Mental Health in Adults with ASD: Impact of the Success Program
The burgeoning population of adults with ASD is considered an emerging public health challenge (Bailey, 2012). Clinical reports suggest that mental health disorders are prevalent in adults with autism (Guillot, 2007). Research studies with adults with ASD indicate a rise in emotional disorders such as depression and anxiety in adulthood even when individuals receive autism specific treatments (Mazurek, 2014). The literature to date suggests mental health issues are common among adults with ASD, but what is unknown is how to best address such mental health issues (Trembath, 2012).
This study assessed mental health outcomes in adults with ASD as a result of an innovative intervention, SUpported employment, Comprehensive Cognitive Enhancement and Social Skills (SUCCESS) program. The SUCCESS intervention targets increasing executive functioning and social cognitive skills in adults with ASD. As part of the SUCCESS program, co-occurring mental health issues were measured using the Adult Self-Reports (ASR) and Adult Behavioral Check List (ABCL) to understand the impact the intervention may have on mental health issues, such as anxiety disorders, attention deficit hyperactivity disorder (ADHD), depression and related internalizing and externalizing symptoms.
A total of 8 young adults participated in an open trial pilot study of the SUCCESS program (with an additional sample of 12 participants currently receiving the intervention and the data will be available for analyses by April 2017). ASR and ABCL were obtained pre and post the SUCCESS intervention. SUCCESS was delivered weekly for 90minutes via active group participation during a simulated work meeting within a larger vocational training program in a community vocational service. The program involved 24 sessions over 5 months with the 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). Participants completed the ASR and parents completed the ABCL. The majority of participants were male (77%), white race/ethnicity (88%) with a mean age of 22 years (SD=3.67) and all graduated with a high school diploma. Some were involved with various social services: 33% disability services, 22% department of rehabilitation, 0% social security income.
Analyses consisted of calculating effect sizes using Cohen’s d to measure the magnitude of the effect of the SUCCESS intervention on mental health symptomatology. Preliminary findings reveal positive outcomes per self-reports (ASR). Participants are reporting less anxiety and avoidant issues and less overall internalizing, externalizing and total symptoms. No improvements were reported by parents (ABCL) (Refer to Tables). These differences by informant reflects the differences of an external perception of mental health from parents to the self-perception from individuals.
This pilot study demonstrates that mental health issues may improve by targeting other core autism related symptoms as executive functioning and social cognition skills. More study is needed before conclusions can be drawn.