A School-Based Transition Intervention for Adolescents with ASD: A Pilot Efficacy Study

Background: Research indicates that persons with high functioning autism spectrum disorder (HFASD) have poor employment and post-secondary outcomes (Roux et al., 2013). Taylor et al. (2012) reported that only five evidence-based intervention papers addressed vocational skills in adults with ASD and all were of poor quality. For students enrolled in the general education high school curriculum, there has been little opportunity to support the soft skills difficulties (e.g., executive function, social competence, and emotion regulation) that are associated with poor college and employment outcomes.

Objectives: The current study used a waitlist control design to examine the efficacy of a 21-session, manualized high school-based transition intervention (TEACCH School Transition to Employment and Post-Secondary Education Program; T-STEP) addressing executive function (EF), social competence, and emotion regulation skills.

Methods: Participants were 37 high-schoolers (32 males; M age=16.79) with HFASD (FSIQ>85). Participants received 21 group intervention sessions (twice weekly for 90 minutes). Interventionists were a university-clinic therapist partnered with a special educator. At baseline, an abbreviated IQ test (WASI-II) and ASD diagnostic measures (ADOS-2, SRS-2) were completed. At baseline and post-testing (20 participants received the intervention; 17 were in the waitlist control group), caregivers completed a measure of real-world executive function (BRIEF) and a measure of employability skills including EF and interpersonal relations (Becker Work Adjustment Profile, BWAP). Additionally, teens participated in a semi-structured, 1-hour mock employment observation developed for this project (Job Skills Assessment Profile; JSAP) that incorporated presses for executive function, social, and emotion regulation skills targeted by the intervention. JSAP videos were coded by blind raters for 26 participants, and coding is ongoing for remaining participants.

Results: There were no significant differences between groups on IQ or ASD symptom variables (p’s=.26-.99). Three separate 2(time) X 2(condition) ANOVAs (BRIEF, BWAP, JSAP) were conducted to examine whether those in the intervention group showed more improvement compared to those in the waitlist control group. Significant time-by-condition interactions with medium-large effect sizes were obtained across all measures: BWAP, F(1,34)=3.98, p=.05; BRIEF Composite, F(1,34)=3.96, p=.06; and JSAP Composite, F(1,23)=4.18, p=.05. Largest effects were seen for the BWAP Work Performance (p=.02) and Interpersonal Relations (p=.05) subscales, for the BRIEF Metacognitive Index (p=.04), and the JSAP emotion regulation (p=.03) subscale. No effects were observed in areas that were not targeted by the intervention (e.g., the Cognitive Skills and Work Habits indices of the BWAP).

Conclusions: This pilot study provides promising evidence for the efficacy of the T-STEP as a transition intervention for high school students with ASD who are completing a general education high school curriculum. Improvements were found across both parent report and blind observation measures of the executive function, social competence, and emotion regulation skills targeted by this intervention. Results also support the feasibility of implementing the T-STEP in a school-based setting. Future research is needed to replicate these findings within a larger sample, to examine moderators of treatment effectiveness (e.g., symptom severity, intellectual functioning), and to follow students through graduation to examine long-term postsecondary and employment outcomes.