Supported Employment, Comprehensive Cognitive Enhancement and Social Skills (SUCCESS) Program for Adults with ASD: Who, What, Where, When and How Plus Outcomes

Background:  

The increasing population of adults with ASD is considered a pressing, challenging public health issue (Bailey, 2012). Longitudinal studies of intellectually able adults with autism have shown consistent and persistent deficits across cognitive, social, and vocational domains, indicating a significant need for effective treatments for these functional disabilities (Howlin, 2000). The cognitive and social skill deficits that are core features of ASD have been identified as major challenges to employment success for these adults (Hillier et al, 2007). 

Objectives:  

This study developed a novel, integrated community-based intervention, Supported employment, Comprehensive Cognitive Enhancement & Social Skills (SUCCESS) treatment that augments existing community supported employment practice with a newly developed a manualized “soft skills” curriculum.  A pilot study was conducted to obtain estimates of effects of outcomes which include cognitive skills and social skills for young adults with ASD.

Methods:

A total of 18 young adults participated in an open trial pilot study of the SUCCESS program to date with another 15-25 estimated to have participated by April 2016. SUCCESS was delivered weekly for 90minutes via active group participation during a simulated work meeting within a larger vocational training program in community services. The program involves 24 sessions over 5 months with first half of the curriculum teaching executive functioning skills as attention, learning, memory, prospective memory, cognitive flexibility, problem solving, goal oriented thinking and contextual awareness. The second half teaching social communication skills including social conversation (giving and receiving compliments, feedback and help), social relationships, initiations and social networking (including do’s & don’ts of social media). Pre and post assessments include a full battery of assessments with the Behavior Rating Inventory of Executive Function- Adult Version (BRIEF-A) and Social Responsiveness Scale-2 (SRS-2) adult form presented. Participants and caregiver informants completed each measure. The majority of participants were male (84%), white race/ethnicity (84%) and all graduated with a high school diploma. Some were involved with various social services: 42% disability services, 26% department of rehabilitation, 11% social security income.

Results:  

Analyses consisted of calculating effect sizes using Cohen’s d to measure the magnitude of the effect of the SUCCESS intervention pre and post training program on executive functioning (8 clinical subscales; 2 indexes and 1 Total score: Global Executive Composite) and social skills (6 subscales and 1 Total score) by informants (self and caregiver).  Preliminary findings reveal small to large negative effects per participant and caregiver report on the BRIEF. This may be a reflection of increased awareness of issues. Small to large positive effects were found on the SRS-2 subscales per parent report and minimal effects for participants (Refer to Tables).

Conclusions:  This study demonstrates that it is feasible to develop the “soft skills”, a cluster of cognitive abilities and social graces that make someone a good employee and compatible to work with, within a community supported employment environment for adults with ASD. Specifically, the SUCCESS program has potential to improve social skills and it can be offered within vocational preparedness programs. Additional measures should be analyzed to examine effectiveness.