Pilot RCT of the Employment Success Intervention: Increasing Vocational Soft Skills in Adults with ASD
Longitudinal studies of intellectually able adults with autism have shown consistent and persistent deficits across cognitive, social, and vocational domains, indicating a significant need for effective treatments for these functional disabilities (Howlin, 2000). The cognitive and social skill deficits, "Soft Skills" which predict vocational outcomes, have been identified as major challenges to employment success for these adults (Kautz et al, 2014).
This study tested through a pilot randomized clinical trial a novel, community-based intervention teaching vocational soft skills through the manualized Supported employment, Comprehensive Cognitive Enhancement & Social Skills (SUCCESS) program within public vocational agencies. Multiple outcomes were assessed including cognitive skills, social skills, functioning, employment and satisfaction
A total of 39 adults (μ= 25.5 SD=6.01 yrs) participated. The participants were male (80.5%), race/ethnically diverse (44%), average IQ ((μ= 64.6 SD=15.6), 61% receiving Disability Services and 39% on SSI. A total of 16 adults were randomized to the SUCCESS intervention group. The SUCCESS curriculum was delivered weekly for 90minutes via active group participation during a work meeting. Skills taught include executive functioning: attention, learning, memory, prospective memory, cognitive flexibility, problem solving, goal oriented thinking and contextual awareness and social cognition: social conversation (giving and receiving compliments, feedback and help), social relationships, initiations, social media and social networking. Adults in the usual care control group (n=23) received similar level of supportive contacts. Pre and post assessments include a full battery of assessments including 1) cognitive skills: Behavior Rating Inventory of Executive Function- Adult Version (BRIEF-A), DKEFS; 2) social skills: Social Responsiveness Scale-2 (SRS-2), Social Skills Performance Assessment (SSPA); 3) functioning skills Waisman-Adaptive Daily Living (W-ADL) and 4) vocational outcomes of employment: pay rate, hrs worked, type of job. Data was gathered from standardized measures (participant and parent report) and program staff ratings.
Analyses consisted of calculating Intent-to-treat ANCOVAs (Group) by (Time) Controlling for IQ. Findings reveal significant differences by group on cognitive, social, employment and efficacy measures with medium to large effects on executive functioning (ES=.23- .86) and social functioning (.75-1.31) for the intervention group but no to small improvements for control group (ES=.01-.25) (Refer to Table 1 & Figures 1 & 2). Intervention group had greater improvement with 38% (n=6) participants obtaining employment and 69% (n=11) increasing wages overtime while 0% of control group obtained employment while 3 adults loss jobs. Only 13% (3 adults) increased wages.
This study demonstrates that a vocational soft skills intervention positively impacts adults with ASD. Adults receiving the intervention were substantially more prepared for the workforce and were employed at higher rates. This job-training program revealed high satisfaction and promise towards vocational success for adults with ASD.