Results of a RCT on a Transition Support Program for Adults with ASD: Effects on Self‐Determination and Quality of Life

Abstract

Few evidence-based services exist for people with Autism Spectrum Disorder (ASD) as they transition into adulthood, particularly those that foster appreciation of one's own goals and strengths. We developed a transition service for adults with ASD (without Intellectual Disability), and conducted a randomized controlled trial (RCT) focusing on self-report of Quality of Life and Self-Determination outcomes. Thirty participants aged 18-29 were randomized to immediate or delayed intervention, with 26 participants analyzed after 4 were lost to follow-up. Curriculum was tailored to participants' selfexpressed needs in three areas: social communication, self-determination, and working with others. Groups of four-to-six participants with ASD and two facilitators met weekly for 10 weeks. Positive intervention effects were observed on selfreport of Quality of Life; the intervention group scored on average 2 points higher than the control group, 95% CI [−0.2, 3.9]. Positive effects were also observed on the Self Determination Scale (Interpersonal Cognitive Problem-Solving subdomain), where the intervention group scored 2 points higher than control group 95% CI [0.082, 3.4]. In addition, participants rated skills targeted by the curriculum 6 points higher after versus before intervention, 95% CI [3.7, 8.6]. This was echoed by a subset of parents rating their child's skills as seven points higher after versus before intervention, 95% CI [1, 14].Lay Summary: These findings indicate that it is possible to increase Self-Determination and subjective Quality of Life in adults with ASD through a brief group-format service, and provide a model for doing so. Self-Determination abilities are linked to improved adult outcomes in individuals with other disabilities. These often overlooked factors should be incorporated in programming for adults with ASD as they transition to adulthood.

The Role of Decision-Making in Psychological Wellbeing and Risky Behaviours in Autistic Adolescents Without ADHD: Longitudinal Evidence from the UK Millennium Cohort Study

“…Allowing autistic adolescents enough time to make decisions may therefore promote their mental health and help them in their transition to adulthood. Recent studies report the effectiveness of interventions aiming to promote self-determination, including decision-making skills, in this population (Nadig, Flanagan, White, & Bhatnagar, 2018). Therefore, considering this unique feature of 'autistic' decision-making when implementing these interventions may be useful in this regard as well.…”

Transitional Care Interventions for Youth With Disabilities: A Systematic Review

“…80 The overall QoL in this study increased from 230.9 (SD = 24.6) to 259.5 (SD = 17.5) from preintervention to postintervention; however, this score dropped to 204.0 (SD = 43.0) 6 weeks after completion of the intervention. 80 Cramm et al, 99 Hatfield et al, 70 and Nadig et al 73 did not find any significant changes in QoL after participation in TCIs. However, Cramm et al 99 did note significant relationships between satisfaction with transitional care preintervention and emotional and physical QoL postintervention (P # .05) and between satisfaction with transitional care postintervention and emotional, physical, and social QoL postintervention (P # .001).…”

“…58,70,73,80,99 The outcome was assessed by using a Likert-type scale (ie, nonvalidated, self-reported ratings), the DISABKIDS conditiongeneric module questionnaire, 100 the San Martín Scale for QoL, 101 the Personal Wellbeing Index-School Children, 102 and the QoL Questionnaire, abridged version. 73 Significant improvements in postintervention QoL were noted only in a single study of 18 participants whose disabilities included autism spectrum disorder, hydrocephalus, Down syndrome, and intellectual disabilities. These improvements applied to subscales of the QoL measure only, rather than overall QoL.…”

Program evaluation of a community organization offering supported employment services for adults with autism

“…The first area is facilitating the transition of young adults from school to adult life (e.g. Hillier et al, 2011;Hotez et al, 2018;Nadig et al, 2018;Strickland et al, 2013;Timmons et al, 2017).…”