Improvement in Social Functioning Following Participation in TUNE in, a Novel Cognitive-Behavioral Treatment Program – Results from a 2nd Cohort of Adults with ASD

Poster Presentation
Friday, May 11, 2018: 11:30 AM-1:30 PM
Hall Grote Zaal (de Doelen ICC Rotterdam)
A. A. Pallathra1, J. Day-Watkins2, M. E. Calkins3, B. B. Maddox3, J. S. Miller4, J. Parish-Morris5, J. D. Herrington4, S. Kangovi3, R. Tomlinson6, T. A. Creed7, C. M. Kerns8, W. Bilker9, F. Handy3,10, J. Connell11, G. S. Dichter12, D. S. Mandell13, R. T. Schultz5 and E. S. Brodkin14, (1)Department of Psychiatry, Catholic University of America, Washington, DC, (2)Drexel University, Philadelphia, PA, (3)University of Pennsylvania, Philadelphia, PA, (4)Center for Autism Research, The Children's Hospital of Philadelphia, Philadelphia, PA, (5)Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, (6)Temple University, Philadelphia, PA, (7)Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, (8)University of British Columbia, Vancouver, BC, Canada, (9)Univ of Pennsylvania, Phila, PA, (10)School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, (11)AJ Drexel Autism Institute, Philadelphia, PA, (12)Psychiatry, University of North Carolina, Chapel Hill, NC, (13)Center for Mental Health, University of Pennsylvania, Philadelphia, PA, (14)Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
Background: Impairments in social functioning—the ability to navigate the social world and form and maintain relationships in community settings—are among the most critical challenges faced by individuals with autism spectrum disorder (ASD). Social functioning difficulties become particularly problematic in adulthood, when expectations for skillful social functioning increase. However, there are few evidence-based social functioning treatment programs for adults with ASD beyond their early twenties (Bishop-Fitzpatrick et al., 2013, Spain and Blainey, 2015). TUNE In (Training to Understand & Navigate Emotions and Interactions) is an integrated, three-part cognitive-behavioral intervention, which targets the multiple behavioral categories 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. In a first group of adults with ASD to complete TUNE In, we reported significant improvements in overall social functioning, as measured by the Social Responsiveness Scale-2 (SRS-2) and the Social Network Index – Number of People in Social Network Subscale (SNI) (Pallathra et al. 2017, IMFAR). We hypothesized that a second cohort of adults with ASD would show the same improvements in SRS-2 and SNI following TUNE In treatment.

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

Methods: Adults with ASD and without intellectual disability were recruited for the study. TUNE In consists of 17 weekly sessions divided into three consecutive components addressing (1) social motivation/anxiety, (2) social cognition/social skills, and (3) generalization of skills to community settings (Pallathra et al. 2017, IMFAR). Participants underwent assessments of social functioning before starting (Time 1) and after completing (Time 2) TUNE In. Based on our previous results (Pallathra et al. 2017, IMFAR), we tested the hypothesis that this second cohort would also show an improvement in the SRS-2 (informant-report) and the SNI (Cohen, 1991), a self-report assessment of social network size. A paired analysis was performed to assess changes in outcome measures between Time 1 and Time 2, using the nonparametric Signed Rank Test, because the data were not normally distributed.

Results: Fifteen adults were enrolled into this second treatment group, of which 13 completed TUNE In (Table 1). Results demonstrate evidence of social functioning improvements from Time 1 to Time 2 as reflected by a significant reduction in the SRS-2 score (z=2.76, p<0.01, Cohen’s effect size, d=0.44) (Figure 1a) and a significant increase in the SNI score (z=-2.25, p<0.05, d=0.38) (Figure 1b).

Conclusions: Data from this study replicate the findings of improvement in social functioning, as reflected by the SRS-2 and SNI, following participation in TUNE In. These results 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. A randomized control trial of TUNE In with a larger sample size and with greater inclusion of women, minorities, and older age groups is warranted in order to address the urgent need for evidence-based treatments targeting social functioning in adults with ASD.