TUNE in, a Novel Cognitive Behavioral Treatment Program to Improve Social Functioning in Adults with ASD: Pilot Study Results

Background:  In the coming decade, approximately 600,000 children with autism spectrum disorder (ASD) will reach adulthood in the United States. They, and the several million adults currently diagnosed with ASD, will need ongoing services and support. However, there are few evidence-based treatment programs for adults with ASD beyond their early twenties to improve social functioning, a key factor in adults’ employment, relationships, and overall quality of life (Howlin, Moss, Savage, & Rutter, 2013; Shattuck et al., 2012). We developed an, integrated three-part intervention, TUNE In (Training to Understand & Navigate Emotions and Interactions), which targets the multiple behavioral domains underlying social functioning (social motivation, social anxiety, social cognition, social skills) in adults with ASD, and has components to generalize new social understanding and social skills to community settings. By targeting all of these domains, we hypothesized that TUNE In would improve overall social functioning.

Objectives:  To preliminarily assess the effects of TUNE In on social functioning in adults with ASD.

Methods:  Twenty-nine adults were enrolled and assigned to either immediate treatment (Cohort 1) or delayed treatment (Cohort 2) conditions (Table 1). TUNE In consists of 17 weekly sessions divided into three consecutive components: 1) five one-on-one sessions addressing social motivation and anxiety through cognitive coaching and mindfulness exercises; 2) eight group sessions addressing social cognition through a didactic curriculum, and addressing social skills through video modeling; 3) four sessions addressing generalization of skills to community settings by having participants engage in a philanthropic volunteer work team. To date, participants in both groups underwent assessments of social functioning at two time points: baseline (Time 1) and again after Cohort 1 completed treatment but before Cohort 2 started treatment (Time 2). Cohort 2 has now started treatment, after which data will again be collected from both groups at Time 3. We used the Wilcoxon Rank Sum Test to test the hypothesis that there would be a significant difference between the “immediate treatment” group (Cohort 1) and the “delayed treatment” group (Cohort 2) in percent change in two measures of overall social functioning—the Social Responsiveness Scale-2 (SRS-2) and the Social Network Index - People in Social Network Subscale (SNI; Cohen, 1991)—between Time 1 and Time 2.

Results:  Seven participants in Cohort 1 completed TUNE In and are compared with the 13 participants in Cohort 2 (delayed treatment group). Evidence of significant social functioning improvements from Time 1 to Time 2 were observed in Cohort 1 but not in Cohort 2, as reflected in percent change in the SRS-2 and SNI.

Conclusions: These pilot data suggest there are benefits to the integrated service strategy of TUNE In that targets multiple behavioral domains underlying social functioning and provides opportunities for skill generalization. Data to be collected at Time 3 will enable us to assess effects in Cohort 2. Further study of TUNE In is warranted in order to address the urgent need for evidence-based treatment options targeting social functioning in adults with ASD.