2011) and if results should be generalized across individuals with ASD.

Objectives: Ourlong term goal is to understand key factors that contribute to social competence across development, resulting in innovative interventions and preventive measures to improve the social-emotional health of females with ASD and related disabilities. Our current objective is to establish preliminary evidence for an intervention package that targets social competence and co-occurring internalizing symptoms in adolescent girls with ASD.

Methods: We utilized a repeated measure, within subjects design including participants from multiple intervention groups to examine the preliminary efficacy of our intervention and obtain effect size estimates to power a future multi-site RCT. We hypothesizedthat targeting age and gender specific social and self-care skills through strategies based in cognitive-behavioral and social learning theories will result in: 1) improved social competence and self-perception and 2) fewer autism and internalizing symptoms, from pre-to post intervention in adolescent girls with ASD (ages 14-19).

Results: Participant data (n = 18) across intervention groups (n = 5) from the past four years suggests significant, medium to large effect size estimates for improvements in social competence (d = .529) and self-perception (d = .53) and significant decreases in internalizing symptoms (d = .47) following intervention. Consumer satisfaction (n = 30-35) from parents, participants, and peers is high (satisfaction with program activities = 4.5/5.0; positive changes in specific skills = 3.5/5.0). These data, including treatment fidelity data, suggest preliminary support for the efficacy and social validity of our intervention.

Conclusions: Outcomes include significant improvements in a core area impacted by ASD (social competence) and co-occurring symptoms prevalent in our population, providing evidence for novel approaches that target females with ASD. Continuing to study primarily male samples will perpetuate current disparities in ASD research and limit the development of appropriate interventions to improve the lives of females with ASD.