Strengths-Based Computer Coding Groups for Adolescents with ASD: A Realist Evaluation

Background: While research suggests that there has been much progress in improving outcomes for children and adolescents with Autism Spectrum Disorder (ASD) adult outcomes continue to be less than optimal. Specifically, the employment rate of individuals with ASD internationally remain poor. Strengths-based programs leverage individual strengths, potentially building skills that could assist in preparing adolescents with ASD for work and adult life, ultimately improving outcomes. Strengths-based programs focus on pathways for the future rather than trying to ‘fix’ impairments. However, little is known as to what constitutes a ‘strengths-based program’ and few studies document the active ingredients or the essential components of programs that result in a positive change in participants.

Objectives: To synthesise literature describing strengths-based programs for individuals with ASD and define their active ingredients.

Methods: A scoping review of strengths-based programs for individuals with ASD was undertaken. Database searches of AMED, CINAHL, MEDLINE, PsychINFO, EMBASE, Cochrane Library, Scopus and ERIC were undertaken for studies published between 1990 and 2017. Studies recruiting participants of any age with a diagnosis of ASD and claiming to describe a ‘strengths-based program’ were included. Descriptive data such as author, publication date, country, sample characteristics, aim, methodology, intervention type, outcome measures and results were extracted. The methodological quality of the studies was assessed via the quality assessment tool developed by Kmet, Lee and Cook. Thematic analysis identified the active ingredients of the strengths-based programs described in the studies which were linked to the International Classification of Functioning, Disability and Health (ICF) Core Sets for ASD. Consultation with stakeholders occurred in interpreting the results.

Results: Searches of relevant databases identified a total of 27 articles. Twenty articles evaluated strengths-based programs for individuals with ASD, including 9 qualitative and 11 quantitative studies, which ranged in methodological quality from limited (k=3) to very strong (k=11). The remaining articles (k=7) consisted of published feature or discussion articles and did not include or report any research methods. All articles were published between 2003 and 2017, with the majority of undertaken in the United States of America (k=20). Thematic analysis revealed ten major themes representing the active ingredients of strength-based programs for individuals with ASD; interests, family involvement, skill development, visual instruction, reframing weaknesses, autonomy, peer mentoring, routine, adult mentors and talents. Linking to the ICF Core sets for ASD highlighted the importance of environmental factors including Chapter 1 Products and technology and Chapter 3 Support and relationships in underpinning strengths-based programs.

Conclusions: While there is a paucity of research evaluating the efficacy of strengths-based programs for individuals with ASD and what constitutes a ‘strengths-based program’ is poorly defined in the literature, this review articulates for the first time a framework with the potential to underpin future programs. Future research is needed to evaluate the effectiveness of programs underpinned by these active ingredients in improving outcomes for people with ASD.