Enhancing Social Competence in Adults with Autism Spectrum Disorder: A Pilot RCT

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PROJECT SUMMARY Autism spectrum disorder (ASD) is characterized by primary impairment in social competence. Current psychosocial interventions for adults with ASD are lacking and urgently needed. The goal of the current proposal is to address this critical, unmet need for the development of psychosocial interventions for adults with ASD by utilizing an innovative intervention with emerging efficacy in children and adolescents with ASD. SENSE Theatre combines established behavioral techniques alongside theatrical strategies delivered in a peer- mediated, community service model with strong evidence of significant improvement in social competence. Recent findings from a randomized control trial (RCT) in youth with ASD show immediate between-group effects and evidence of target engagement on the hypothesized mechanism of action, social salience (e.g., memory for faces), evaluated by event-related potentials (ERP) and neuropsychological measures, which were linked to improvement in social interaction, social communication and adaptive functioning. While previous research has been efficacious, the objective of the application is to determine if SENSE Theatre is effective for adults with ASD at impacting social cognition, which in turn results in changes in functional clinical outcomes for adults with ASD. The proposal will develop and conduct a pilot RCT on an existing and novel psychosocial intervention explicitly tailored for adults with ASD. The intervention consists of 10 weekly sessions, 3 hours per session as well as dress/technical rehearsal and two public performances. Modifications to the current SENSE Theatre program will include: 1) having trained adult peers, 2) more age-appropriate theatrical play themes and individualized monologues (e.g., social relationships, employment), and 3) individualized character development and performance goals. The study will enroll 40 participants with high-functioning ASD 18 to 35 years of age randomized to experimental (EXP = 20) and waitlist control (WLC = 20) groups. The proposed RCT aims to: 1) assess target engagement of memory for faces, a foundational skill for social competence, using neuroimaging (ERP) and neuropsychological measures, and 2) test the link between the degree of target engagement of face memory and functional outcomes (e.g., social skills, and social interaction with novel peers). Measures will be assessed at pretest, posttest, and 2-month follow-up. The project will help achieve the goal to inform, refine and finalize a SENSE Theatre manual for adults with ASD. If predicted results occur, it will provide strong empirical support for a psychosocial intervention that has generalized and maintained effects on social competence that left untreated has significant consequences for adults with ASD.