Healthy Relationships on the Autism Spectrum: Feasibility and Target Engagement

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PROJECT SUMMARY/ABSTRACT Autistic people are vulnerable to traumatic social experiences such as relational bullying and sexual violence by peers. Social anxiety and unhappiness with the quality of peer relationships are impairing problems for many. There are too few social skills interventions for autistic adults that have been tested through randomized controlled trials (RCTs). This project will test mechanism engagement and feasibility of Healthy Relationships on the Autism Spectrum (HEARTS). The HEARTS intervention was developed through a NIMH K18 (2020- 2022) and feasibility tested with a sample of N=55 autistic adults ages 18-40 years old from across the US. HEARTS is a six-session class delivered in real time online. HEARTS is novel because it was developed through a community-based participatory process with autistic adults, the class sessions are co-delivered by one autistic and one non-autistic facilitator who work as a team, and the curriculum uses a neurodiversity- embracing stance instead of a deficit model approach. Specifically, HEARTS does not teach social skills such as small talk, making eye contact, practice at conversational turn-taking, or other skills that may contribute to autistic “masking” or camouflaging. Instead, HEARTS draws on evidence-based violence prevention programming and teaches autistic participants to recognize the differences between healthy and unhealthy relationships, how to meet people and start new friendships or romantic relationships, how to negotiate sexual consent, recognize boundaries, and end friendships or dating relationships when needed—while respecting, rather than seeking to minimize or eliminate, autistic differences. The goal of the proposed clinical trial is to demonstrate that the target mechanism can be engaged and to pilot all methods (e.g., randomization, facilitator training) in preparation for a fully powered trial to test HEARTS’ effectiveness. HEARTS is highly scalable in that it was intentionally created for online delivery. In the HEARTS K18 non-experimental feasibility test, participation was associated with positive changes in outcomes including social motivation. In the proposed RCT we will test HEARTS acceptability and participant engagement; fidelity of the facilitators to the original manual; and provider satisfaction with HEARTS (N=160). We will also test mechanism engagement. We hypothesize that HEARTS participants will demonstrate significant decreases in hostile automatic thoughts, decreased rejection sensitivity, and increased social motivation, relative to participating completing the active control condition (ACC). We will also test clinical impact. We hypothesize that participants who complete HEARTS will demonstrate statistically significant improvement in satisfaction with quality of peer relationships (clinical outcome), relative to ACC participants. We will recruit 160 research participants in partnership with the Asperger/Autism Network (AANE) organization, and benefit from a 5-person autistic Advisory Board. Consistent with stated priorities in the IACC Strategic Plan for autism research, the proposed research constitutes a new and innovative approach to promoting wellness and health for autistic adults.